Efficacy and safety of cold versus hot snare polypectomy for small (5–9 mm) colorectal polyps: a multicenter randomized controlled trial

Marina de Benito Sanz; Luis Hernández; María Isabel Garcia Martinez; Pilar Diez-Redondo; Diana Joao Matias; Jesús M. Gonzalez-Santiago; Mercedes Ibáñez; María Henar Núñez Rodríguez; Marta Cimavilla; Carla Tafur; Laura Mata; Antonio Guardiola-Arévalo; Jorge Feito; Francisco Javier García-Alonso; on behalf of the POLIPEC HOT-COLD Study Group

doi:10.1055/a-1327-8357

Endoscopy, Table of Contents

Endoscopy 2022; 54(01): 35-44
DOI: 10.1055/a-1327-8357

Original article

Efficacy and safety of cold versus hot snare polypectomy for small (5–9 mm) colorectal polyps: a multicenter randomized controlled trial

Marina de Benito Sanz

¹Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain

,

Luis Hernández

²Department of Gastroenterology, Hospital Santos Reyes, Aranda de Duero, Burgos, Spain

,

María Isabel Garcia Martinez

³Department of Pathology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain

,

Pilar Diez-Redondo

¹Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain

,

Diana Joao Matias

⁴Department of Gastroenterology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain

,

Jesús M. Gonzalez-Santiago

⁴Department of Gastroenterology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain

,

Mercedes Ibáñez

⁵Department of Gastroenterology, Hospital de Medina del Campo, Valladolid, Spain

,

María Henar Núñez Rodríguez

¹Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain

,

Marta Cimavilla

⁶Department of Gastroenterology, Hospital Río Carrión, Palencia, Spain

,

Carla Tafur

⁵Department of Gastroenterology, Hospital de Medina del Campo, Valladolid, Spain

,

Laura Mata

⁵Department of Gastroenterology, Hospital de Medina del Campo, Valladolid, Spain

,

Antonio Guardiola-Arévalo

⁷Department of Gastroenterology, Hospital Universitario de Fuenlabrada, IdiPAz (Instituto de investigación Hospital Universitario La Paz), Madrid, Spain

,

Jorge Feito

³Department of Pathology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain

,

Francisco Javier García-Alonso

¹Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain

,

on behalf of the POLIPEC HOT-COLD Study Group

› Author Affiliations

Abstract

Background Resection techniques for small polyps include cold snare polypectomy (CSP) and hot snare polypectomy (HSP). This study compared CSP and HSP in 5–9 mm polyps in terms of complete resection and adverse events.

Methods This was a multicenter, randomized trial conducted in seven Spanish centers between February and November 2019. Patients with ≥ 1 5–9 mm polyp were randomized to CSP or HSP, regardless of morphology or pit pattern. After polypectomy, two marginal biopsies were submitted to a pathologist who was blinded to polyp histology. Complete resection was defined as normal mucosa or burn artifacts in the biopsies. Abdominal pain was only assessed in patients without < 5 mm or > 9 mm polyps.

Results 496 patients were randomized: 237 (394 polyps) to CSP and 259 (397 polyps) to HSP. Complete polypectomy rates were 92.5 % with CSP and 94.0 % with HSP (difference 1.5 %, 95 % confidence interval –1.9 % to 4.9 %). Intraprocedural bleeding occurred during three CSPs (0.8 %) and seven HSPs (1.8 %) (P = 0.34). One lesion per group (0.4 %) presented delayed hemorrhage. Post-colonoscopy abdominal pain presented similarly in both groups 1 hour after the procedure (CSP 18.8 % vs. HSP 18.4 %) but was higher in the HSP group after 5 hours (5.9 % vs. 16.5 %; P = 0.02). A higher proportion of patients were asymptomatic 24 hours after CSP than after HSP (97 % vs. 86.4 %; P = 0.01).

Conclusions We observed no differences in complete resection and bleeding rates between CSP and HSP. CSP reduced the intensity and duration of post-colonoscopy abdominal pain.

Full Text

References

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