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

Background Resection techniques for small polyps include cold snare polypectomy (CSP) and hot snare polypectomy (HSP). This study compared CSP and HSP in 5-9mm 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 >= 15-9mm 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 <5mm or >9mm 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.