Cold versus hot snare endoscopic mucosal resection for 10-19-mm nonpedunculated colorectal polyps: a multicenter randomized trial
In brief
Cold-snare removal was noninferior to hot snare, completely clearing 90%
In a randomized trial of 233 polyps measuring 10 to 19 mm, cold-snare resection achieved complete histologic removal in 90.4%, versus 93.2% with hot snare, meeting the trial's noninferiority threshold. Bleeding during the procedure was more frequent with cold snare, and whether it works as well for 15 to 19 mm polyps remains uncertain.
- Journal
- Endoscopy (Q1)
- Published
- 22 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Qingwei Jiang, Xiyi An, Xiaxiao Yan, Ziqi Guo, Yuelun Zhang, Na Li, et al.
- PMID
- 42913702
- DOI
- 10.1055/a-2955-8772
Why clinicians should know about it
- Picked for Gastroenterology (paper of the day, 24 October 2026): Cold vs hot snare EMR for 10‑19 mm polyps
Abstract
BACKGROUND: Evidence for cold snare endoscopic mucosal resection (CS-EMR) in 10-19-mm nonpedunculated colorectal polyps is scarce. We conducted a multicenter randomized controlled trial (RCT) to compare CS-EMR against hot snare EMR (HS-EMR) in this setting. METHODS: We enrolled patients with 10-19-mm nonpedunculated colorectal polyps from 15 centers. Eligible polyps were individually randomized (1:1) to CS-EMR or HS-EMR. The primary outcome was histologic complete resection, analyzed in modified intention-to-treat (mITT) and per-protocol (PP) populations (noninferiority margin -10%). Secondary outcomes included en bloc resection, intraprocedural and delayed adverse events, and resection time. RESULTS: 216 patients with 233 eligible polyps were included (CS-EMR 116; HS-EMR 117). In the mITT analysis, complete resection was 90.4% in the CS-EMR group and 93.2% in the HS-EMR group (difference -2.7%, 95%CI -9.8 to 4.3), showing noninferiority of CS-EMR vs. HS-EMR. PP results were consistent (CS-EMR 93.3%; HS-EMR 93.2%; difference 0.2%, 95%CI -6.7 to 7.1). CS-EMR was noninferior for 10-14-mm polyps (94.3% vs. 94.0%; 95%CI -6.8 to 7.2) but not for 15-19-mm polyps (78.6% vs. 90.9%; 95%CI -30.4 to 5.8), although interaction was not significant. En bloc resection rates and resection time were similar between groups. Intraprocedural bleeding was more frequent with CS-EMR (19.1% vs. 3.4%), whereas delayed bleeding was rare (0.0% vs. 0.9%), and no perforation occurred in either group. CONCLUSION: CS-EMR was noninferior to HS-EMR for histologic complete resection of 10-19-mm nonpedunculated colorectal polyps, but its applicability to 15-19-mm lesions remains uncertain.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.