Cold vs hot snare polypectomy: Which method is better for colorectal polyps?

Hot snare polypectomy (HSP) tends to result in higher complete resection and lower recurrence rates, but a greater incidence of adverse events, compared with cold snare polypectomy (CSP), according to a study.

A systematic review and meta-analysis was conducted to gather evidence from randomized controlled trials identified from the databases of PubMed, Embase, WOS, Scopus, and Central until 16 July 2022. The authors pooled dichotomous outcomes using risk ratio (RR) with corresponding confidence interval (CI).

Eighteen trials, including a total of 4,317 patients and 7,509 polyps, met the eligibility criteria. Pooled outcomes showed better complete resection rates (RR, 0.96, 95 percent CI, 0.95‒1; p=0.03) and local recurrence incidence (RR, 5.74, 95 percent CI, 1.27‒25.8; p=0.02) with HSP.

On the other hand, CSP had better colonoscopy time (mean difference, ‒6.50, 95 percent CI, ‒7.55 to ‒5.44; p=0.00001) and polypectomy time (mean difference, ‒57.36, 95 percent CI, ‒81.74 to ‒32.98; p=0.00001).

No difference was observed on the incidence of immediate bleeding (p=0.06) and perforation (p=0.39) between HSP and CSP, but the former tended to have more incidence of delayed bleeding (p=0.01), abdominal pain (p=0.007), and postresection syndrome (p=0.02).

“Therefore, improving the complete resection rate with CSP still warrants more innovation, giving the technique safety and shorter procedure duration,” the authors said.

“Endoscopic polypectomy is an excellent tool for colon cancer prevention. With the innovation of novel resection techniques, the best method is still being investigated,” they noted.