Cold Snaring Effective for Colorectal Lesions Up to 15 mm

Cold Snaring Effective for Colorectal Lesions Up to 15 mm

Douglas K. Rex, MD, MASGE, reviewing Rex DK, et al. Gastrointest Endosc 2022 Mar 11.

Cold snare resection is well established as comparably effective to and safer than hot snare resection for lesions ≤10 mm in size. 

In a study at 3 U.S. centers, 235 patients with 286 colorectal lesions 6 to 15 mm in size were randomized to cold snaring, cold endoscopic mucosal resection (EMR), hot snaring, or hot EMR. After resection, biopsy specimens were taken from the 4 quadrants of the defect margin and 1 from the center of the resection defect. 

The overall incomplete resection rate was low at 2.4%. There were 157 lesions 6 to 9 mm and 129 lesions 10 to 15 mm. 

Mean polyp resection time was shortest with cold snaring (60 seconds), followed by hot snaring (100 seconds), cold EMR (141 seconds), and hot EMR (172 seconds). The complete resection rate was 96.8% in lesions 10 to 15 mm in size and 100% in lesions 6 to 9 mm in size. There were no incomplete resections in the cold snare arm. There were 2 delayed hemorrhages, 1 possibly related to the study polyp and 1 definitely related to the study polyp, and both occurred after use of electrocautery.

Douglas K. Rex, MD, FASGE


These data indicate that, for nonpedunculated lesions up to 15 mm in size, cold snaring is noninferior regarding efficacy of resection and is more efficient to perform. Based on all available evidence from this and other studies, cold snaring is safer than hot snaring. Finally, it’s self-evident that cold snaring results in less cost and produces less plastic waste compared with methods involving injection.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Rex DK, Anderson JC, Pohl H, et al. Cold versus hot snare resection with or without submucosal injection of 6-15 mm colorectal polyps: a randomized controlled trial. Gastrointest Endosc 2022 Mar 11. (Epub ahead of print) (

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