Hot Snare Polypectomy of 5-9 mm Polyps Leads To More Next-Day Abdominal Pain
Douglas K. Rex, MD, MASGE, reviewing De Benito Sanz M, et al. Endoscopy 2020 Dec 2.
Cold snare polypectomy is widely considered to be comparably effective and safer than hot snare polypectomy for colorectal polyps <10 mm. In a randomized trial in 7 Spanish centers, 394 polyps were randomized to cold snare polypectomy and 397 to hot snare polypectomy, with 2 marginal biopsies used to judge completeness. Complete polypectomy rates were similar at 92.5% for cold snare and 94% for hot snare. One patient in each arm had a delayed bleed.
One hour postprocedure, abdominal pain was similar between groups (18.8% with cold snare vs 18.4% with hot snare) but was higher with hot snare at 5 hours (16.5% vs 5.9%) and 24 hours (13.6% vs 3%).
COMMENTThese results favor cold snare polypectomy again as the choice procedure for colorectal lesions 5 to 9 mm in size, though the difference between arms in this study was mainly that the risk of abdominal discomfort extended into the following day in the hot snare arm. These results suggest that thermal injury extending through the wall but not resulting in perforation is common after hot snare polypectomy.
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.
CITATION(S)
De Benito Sanz M, Hernández L, García-Martínez MI, et al. Efficacy and safety of cold vs hot snare polypectomy for small (5-9 mm) colorectal polyps: A multicenter randomized controlled trial. Endoscopy 2020 Dec 2. (Epub ahead of print) (https://doi.org/10.1055/a-1327-8357)
