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The following is a summary of “Cold versus hot snare endoscopic resection of large nonpedunculated colorectal polyps: randomized controlled German CHRONICLE trial,” published in the September issue of Gastroenterology by Steinbrück et al.
Hot snare endoscopic mucosal resection (EMR) is the standard treatment for resectioning nonpedunculated colorectal polyps that are 20 mm or larger. Recently, cold resection (without current) has been suggested as a safer option compared to the usual hot resection, but no randomized trial has confirmed this yet.
Researchers conducted a prospective study to verify whether cold resection is better than hot resection for reducing adverse events (AEs) during polyp removal.
They randomly assigned patients with nonpedunculated colorectal polyps ≥20 mm to cold or hot EMR across 19 centers. The primary goal was to track significant AEs like perforation or bleeding, while secondary focuses included specific AE types, post-polypectomy syndrome, and residual adenoma.
The results showed that between 2021 and 2023, 396 polyps from 363 patients (48.2% female) were analyzed. Major AEs occurred in 1.0% of the cold group vs. 7.9% in the hot group (P=0.001, OR 0.23, 95% CI: 0.03-0.54). Perforation and bleeding rates were lower in the cold group, 0% vs. 3.9% (P=0.007) and 1.0% vs. 4.4% (P=0.040). Postpolypectomy syndrome occurred with similar frequency (3.1% vs. 4.4%, P=0.490). Residual adenoma was more common after cold resection, 23.7% vs. 13.8% (P=0.020, OR 1.94, 95% CI: 1.12-3.38). Lesions ≥4cm predicted major AEs (OR, 3.37) and residual adenoma (OR 2.47), while high-grade dysplasia/cancer also predicted residual adenoma (OR, 2.92).
Investigators concluded that cold resection of large, nonpedunculated colorectal polyps is safer than hot EMR but has a higher chance of residual adenoma. More research is needed to determine how polyp size and histology can guide personalized treatment approaches.
Source: sciencedirect.com/science/article/pii/S0016508524049357
