Year 2025 / Volume 117 / Number 2
Review
A comprehensive meta-analysis comparing the effectiveness and safety of cold snare polypectomy and hot snare polypectomy in removing colorectal polyps ≤ 10 mm

92-101

DOI: 10.17235/reed.2024.10303/2024

Can Wu, Yujie Wang, Tao Shu, Zhongxin Sun, Li Liu, Xiaobin Sun,

Abstract
Objective: The optimal methods for removing polyps remain controversial, especially for polyps ≤ 10 mm. We aim to combine the latest evidence to evaluate and compare the effectiveness and safety of cold snare polypectomy (CSP) and hot snare polypectomy (HSP) in the removal of colorectal polyps ≤ 10 mm in size. Methods: We performed an extensive search across multiple databases, including PubMed, Embase, Cochrane, and Web of Science, with the search period ending in April 2023, for randomized, controlled trials comparing the effectiveness and/or safety of CSP and HSP for the removal of ≤ 10 mm colorectal polyps. The final outcomes included complete resection rate, operation time, and postoperative adverse event (including immediate bleeding, delayed bleeding, and perforation) rates. Results: A total of 14 eligible randomized, controlled trials were included involving 7,460 patients and 15,829 polyps. The incidence of immediate bleeding was observed to be more prevalent in CSP in contrast to HSP, and the disparity was statistically notable (OR = 2.18, 95 % CI: 1.43-3.30, I2 = 36 %, p = 0.0003). The incidence of delayed bleeding was observed to be lower in CSP in contrast to HSP, and this difference was statistically significant (OR = 0.30, 95 % CI: 0.15-0.58, I2 = 0 %, p = 0.0003). Procedure time: both total colonoscopy time and specific polypectomy time were shorter in CSP versus HSP (MD = -5.92, 95 % CI: -9.70 to -2.14, I2 = 96 %, p = 0.002; MD = -0.56, 95 % CI: -0.91 to -0.20, I2 = 77 %, p = 0.002). There were no statistically significant differences in complete resection and polyp retrieval rate between CSP and HSP. Conclusion: CSP is as effective and safe as HSP for ≤ 10 mm colorectal polyps, while effectively reducing the risk of delayed bleeding and shortening procedure time.
New comment
Comments
No comments for this article
References
[1] Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: a cancer journal for clinicians. 2021 May;71(3):209-249.http://dx.doi.org/10.3322/caac.21660
[2] García Sánchez J. [Colonoscopic polypectomy and long-term prevention of colorectal cancer deaths]. Revista clinica espanola. 2012 Jul;212(7):408
[3] Joseph DA, King JB, Miller JW, et al. Prevalence of colorectal cancer screening among adults--Behavioral Risk Factor Surveillance System, United States, 2010. MMWR supplements. 2012 Jun 15;61(2):51-6
[4] Suna N, Köksal A, Yıldız H, et al. Prevalence of advanced histologic features in diminutive colon polyps. Acta gastro-enterologica Belgica. 2015 Jul-Sep;78(3):287-91
[5] Aslan F, Camcı M, Alper E, et al. Cold snare polypectomy versus hot snare polypectomy in endoscopic treatment of small polyps. The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology. 2014 Jun;25(3):279-83.http://dx.doi.org/10.5152/tjg.2014.5085
[6] Horiuchi A, Ikuse T, Tanaka N. Cold snare polypectomy: Indications, devices, techniques, outcomes and future. Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society. 2019 Jul;31(4):372-377.http://dx.doi.org/10.1111/den.13314
[7] Paspatis GA, Tribonias G, Konstantinidis K, et al. A prospective randomized comparison of cold vs hot snare polypectomy in the occurrence of postpolypectomy bleeding in small colonic polyps. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2011 Oct;13(10):e345-8.http://dx.doi.org/10.1111/j.1463-1318.2011.02696.x
[8] Qu J, Jian H, Li L, et al. Effectiveness and safety of cold versus hot snare polypectomy: A meta-analysis. J Gastroenterol Hepatol. 2019 Jan;34(1):49-58.http://dx.doi.org/10.1111/jgh.14464
[9] Suzuki S, Gotoda T, Kusano C, et al. Width and depth of resection for small colorectal polyps: hot versus cold snare polypectomy. Gastrointest Endosc. 2018 Apr;87(4):1095-1103.http://dx.doi.org/10.1016/j.gie.2017.10.041
[10] Takeuchi Y, Yamashina T, Matsuura N, et al. Feasibility of cold snare polypectomy in Japan: A pilot study. World journal of gastrointestinal endoscopy. 2015 Nov 25;7(17):1250-6.http://dx.doi.org/10.4253/wjge.v7.i17.1250
[11] Yamashina T, Fukuhara M, Maruo T, et al. Cold snare polypectomy reduced delayed postpolypectomy bleeding compared with conventional hot polypectomy: a propensity score-matching analysis. Endosc Int Open. 2017 Jul;5(7):E587-e594.http://dx.doi.org/10.1055/s-0043-105578
[12] Tappero G, Gaia E, De Giuli P, et al. Cold snare excision of small colorectal polyps. Gastrointest Endosc. 1992 May-Jun;38(3):310-3.http://dx.doi.org/10.1016/s0016-5107(92)70422-2
[13] Ferlitsch M, Moss A, Hassan C, et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2017 Mar;49(3):270-297.http://dx.doi.org/10.1055/s-0043-102569
[14] Chang LC, Chang CY, Chen CY, et al. Cold Versus Hot Snare Polypectomy for Small Colorectal Polyps : A Pragmatic Randomized Controlled Trial. Ann Intern Med. 2023 Mar;176(3):311-319.http://dx.doi.org/10.7326/m22-2189
[15] de Benito Sanz M, Hernández L, Garcia Martinez MI, et al. Efficacy and safety of cold versus hot snare polypectomy for small (5-9 mm) colorectal polyps: a multicenter randomized controlled trial. Endoscopy. 2022 Jan;54(1):35-44.http://dx.doi.org/10.1055/a-1327-8357
[16] Fujiya M, Sato H, Ueno N, et al. Efficacy and adverse events of cold vs hot polypectomy: A meta-analysis. World J Gastroenterol. 2016 Jun 21;22(23):5436-44.http://dx.doi.org/10.3748/wjg.v22.i23.5436
[17] Gómez V, Badillo RJ, Crook JE, et al. Diminutive colorectal polyp resection comparing hot and cold snare and cold biopsy forceps polypectomy. Results of a pilot randomized, single-center study (with videos). Endosc Int Open. 2015 Feb;3(1):E76-80.http://dx.doi.org/10.1055/s-0034-1390789
[18] Ichise Y, Horiuchi A, Nakayama Y, et al. Prospective randomized comparison of cold snare polypectomy and conventional polypectomy for small colorectal polyps. Digestion. 2011;84(1):78-81.http://dx.doi.org/10.1159/000323959
[19] Zhang Q, Gao P, Han B, et al. Polypectomy for complete endoscopic resection of small colorectal polyps. Gastrointest Endosc. 2018 Mar;87(3):733-740.http://dx.doi.org/10.1016/j.gie.2017.06.010
[20] Horiuchi A, Nakayama Y, Kajiyama M, et al. Removal of small colorectal polyps in anticoagulated patients: a prospective randomized comparison of cold snare and conventional polypectomy. Gastrointest Endosc. 2014 Mar;79(3):417-23.http://dx.doi.org/10.1016/j.gie.2013.08.040
[21] Takeuchi Y, Mabe K, Shimodate Y, et al. Continuous Anticoagulation and Cold Snare Polypectomy Versus Heparin Bridging and Hot Snare Polypectomy in Patients on Anticoagulants With Subcentimeter Polyps: A Randomized Controlled Trial. Ann Intern Med. 2019 Aug 20;171(4):229-237.http://dx.doi.org/10.7326/m19-0026
[22] Yeh JH, Wang WL, Lin CW, et al. Safety of cold snare polypectomy with periprocedural antithrombotic agents for colorectal polyps: a systematic review and meta-analysis. Therap Adv Gastroenterol. 2022;15:17562848211070717.http://dx.doi.org/10.1177/17562848211070717
[23] Luo D, Wan X, Liu J, et al. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Statistical methods in medical research. 2018 Jun;27(6):1785-1805.http://dx.doi.org/10.1177/0962280216669183
[24] Wan X, Wang W, Liu J, et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC medical research methodology. 2014 Dec 19;14:135.http://dx.doi.org/10.1186/1471-2288-14-135
[25] Ito T, Takahashi K, Tanabe H, et al. Safety and efficacy of cold snare polypectomy for small colorectal polyps: A prospective randomized control trial and one-year follow-up study. Medicine (Baltimore). 2021 Jun 11;100(23):e26296.http://dx.doi.org/10.1097/md.0000000000026296
[26] Pedersen IB, Rawa-Golebiewska A, Calderwood AH, et al. Complete polyp resection with cold snare versus hot snare polypectomy for polyps of 4-9 mm: a randomized controlled trial. Endoscopy. 2022 Oct;54(10):961-969.http://dx.doi.org/10.1055/a-1734-7952
[27] Fatima H, Rex DK, Imperiale T. A Pilot Randomized Trial of Polypectomy Techniques for 4 to 6 mm Colonic Polyps. J Clin Gastroenterol. 2022 May-Jun 01;56(5):426-432.http://dx.doi.org/10.1097/mcg.0000000000001571
[28] Varytimiadis L, Viazis N, Gkolfakis P, et al. Cold snare polypectomy vs. hot snare polypectomy vs. argon plasma coagulation for small (5-9mm) left-sided colorectal polyps: a prospective randomized trial. Eur J Gastroenterol Hepatol. 2021 Dec 1;33(1S Suppl 1):e909-e915.http://dx.doi.org/10.1097/meg.0000000000002300
[29] Kawamura T, Takeuchi Y, Asai S, et al. A comparison of the resection rate for cold and hot snare polypectomy for 4-9 mm colorectal polyps: a multicentre randomised controlled trial (CRESCENT study). Gut. 2018 Nov;67(11):1950-1957.http://dx.doi.org/10.1136/gutjnl-2017-314215
[30] Papastergiou V, Paraskeva KD, Fragaki M, et al. Cold versus hot endoscopic mucosal resection for nonpedunculated colorectal polyps sized 6-10 mm: a randomized trial. Endoscopy. 2018 Apr;50(4):403-411.http://dx.doi.org/10.1055/s-0043-118594
[31] McDonald N, Chandan S, Bilal M. Colonoscopic polypectomy in patients on anticoagulation: time to embrace the cold revolution? Gut. 2022 Mar;71(3):653.http://dx.doi.org/10.1136/gutjnl-2021-324790
[32] Jegadeesan R, Aziz M, Desai M, et al. Hot snare vs. cold snare polypectomy for endoscopic removal of 4 - 10 mm colorectal polyps during colonoscopy: a systematic review and meta-analysis of randomized controlled studies. Endosc Int Open. 2019 May;7(5):E708-e716.http://dx.doi.org/10.1055/a-0808-3680
[33] Liu W, Gong J, Gu L. The efficacy and safety of cold snare versus hot snare polypectomy for endoscopic removal of small colorectal polyps: a systematic review and meta-analysis of randomized controlled trials. Int J Colorectal Dis. 2023 May 19;38(1):136.http://dx.doi.org/10.1007/s00384-023-04429-2
[34] Takayanagi D, Nemoto D, Isohata N, et al. Histological Comparison of Cold versus Hot Snare Resections of the Colorectal Mucosa. Dis Colon Rectum. 2018 Aug;61(8):964-970.http://dx.doi.org/10.1097/dcr.0000000000001109
[35] Yang Y-c, Wang K-y, You Z-x, et al. A Meta-analysis of the efficacy and safety of cold snare polypectomy versus hot snare polypectomy for small colorectal polyps, China Journal of Endoscopy. 2022;28(09):31-40.http://dx.doi.org/10.12235/E20210746
[36] Repici A, Hassan C, Vitetta E, et al. Safety of cold polypectomy for 10mm polyps at colonoscopy: a prospective multicenter study. Endoscopy. 2012 Jan;44(1):27-31.http://dx.doi.org/10.1055/s-0031-1291387
[37] Horiuchi A, Hosoi K, Kajiyama M, et al. Prospective, randomized comparison of 2 methods of cold snare polypectomy for small colorectal polyps. Gastrointest Endosc. 2015 Oct;82(4):686-92.http://dx.doi.org/10.1016/j.gie.2015.02.012
[38] Lee CK, Shim JJ, Jang JY. Cold snare polypectomy vs. Cold forceps polypectomy using double-biopsy technique for removal of diminutive colorectal polyps: a prospective randomized study. The American journal of gastroenterology. 2013 Oct;108(10):1593-600.http://dx.doi.org/10.1038/ajg.2013.302
[39] Kato M, Shiraishi J, Uraoka T. Second local recurrence with advanced rectal cancer after salvage endoscopic mucosal resection of local recurrence following initial cold polypectomy. Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society. 2017 Jul;29(5):636.http://dx.doi.org/10.1111/den.12865
Related articles

Letter

Intestinal metastases of colorectal cancer

DOI: 10.17235/reed.2024.10089/2023

Digestive Diseases Image

Underwater polypectomy at the appendiceal orifice in a patient on anticoagulation

DOI: 10.17235/reed.2023.9842/2023

Digestive Diseases Image

Spontaneous regression of a rectal cancer

DOI: 10.17235/reed.2023.9486/2023

Letter

Vaginal lesion as first manifestation of colorectal disease

DOI: 10.17235/reed.2022.9270/2022

Digestive Diseases Image

Steatotic hepatocellular adenoma: an unusual cause of a hypermetabolic liver lesion

DOI: 10.17235/reed.2022.9026/2022

Editorial

Colonoscopy — When quality matters

DOI: 10.17235/reed.2022.8942/2022

Review

Clinical settings with tofacitinib in ulcerative colitis

DOI: 10.17235/reed.2022.8660/2022

Letter

Brunneroma: an infrequent duodenal neoplasm

DOI: 10.17235/reed.2021.8349/2021

Digestive Diseases Image

Cold loop polypectomy perforation of a tiny colon polyp

DOI: 10.17235/reed.2021.8221/2021

Letter

Mucinous cystadenoma arising from a pancreatic heterotopia

DOI: 10.17235/reed.2020.7486/2020

Review

Inflammatory bowel disease and solid organ transplantation

DOI: 10.17235/reed.2020.7361/2020

Review

New non-invasive biomarkers for colorectal cancer screening

DOI: 10.17235/reed.2020.7233/2020

Letter

Hemorrhagic complications following paracentesis

DOI: 10.17235/reed.2020.6914/2020

Letter

Colonic adenocarcinoma arising from traditional serrated adenoma

DOI: 10.17235/reed.2020.6818/2019

Letter

Medullary colorectal carcinoma. Do we really know it?

DOI: 10.17235/reed.2020.6728/2019

Letter

Gastric serrated adenoma

DOI: 10.17235/reed.2019.6145/2018

Letter

The rectosigmoid junction: are limits important?

DOI: 10.17235/reed.2019.5983/2018

Letter

A granular cell tumor: an unusual colon polyp

DOI: 10.17235/reed.2018.5918/2018

Editorial

Colorectal cancer screening and survival

DOI: 10.17235/reed.2018.5870/2018

Special Article

Endoscopy and sedation: an inseparable binomial for the gastroenterologist

DOI: 10.17235/reed.2018.5585/2018

Letter

Giant hepatobiliary cystadenoma: clinic-pathological findings

DOI: 10.17235/reed.2018.5414/2017

Letter to the Editor

Lactulose enemas in the treatment of hepatic encephalopathy. Do we help or harm?

DOI: 10.17235/reed.2017.5106/2017

Letter to the Editor

Propofol sedation Quality and safety. Failure mode and effects analysis.

DOI: 10.17235/reed.2017.4976/2017

Letter to the Editor

Liver metastasis from colorectal cancer 12 years after liver transplantation

DOI: 10.17235/reed.2017.4507/2016

Original

Multicenter study on the safety of bariatric endoscopy

DOI: 10.17235/reed.2017.4499/2016

Review

Serrated lesions and serrated polyposis syndrome

DOI: 10.17235/reed.2017.4065/2015

Letter to the Editor

Endobronchial metastases of colorectal cancer

DOI: 10.17235/reed.2016.4080/2015

Review

Endoscopic ampullectomy: a technical review

DOI: 10.17235/reed.2016.3867/2015

Letter to the Editor

Mucinous hepatic cystic neoplasm: An uncommon cystic lesion in the liver

DOI: 10.17235/reed.2015.3698/2015

Citation tools
Wu C, Wang Y, Shu T, Sun Z, Liu L, Sun X, et all. A comprehensive meta-analysis comparing the effectiveness and safety of cold snare polypectomy and hot snare polypectomy in removing colorectal polyps ≤ 10 mm. 10303/2024


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 14 visits.
This article has been downloaded 0 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 27/01/2024

Accepted: 15/05/2024

Online First: 22/05/2024

Published: 05/02/2025

Article revision time: 102 days

Article Online First time: 116 days

Article editing time: 375 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2025 y Creative Commons. The Spanish Journal of Gastroenterology