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Endoscopy 2022; 54(10): 961-969
DOI: 10.1055/a-1734-7952
Original article

Complete polyp resection with cold snare versus hot snare polypectomy for polyps of 4–9 mm: a randomized controlled trial

Ina B. Pedersen
 1   Department of Medicine, Sørlandet Hospital, Kristiansand, Norway
 2   Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
,
Anna Rawa-Golebiewska
 3   Department of Cancer Prevention and Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
,
Audrey H. Calderwood
 4   Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
,
Lone D. Brix
 5   Department of Anesthesiology, Surgery and Intensive Care, Horsens Regional Hospital, Horsens, Denmark
,
Louise B. Grode
 6   Department of Medicine, Horsens Regional Hospital, Horsens, Denmark
,
Edoardo Botteri
 7   Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
 8   Department of Research, Cancer Registry of Norway, Oslo, Norway
,
Marek Bugajski
 2   Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
 3   Department of Cancer Prevention and Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
 9   Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
,
Michal F. Kaminski
 2   Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
 3   Department of Cancer Prevention and Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
 9   Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
,
Wladyslaw Januszewicz
 3   Department of Cancer Prevention and Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
 9   Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
,
Hjalmar Ødegaard
10   Department of Medicine, Sørlandet Hospital, Flekkefjord, Norway
,
Britta Kleist
11   Department of Pathology, Sørlandet hospital, Kristiansand, Norway
,
Mette Kalager
 2   Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
12   Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
,
Magnus Løberg
 2   Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
12   Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
,
Michael Bretthauer
 2   Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
12   Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
,
Geir Hoff
 7   Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
13   Department of Medicine, Telemark Hospital Skien, Skien, Norway
,
Asle Medhus
14   Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
,
Øyvind Holme
 1   Department of Medicine, Sørlandet Hospital, Kristiansand, Norway
 2   Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
 7   Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
› Author AffiliationsSupported by: Helse Sør-Øst RHF 2014108

Trial Registration: ClinicalTrials.gov Registration number (trial ID): NCT02484079 Type of study: Randomized, Multi Center Study
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Referred to by:

Author commentary on Ina B. Pedersen et al.Endoscopy 2022; 54(10): v32-v32
DOI: 10.1055/a-1765-3415

Referred to by:

The “Cold Revolution” – cold snare resection of sessile colorectal polypsEndoscopy 2022; 54(10): 970-971
DOI: 10.1055/a-1823-0937

Abstract

Background Endoscopic screening with polypectomy reduces the incidence of colorectal cancer (CRC). Incomplete polyp removal may attenuate the effect of screening. This randomized trial compared cold snare polypectomy (CSP) with hot snare polypectomy (HSP) in terms of complete polyp resection.

Methods We included patients ≥ 40 years of age at eight hospitals in four countries who had at least one non-pedunculated polyp of 4–9 mm detected at colonoscopy. Patients were randomized 1:1 to CSP or HSP. Biopsies from the resection margins were obtained systematically after polypectomy in both groups. We hypothesized that CSP would be non-inferior to HSP, with a non-inferiority margin of 5 %. Logistic regression models were fitted to identify the factors explaining incomplete resection.

Results 425 patients, with 601 polyps, randomized to either CSP or HSP were included in the analysis. Of 318 polyps removed by CSP and 283 polyps removed by HSP, 34 (10.7 %) and 21 (7.4 %) were incompletely resected, respectively, with an adjusted risk difference of 3.2 % (95 %CI −1.4 % to 7.8 %). There was no difference between the groups in terms of post-polypectomy bleeding, perforation, or abdominal pain. Independent risk factors for incomplete removal were serrated histology (odds ratio [OR] 3.96; 95 %CI 1.63 to 9.66) and hyperplastic histology (OR 2.52; 95 %CI 1.30 to 4.86) in adjusted analyses.

Conclusion In this randomized trial, non-inferiority for CSP could not be demonstrated. Polyps with serrated histology are more prone to incomplete resection compared with adenomas. CSP can be used safely for small polyps in routine colonoscopy practice.



Publication History

Received: 06 July 2021

Accepted after revision: 10 January 2022

Accepted Manuscript online:
10 January 2022

Article published online:
18 February 2022

© 2022. Thieme. All rights reserved.

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