Cold vs. hot snare polypectomy for small polyps reduced risk for delayed bleeding events after procedure

A recent randomized controlled trial found that cold snare polypectomy for small colorectal polyps significantly reduced the risk for delayed bleeding after the procedure compared with hot snare polypectomy.

The study was funded by Boston Scientific Corporation. Researchers conducted the open-label, single-blind trial among 4,270 participants ages 40 years and older with polyps of 4 to 10 mm who were randomly assigned to receive cold snare (n=2,137) or hot snare polypectomy (n=2,133) at six sites in Taiwan from July 2018 through July 2020. The primary outcome was the delayed bleeding rate within 14 days after polypectomy. Results were published Feb. 21 by Annals of Internal Medicine.

Eight patients (0.4%) in the cold snare group and 31 (1.5%) in the hot snare group had delayed bleeding (risk difference, −1.1%; 95% CI, −1.7% to −0.5%). Severe delayed bleeding was also lower in the cold versus hot snare group, with one (0.05%) versus eight (0.4%) events (risk difference, −0.3%; 95% CI, −0.6% to −0.05%). Mean polypectomy time (119.0 vs. 162.9 seconds; difference in mean, −44.0 seconds [95% CI, −53.1 to −34.9 seconds]) was shorter in the cold snare group, although successful tissue retrieval, en bloc resection, and complete histologic resection did not differ between groups. In addition, the cold snare group had fewer emergency service visits than the hot snare group (4 [0.2%] vs. 13 [0.6%] visits; risk difference, −0.4% [95% CI, −0.8% to −0.04%]). The study was limited by its lack of subgroup analysis due to the paucity of bleeding events, the authors noted. “In conclusion, this trial showed that [cold snare polypectomy] reduces the risk for mild and severe delayed bleeding events after polypectomy, providing evidence-based guidance for managing small colorectal polyps,” they wrote.