ABSTRACT
BACKGROUND: Resection techniques for small polyps include cold snare polypectomy (CSP) and hot snare polypectomy (HSP). This study compared CSP and HSP in 5-9âmm polyps in terms of complete resection and adverse events. METHODS: This was a multicenter, randomized trial conducted in seven Spanish centers between February and November 2019. Patients with ≥â1 5-9âmm polyp were randomized to CSP or HSP, regardless of morphology or pit pattern. After polypectomy, two marginal biopsies were submitted to a pathologist who was blinded to polyp histology. Complete resection was defined as normal mucosa or burn artifacts in the biopsies. Abdominal pain was only assessed in patients without <â5âmm or >â9âmm polyps. RESULTS: 496 patients were randomized: 237 (394 polyps) to CSP and 259 (397 polyps) to HSP. Complete polypectomy rates were 92.5â% with CSP and 94.0â% with HSP (difference 1.5â%, 95â% confidence interval -1.9â% to 4.9â%). Intraprocedural bleeding occurred during three CSPs (0.8â%) and seven HSPs (1.8â%) (Pâ=â0.34). One lesion per group (0.4â%) presented delayed hemorrhage. Post-colonoscopy abdominal pain presented similarly in both groups 1 hour after the procedure (CSP 18.8â% vs. HSP 18.4â%) but was higher in the HSP group after 5 hours (5.9â% vs. 16.5â%; Pâ=â0.02). A higher proportion of patients were asymptomatic 24 hours after CSP than after HSP (97â% vs. 86.4â%; Pâ=â0.01). CONCLUSIONS: We observed no differences in complete resection and bleeding rates between CSP and HSP. CSP reduced the intensity and duration of post-colonoscopy abdominal pain.