Hot vs. Cold Resection of ≤10-mm Polyps — What's Getting Cut?

Studies of hot- versus cold-snare resection of polyps ≤1 cm in size have shown that cold snaring is as effective as hot snaring, and safer. In this study from Japan, 52 patients with rectosigmoid adenomas ≤10 mm in size were randomized to hot or cold snare (with 1–2 mm of normal tissue around the polyp grasped using a 10-mm stiff snare with or without electrocautery [endo-cut mode at 80 W]). Endoscopy was repeated 1 day later to assess the site.

Immediately after resection, mucosal defects were larger with cold snare than with hot (7.5 mm vs 5.1 mm; P<0.001). One day later, the cold-snare mucosal defects had diminished in size by 25% and the hot-snare defects had enlarged by 29%. Overall, no endoscopic evidence of residual polyp was detected…