Volume 87 - 2024 - Fasc.4 - Reviews
Colonic polypectomy in 2024: hot or cold?
Colorectal cancer (CRC) is the second and third leading
cause of cancer death in men and women respectively worldwide.
Colonoscopy is the gold standard screening test to detect
premalignant lesions with endoscopic polypectomy preventing
evolution to CRC. Endoscopic polypectomy is effective with a
higher safety profile and is less costly as compared to surgery. Bestpractice
polypectomy technique is crucial, as 10% of polyps <2
cm are incompletely resected and may therefore play a significant
role in the development of post colonoscopy colorectal cancer
(PCCRC). Hot snare polypectomy (HSP) has traditionally been the
technique of choice for endoscopic polypectomy but is associated
with a small but appreciable risk of adverse events, primarily postpolypectomy
bleeding and perforation. Recent high-quality studies
have demonstrated the similar efficacy and superior safety profile
of cold snare polypectomy (CSP) for polyps less than 10 mm in size.
In daily clinical practice, the vast majority of colorectal polyps
encountered by gastroenterologists are less than 10 mm, making
CSP the technique of choice. Widespread use of CSP over HSP
may therefore significantly reduce the number of adverse events
associated with endoscopic polypectomy. The indication for CSP
may be extended to larger lesions, including large, non-dysplastic
sessile serrated lesions and small pedunculated polyps with a thin
stalk. In addition, the risk-benefit ratio of CSP is favourable in
patients in whom interruption of anticoagulants is a concern in
terms of thromboembolic risk.
In this review, the focus will be on safety of hot versus cold snare
polypectomy as a technique for the resection of diminutive and
small polyps.
