Cold versus hot snare endoscopic mucosal resection for 10–19-mm nonpedunculated colorectal polyps: a multicenter randomized trial
Qingwei Jiang, Xiyi An, Xiaxiao Yan, Ziqi Guo, Yuelun Zhang, Na Li, Junjie Ren, Pan Li, Ying Tu, Hui Ding, Ailing Liu, Dekun Yang, Zhizhi Wang, Jie Liu, Ruigang Wang, Shanhong Tang, Lin Jin, Ai-Ming Yang, Dong WuAbstract
Evidence for cold snare endoscopic mucosal resection (CS-EMR) in 10–19-mm nonpedunculated colorectal polyps is scarce. We conducted a multicenter randomized controlled trial (RCT) to compare CS-EMR against hot snare EMR (HS-EMR) in this setting.
We enrolled patients with 10–19-mm nonpedunculated colorectal polyps from 15 centers. Eligible polyps were individually randomized (1:1) to CS-EMR or HS-EMR. The primary outcome was histologic complete resection, analyzed in modified intention-to-treat (mITT) and per-protocol (PP) populations (noninferiority margin −10%). Secondary outcomes included en bloc resection, intraprocedural and delayed adverse events, and resection time.
216 patients with 233 eligible polyps were included (CS-EMR 116; HS-EMR 117). In the mITT analysis, complete resection was 90.4% in the CS-EMR group and 93.2% in the HS-EMR group (difference −2.7%, 95%CI −9.8 to 4.3), showing noninferiority of CS-EMR vs. HS-EMR. PP results were consistent (CS-EMR 93.3%; HS-EMR 93.2%; difference 0.2%, 95%CI −6.7 to 7.1). CS-EMR was noninferior for 10–14-mm polyps (94.3% vs. 94.0%; 95%CI −6.8 to 7.2) but not for 15–19-mm polyps (78.6% vs. 90.9%; 95%CI −30.4 to 5.8), although interaction was not significant. En bloc resection rates and resection time were similar between groups. Intraprocedural bleeding was more frequent with CS-EMR (19.1% vs. 3.4%), whereas delayed bleeding was rare (0.0% vs. 0.9%), and no perforation occurred in either group.
CS-EMR was noninferior to HS-EMR for histologic complete resection of 10–19-mm nonpedunculated colorectal polyps, but its applicability to 15–19-mm lesions remains uncertain.