Gastroenterology · 3 h ago
Cold Snare EMR Noninferior for 10–19-mm Colorectal Polyps in Randomized Trial
In a multicenter randomized trial of 216 patients with 233 nonpedunculated colorectal polyps, cold snare EMR was noninferior to hot snare EMR for histologic complete resection overall. Results for 15–19-mm lesions were uncertain, and intraprocedural bleeding was more frequent with cold snare EMR.
- Overall complete resection met the noninferiority criterion.
- Noninferiority was not established for 15–19-mm polyps.
- Intraprocedural bleeding was more frequent with cold snare EMR.
- No perforations occurred in either group.
This multicenter randomized trial compared cold snare endoscopic mucosal resection (CS-EMR) with hot snare EMR (HS-EMR) for nonpedunculated colorectal polyps measuring 10–19 mm. Eligible polyps were randomized 1:1 across 15 centers. The primary endpoint was histologic complete resection, with a prespecified noninferiority margin of −10%. The study included 216 patients and 233 polyps: 116 assigned to CS-EMR and 117 to HS-EMR.
In the modified intention-to-treat analysis, complete resection was achieved in 90.4% with CS-EMR and 93.2% with HS-EMR; the difference was −2.7 percentage points (95% CI, −9.8 to 4.3), meeting the noninferiority criterion. Per-protocol results were similar. CS-EMR was also noninferior for 10–14-mm polyps, but noninferiority was not established for 15–19-mm polyps; the interaction between size groups was not significant. En bloc resection and procedure time were similar. Intraprocedural bleeding occurred more often with CS-EMR (19.1% vs. 3.4%); delayed bleeding was rare, and neither group had a perforation.
The findings support comparable overall resection efficacy in the studied size range, but leave uncertainty for larger lesions. The supplied abstract does not provide further detail on follow-up or other study limitations.
In practice
For clinicians resecting 10–19-mm nonpedunculated colorectal polyps, this randomized trial found cold snare EMR noninferior to hot snare EMR for histologic complete resection overall, with similar en bloc rates and procedure times. The result was not established for 15–19-mm lesions, and intraprocedural bleeding was more frequent with cold snare EMR. These findings do not resolve the best approach for larger lesions; the supplied abstract provides no additional follow-up or limitation details.
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Endoscopy: Cold versus hot snare endoscopic mucosal resection for 10–19-mm nonpedunculated colorectal polyps: a multicenter randomized trial ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.