Hot Snare vs. Cold Snare Polypectomy for Endoscopic Removal of 4-10mm Colorectal Polyps during Colonoscopy: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

Ramprasad Jegadeesan, University of Kansas
Muhammad Aziz, University of Kansas
Madhav Desai, University of Kansas
Tharani Sundararajan, Kansas City VA Medical Center
Venkata Subhash Gorrepati, Kansas City VA Medical Center
Viveksandeep Thogulva Chandrasekar, University of Kansas
Mahendran Jayaraj, University of Nevada, Las Vegas
Pratiksha Singh, Kansas City VA Medical Center
Ahmed Saeed, Kansas City VA Medical Center
Tarun Rai, Kansas City VA Medical Center
Abhishek Choudhary, Kansas City VA Medical Center
Alessandro Repici, Humanitas Research Hospitals and Humanitas University
Cesare Hassan, Nuovo Regina Margherita Hospital
Lorenzo Fuccio, S. Orsola-Malpighi Hospital
Prateek Sharma, University of Kansas Medical Center


Introduction In recent years, cold snare polypectomy (CSP) has increasingly been used over hot snare polypectomy (HSP) for the removal of colorectal polyps (4 – 10 mm in size). However, the optimal technique (CSP vs. HSP), in terms of complete polyp resection and complications, is uncertain. Our aim was to compare incomplete resection rate (IRR) of polyps and complications using CSP vs. HSP. Methods Randomized controlled studies (RCTs) comparing CSP and HSP for removal of 4 – 10 mm colorectal polyps were considered. Studies were included in the analysis if they obtained biopsy specimens from the resection margin to confirm the absence of residual tissue and reported complications. IRR and complication rate were the outcome measures. Pooled rates were reported as Odds Ratios (OR) or risk difference with 95 % Confidence Interval (CI). Results In total, three RCTs were included in the final analysis. A total of 1051 patients with 1485 polyps were randomized to either HSP group (n = 741 polyps) or CSP group (n = 744 polyps). The overall IRR did not differ between the two groups (HSP vs. CSP: 2.4 % vs. 4.7 %; OR 0.51, 95 %CI 0.13 – 1.99, P = 0.33, I 2 = 73 %). The HSP group had a lower rate of overall complications compared to the CSP group (3.7 % vs. 6.6 %; OR 0.53, 95 % CI 0.3 – 0.94, P = 0.03, I 2 = 0 %). Polyp retrieval rates were not different between the two groups (99 % vs. 98.1 %). Conclusion Our results suggest that HSP and CSP techniques can be effectively used for the complete removal of 4 – 10 mm colorectal polyps; however, HSP has a lower incidence of overall complications.