Download PDF
CC BY 4.0 · Endosc Int Open 2025; 13: a25490922
DOI: 10.1055/a-2549-0922
Original article

Comparing underwater and conventional cold snare polypectomy for colorectal adenomas: Prospective randomized controlled trial

Biao Fu 
1   Department of Gastroenterology, Jianyang People’s Hospital, Jianyang, Chengdu, China
,
Xiangrong Zhou
1   Department of Gastroenterology, Jianyang People’s Hospital, Jianyang, Chengdu, China
,
Tian Xiaofeng
2   Department of Internal Medicine I, Jianyang Hospital of Traditional Chinese Medicine, Jianyang, Chengdu, Sichuan Province, China
,
Zhi qiang Du
1   Department of Gastroenterology, Jianyang People’s Hospital, Jianyang, Chengdu, China
,
Fei Wang
1   Department of Gastroenterology, Jianyang People’s Hospital, Jianyang, Chengdu, China
,
Da hai Xu
1   Department of Gastroenterology, Jianyang People’s Hospital, Jianyang, Chengdu, China
,
Wang Yue
1   Department of Gastroenterology, Jianyang People’s Hospital, Jianyang, Chengdu, China
,
Wang Jin
1   Department of Gastroenterology, Jianyang People’s Hospital, Jianyang, Chengdu, China
,
Wei-hui Liu
3   Department of Gastroenterology, Sichuan Provincial People's Hospital, School of medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China (Ringgold ID: RIN89669)
› Author AffiliationsSupported by: Key R&D Projects of Sichuan Province 2021YFS0375
Supported by: the Sichuan Medical Association Digestive Endoscopy Special Committee (Jiexiang) Special Scientific Research Project 2021XHNJ21

Clinical Trial: Registration number (trial ID): ChiCTR2100044872, Trial registry: Chinese Clinical Trial Registry (http://www.chictr.org/), Type of Study: A prospective randomized controlled trial
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims

In this study, we aimed to evaluate efficacy and safety of underwater cold snare polypectomy (UCSP) for treating colorectal adenoma.

Patients and methods

This single-center, prospective, randomized controlled trial screened patients with colorectal adenomas measuring 4 to 9 mm in diameter that were identified through colonoscopies at the Department of Gastroenterology in Jianyang People’s Hospital between April 2022 and October 2023. Patients were randomly assigned to undergo UCSP or cold snare polypectomy (CSP). Both groups underwent narrow-band imaging to determine international colorectal endoscopic morphology of type 2 noncancerous lesions. Following polyp removal, biopsy specimens were collected from the base and margins to assess the completeness of resection.

Results

The study included 227 polyps from 172 patients; median sizes in the UCSP (n = 122) and CSP groups (n=105) were 5 mm and 6 mm, respectively. The R0 (96.7% vs. 86.7%; P=0.005) and muscularis mucosa resection rates (68.9% vs. 43.8%; P <0.0001) were significantly higher in the UCSP group than in the CSP group. However, operative time for the UCSP group (109.5 s; 86.8–134.3 vs. 110.0 s; 83.5–143.5 P=0.890) was not significantly longer than that for the CSP group. Neither group exhibited delayed bleeding or perforations.

Conclusions

UCSP has a high R0 rate for colorectal adenomas measuring 4 to 9 mm.

Keywords

Endoscopy Lower GI Tract - Polyps / adenomas / ... - Tissue diagnosis - Endoscopic resection (polypectomy, ESD, EMRc, ...)


Publication History

Received: 31 October 2024

Accepted after revision: 18 February 2025

Accepted Manuscript online:
28 February 2025

Article published online:
08 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Biao Fu, Xiangrong Zhou, Tian Xiaofeng, Zhi qiang Du, Fei Wang, Da hai Xu, Wang Yue, Wang Jin, Wei-hui Liu. Comparing underwater and conventional cold snare polypectomy for colorectal adenomas: Prospective randomized controlled trial. Endosc Int Open 2025; 13: a25490922.
DOI: 10.1055/a-2549-0922
 

  • References

  • 1 Chakradhar S. Colorectal cancer: 5 big questions. Nature 2015; 521: S16
    Search in Google Scholar
  • 2 Yoshii S, Hayashi Y, Nakamura T. et al. Endoscopic features and clinical course of colorectal carcinoma resected by cold snare polypectomy. J Gastroenterol Hepatol 2023; 38: 948-954
    Search in Google Scholar
  • 3 Shinozaki S, Kobayashi Y, Hayashi Y. et al. Efficacy and safety of cold versus hot snare polypectomy for resecting small colorectal polyps: Systematic review and meta-analysis. Dig Endosc 2018; 30: 592-599
    Search in Google Scholar
  • 4 Chang LC, Chang CY, Chen CY. et al. Cold versus hot snare polypectomy for small colorectal polyps: A pragmatic randomized controlled trial. Ann Intern Med 2023; 176: 311-319
    Search in Google Scholar
  • 5 Kawamura T, Takeuchi Y, Asai S. et al. A comparison of the resection rate for cold and hot snare polypectomy for 4–9 mm colorectal polyps: A multicentre randomised controlled trial (CRESCENT study). Gut 2018; 67: 1950-1957
    Search in Google Scholar
  • 6 Mou Y, Ye L, Qin X. et al. Impact of submucosal saline injection during cold snare polypectomy for colorectal polyps sized 3–9 mm: A multicenter randomized controlled trial. Am J Gastroenterol 2023; 118: 1848-1854
    Search in Google Scholar
  • 7 Yamamoto T, Suzuki S, Kusano C. et al. Histological outcomes between hot and cold snare polypectomy for small colorectal polyps. Saudi J Gastroenterol 2017; 23: 246-252
    Search in Google Scholar
  • 8 Liu W, Gong J, Gu L. The efficacy and safety of cold snare versus hot snare polypectomy for endoscopic removal of small colorectal polyps: A systematic review and meta-analysis of randomized controlled trials. Int J Colorectal Dis 2023; 38: 136
    Search in Google Scholar
  • 9 Zhang Q, Gao P, Han B. et al. Polypectomy for complete endoscopic resection of small colorectal polyps. Gastrointest Endosc 2018; 87: 733-740
    Search in Google Scholar
  • 10 De Benito Sanz M, Hernández L, García-Martínez MI. et al. Efficacy and safety of cold versus hot snare polypectomy for small (5–9 mm) colorectal polyps: A multicenter randomized controlled trial. Endoscopy 2022; 54: 35-44
    Search in Google Scholar
  • 11 Toyosawa J, Yamasaki Y, Fujimoto T. et al. Resection depth for small colorectal polyps comparing cold snare polypectomy, hot snare polypectomy and underwater endoscopic mucosal resection. Endosc Int Open 2022; 10: E602-E608
    Search in Google Scholar
  • 12 Ishii T, Harada T, Tanuma T. et al. Histopathologic features and fragmentation of polyps with cold snare defect protrusions. Gastrointestin Endosc 2021; 93: 952-959
    Search in Google Scholar
  • 13 Shichijo S, Takeuchi Y, Kitamura M. et al. Does cold snare polypectomy completely resect the mucosal layer? A prospective single-center observational trial. J Gastroenterol Hepatol 2020; 35: 241-248
    Search in Google Scholar
  • 14 Choi AY, Moosvi Z, Shah S. et al. Underwater versus conventional EMR for colorectal polyps: Systematic review and meta-analysis. Gastrointest Endosc 2021; 93: 378-389
    Search in Google Scholar
  • 15 Nagl S, Ebigbo A, Goelder SK. et al. Underwater vs conventional endoscopic mucosal resection of large sessile or flat colorectal polyps: A prospective randomized controlled trial. Gastroenterology 2021; 161: 1460-1474 e1
    Search in Google Scholar
  • 16 Suzuki S, Gotoda T, Kusano C. et al. Width and depth of resection for small colorectal polyps: Hot versus cold snare polypectomy. Gastrointest Endosc 2018; 87: 1095-103
    Search in Google Scholar
  • 17 Maruoka D, Kishimoto T, Matsumura T. et al. Underwater cold snare polypectomy for colorectal adenomas. Dig Endosc 2019; 31: 662-671
    Search in Google Scholar
  • 18 Ito A, Suga T, Ota H. et al. Resection depth and layer of cold snare polypectomy versus endoscopic mucosal resection. J Gastroenterol 2018; 53: 1171-1178
    Search in Google Scholar
  • 19 Jegadeesan R, Aziz M, Desai M. et al. Hot snare vs. cold snare polypectomy for endoscopic removal of 4–10 mm colorectal polyps during colonoscopy: A systematic review and meta-analysis of randomized controlled studies. Endosc Int Open 2019; 7: E708-E716
    Search in Google Scholar
  • 20 Ichihara S, Uraoka T, Oka S. Challenges associated with the pathological diagnosis of colorectal tumors less than 10 mm in size. Dig Endosc 2018; 30: 41-44
    Search in Google Scholar
  • 21 Shimodate Y, Itakura J, Takayama H. et al. Impact of submucosal saline solution injection for cold snare polypectomy of small colorectal polyps: A randomized controlled study. Gastrointest Endosc 2020; 92: 715-722.e1
    Search in Google Scholar
  • 22 Ikeda T, Yoshizaki T, Eguchi T. et al. Efficacy of specimen pasting after cold snare polypectomy for pathological evaluation of horizontal margins. Endosc Int Open 2022; 10: E572-E579
    Search in Google Scholar
  • 23 Matsuura N, Takeuchi Y, Yamashina T. et al. Incomplete resection rate of cold snare polypectomy: a prospective single-arm observational study. Endoscopy 2017; 49: 251-257
    Search in Google Scholar
  • 24 Abe Y, Nabeta H, Koyanagi R. et al. Extended cold snare polypectomy for small colorectal polyps increases the R0 resection rate. Endosc Int Open 2018; 6: E254-E258
    Search in Google Scholar