The first data from a prospective, multi-center, randomized controlled trial (RCT) reveals that cold snare endoscopic mucosal resection (CS-EMR) is safer than hot snare (HS)-EMR for removing large, non-pedunculated colorectal polyps. However, the recurrence rate after using cold snare is higher. The findings were presented at the United European Gastroenterology (UEG) Week 2023.
Key Findings:
- CS-EMR almost completely eliminates major complications, making it superior in safety to HS-EMR.
- Despite its safety, the general recurrence rate (or residual neoplasia) is higher after using cold snare.
- Cold snare EMR is recommended for suspected sessile serrated adenomas, laterally spreading tumors of non-granular type without visible signs of malignancy, and selected laterally spreading tumors of granular-type homogenous that are 20 mm or larger.
- Another study presented in the same session indicated a higher recurrence rate of large non-pedunculated colonic lesions after CS-EMR compared to the standard technique, though with a trend of fewer adverse effects.
- Current guidelines suggest polyps of 10 mm or less should be removed by cold snare, while those larger than 10 mm should undergo hot snare EMR. However, recent data indicates potential benefits of cold snare for larger polyps over 20 mm as well.
- The CHRONICLE trial aimed to compare the efficacy of cold snare versus hot snare for resecting non-pedunculated colorectal polyps of 20 mm or more. The trial involved 399 participants across 19 German gastroenterology centers.
- The primary endpoint was major adverse events, including perforations and clinically significant post-endoscopic bleeding. Secondary endpoints included intraprocedural bleeding, post-polypectomy syndrome, technical success, resection speed, and recurrence rate after 4 months.