Cold Snare Resection of Colorectal Polyps: Updates and Recent Developments

Cold snare polypectomy (CSP) has been emerging as increasingly popular technique for the removal of colorectal polyps with expanding indications with regard to larger polyps. We reviewed the recent literature to provide an overview of the indications, outcomes, and recent developments in the field of CSP.

There are currently 2 major guidelines recommending the use of CSP for 1–9 mm polyps, with one guideline suggesting its use for 10–19 mm polyps. There have been more than 30 published studies reporting on CSP outcomes in various patient populations, mostly in 1–9 mm polyps. Research suggests that CSP is safe and effective for the resections of 1–9 mm polyps, although its safety superiority over hot snare polypectomy (HSP) is not as clear except for patients on anticoagulation and antithrombotic medication. Data on CSP in 10–19 mm polyps is currently lacking; however, some research suggests higher incomplete resection compared to HSP. There is limited data suggesting that CSP could be non-inferior to HSP for 10–15 mm polyps and that hot endoscopic mucosal resection (EMR) could be superior to CSP for larger polyps with regard to recurrence risks. Cold EMR has been emerging as a potentially safe and effective tool for the resection of ≥ 20 mm sessile serrated lesions (SSLs); however, the potentially associated recurrence risk (especially for adenomas) requires further investigation in research studies.

CSP can be used safely and effectively in 1–9 mm polyps. There is a lack of data on the efficacy and safety of CSP over HSP and conventional EMR for polyps 10–19 mm. Cold EMR seems to be effective and safe in the resection of ≥ 20 mm SSLs. More research is needed to expand the indications of CSP for its use in routine endoscopic removal of ≥ 10 mm polyps.