AT A GLANCE

A new study published in Gut concludes that cold endoscopic mucosal resection (EMR) results in a greater recurrence rate without a significant difference in severe adverse events versus hot EMR.¹

“Complications of EMR of large colorectal polyps remain a concern,” explain study authors Pohl et al., who sought to compare the safety and efficacy of cold EMR (without electrocautery) and hot EMR (with electrocautery) of large colorectal polyps.

As part of a multicenter, randomized trial, 660 patients with large (≥20 mm) non-pedunculated colon polyps were assigned to cold or hot EMR (primary intervention) (with subsequent submucosal injection with a viscous or non-viscous solution adopted as a secondary intervention, following a 2×2 design). The primary study outcome of interest was the rate of severe adverse events, while secondary outcomes included polyp recurrence.

According to the authors, severe adverse events were documented in 2.1% of patients in the cold EMR group versus 4.3% of patients in the hot EMR group, with fewer perforations observed following cold EMR (0%) compared to hot EMR (1.6%). Post-procedure bleeding did not differ between the groups (1.5% vs. 2.2%). Meanwhile, recurrence was detected in 27.6% and 13.6% of patients in the cold and hot EMR groups, respectively, without significantly differing for 20–29-mm polyps (18.6% vs. 13.4%) or sessile serrated polyps (14.1% vs. 8.5%).

Of note, the authors add, the effect of cold resection was independent of the type of submucosal injection solution, polyp size, and antithrombotic medications.

“Universal application of cold EMR did not significantly lower severe adverse events (unless cold EMR could be completed) and doubled the recurrence rate compared with hot EMR,” conclude the authors.

Reference

1.     Pohl H, Rex DK, Barber J, et al.Cold snare endoscopic resection for large colon polyps: a randomised trial. Gut. 2025;74(11):1804–1813.