Adverse events of cold snare compared with hot snare and ablation endoscopic mucosal resection for large colorectal polyps

Endoscopic mucosal resection (EMR) techniques for large (≥20 mm) nonpedunculated colorectal polyps (LNPCPs) have expanded with the introduction of ablation and cold EMR. This study assessed adverse events (AEs) for the newer EMR techniques, including cold EMR, compared with hot EMR.We conducted a secondary analysis of four prospective multicenter studies of consecutive patients with LNPCPs undergoing EMR from 2019 to 2024. The primary outcome was serious AEs (SAEs) with cold and hot EMR. Secondary outcomes included SAEs in the hot EMR subgroups (no ablation [hEMR], margin ablation [hEMR-m], margin and base ablation [hEMR-mb]).1762 patients (mean age 65.8; 1890 LNPCPs) were included: 522 cold and 1368 hot EMRs (368 hEMR, 770 hEMR-m, 230 hEMR-mb). SAEs were higher with hot EMR (4.7%, 95%CI 3.6%-5.9%) vs. cold EMR (1.9%, 95%CI 0.9%-3.5%), also for the subgroups of hEMR (6.0%, 95%CI 3.8%-8.9%), hEMR-m (3.9%, 95%CI 2.6%-5.5%), and hEMR-mb (5.2%, 95%CI 2.7%-8.9%). Serious postendoscopic bleeding (PEB) was numerically higher with hot EMR (2.3%, 95%CI 1.6%-3.3%) vs. cold EMR (1.3%, 95%CI 0.5%-2.7%), also for the subgroups of hEMR (3.0%, 95%CI 1.5%-5.3%), hEMR-m (1.9%, 95%CI 1.1%-3.2%), and hEMR-mb (2.6%, 95%CI 1.0%-5.6%). Perforation, intraprocedural and post-procedural, was numerically higher with hot EMR (1.2%, 95%CI 0.7%-2.0%) vs. cold EMR (0.2%, 95%CI 0.0%-1.1%). hEMR-m and hEMR-mb with clipping had lower rates of serious and overall PEB than no clipping.Cold EMR demonstrated lower rates of SAEs, serious PEB, and perforation compared with hot EMR. Perforation and mortality occurred almost exclusively after hot EMR. Hot EMR with margin +/- base ablation did not increase SAEs compared with hot EMR without ablation.

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Journal
Endoscopy
Published
2025-07-24
DOI
https://doi.org/10.1055/a-2665-0521
Primary Topic
Gastric Cancer Management and Outcomes
Type
article
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0.00
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article

Adverse events of cold snare compared with hot snare and ablation endoscopic mucosal resection for large colorectal polyps

Douglas K. Pleskow, Pushpak Taunk, Michael B. Wallace, Roupen Djinbachian et al.
Endoscopy
Gastric Cancer Management and Outcomes
article

Adverse events of cold snare compared with hot snare and ablation endoscopic mucosal resection for large colorectal polyps

Douglas K. Pleskow, Pushpak Taunk, Michael B. Wallace, Roupen Djinbachian, Saowanee Ngamruengphong, Daniel von Renteln, Jeremy Barber, John M. Levenick, Mazen Elatrache, Eugene Zolotarevsky, Edgard Medawar, B. Joseph Elmunzer, Aleksandar Gavrić, Jeffrey D. Mosko, Heiko Pohl, Cyrus Piraka, Joshua Melson, Ajaypal Singh, Harry R. Aslanian, Douglas K. Rex, Neal Shahidi, Dennis J. Yang, Mouen A. Khashab, Matthew T. Moyer, Amit Rastogi, Stuart R. Gordon
article en

Abstract

Endoscopic mucosal resection (EMR) techniques for large (≥20 mm) nonpedunculated colorectal polyps (LNPCPs) have expanded with the introduction of ablation and cold EMR. This study assessed adverse events (AEs) for the newer EMR techniques, including cold EMR, compared with hot EMR.We conducted a secondary analysis of four prospective multicenter studies of consecutive patients with LNPCPs undergoing EMR from 2019 to 2024. The primary outcome was serious AEs (SAEs) with cold and hot EMR. Secondary outcomes included SAEs in the hot EMR subgroups (no ablation [hEMR], margin ablation [hEMR-m], margin and base ablation [hEMR-mb]).1762 patients (mean age 65.8; 1890 LNPCPs) were included: 522 cold and 1368 hot EMRs (368 hEMR, 770 hEMR-m, 230 hEMR-mb). SAEs were higher with hot EMR (4.7%, 95%CI 3.6%-5.9%) vs. cold EMR (1.9%, 95%CI 0.9%-3.5%), also for the subgroups of hEMR (6.0%, 95%CI 3.8%-8.9%), hEMR-m (3.9%, 95%CI 2.6%-5.5%), and hEMR-mb (5.2%, 95%CI 2.7%-8.9%). Serious postendoscopic bleeding (PEB) was numerically higher with hot EMR (2.3%, 95%CI 1.6%-3.3%) vs. cold EMR (1.3%, 95%CI 0.5%-2.7%), also for the subgroups of hEMR (3.0%, 95%CI 1.5%-5.3%), hEMR-m (1.9%, 95%CI 1.1%-3.2%), and hEMR-mb (2.6%, 95%CI 1.0%-5.6%). Perforation, intraprocedural and post-procedural, was numerically higher with hot EMR (1.2%, 95%CI 0.7%-2.0%) vs. cold EMR (0.2%, 95%CI 0.0%-1.1%). hEMR-m and hEMR-mb with clipping had lower rates of serious and overall PEB than no clipping.Cold EMR demonstrated lower rates of SAEs, serious PEB, and perforation compared with hot EMR. Perforation and mortality occurred almost exclusively after hot EMR. Hot EMR with margin +/- base ablation did not increase SAEs compared with hot EMR without ablation.

EndoscopyVol. 58(02)
Rush University Medical Center (US), Dartmouth–Hitchcock Medical Center (US), St. Michael's Hospital (CA), Beth Israel Deaconess Medical Center (US), University of British Columbia (CA), Johns Hopkins University (US), Medical University of South Carolina (US), University of Ottawa (CA), Henry Ford Health System (US), University of Toronto (CA), University of South Florida (US), AdventHealth Orlando (US), Ljubljana University Medical Centre (SI), Jacksonville College (US), University of Vermont Medical Center (US), Banner Health (US), WinnMed (US), Henry Ford Hospital (US), Yale University (US), Sheikh Shakhbout Medical City (AE), Michigan United (US), University of Kansas Medical Center (US), Centre Hospitalier de l’Université de Montréal (CA), Butterworth Hospital (ZA), Mayo Clinic in Florida (US), Johns Hopkins Hospital (US), Kansas City VA Medical Center (US), Corewell Health Butterworth Hospital (US), Indiana University School of Medicine, Indiana University – Purdue University Indianapolis (US), Université de Montréal (CA), Penn State Milton S. Hershey Medical Center (US)
Openalex Percentile: Top 71%
Gastric Cancer Management and Outcomes
DOISourceOpenAlex
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