Optimizing cold resection for colorectal polyps: insights from diminutive to large polyps

The purpose of this study was to review the clinical application of cold resection for colorectal polyps and determine its efficacy and safety for polyps of different sizes. A narrative review was conducted to analyze and compare key indicators, including complete resection rate (CRR), bleeding rate, perforation rate, and recurrence rate, for polyps of different sizes undergoing cold versus hot resection. The CRR of cold snare polypectomy (CSP) for resecting colorectal polyps measuring ≤ 10 mm is comparable to that of hot resection. However, the risk of delayed bleeding and perforation is significantly lower with CSP. With nonpedunculated colorectal polyps measuring 10–19 mm, particularly sessile serrated lesions (SSLs), cold resection (e.g., piecemeal cold snare polypectomy (pCSP)) is a safe and feasible option. For colorectal adenomas, however, the risk of recurrence with cold resection may be slightly higher than with hot resection. For large (≥ 20 mm) sessile serrated lesions (L-SSLs), cold resection offers significant safety advantages; however, the risk of recurrence is higher than with hot resection. Due to the higher risk of recurrence, cold resection is not recommended for removing large (≥ 20 mm) nonpedunculated adenomatous polyps (LNPCPs). Cold resection is particularly suitable for patients taking anticoagulants and those in poor health who cannot tolerate complications. Cold resection has become the standard treatment for small polyps due to its excellent safety profile. It is now also used for some larger polyps, particularly SSLs. However, strict adherence to histology guidance is crucial for larger polyps and adenomatous lesions because of the higher rate of postoperative recurrence.