Tag Archives: cold snare

Lack of Pediatric Polypectomy Guidelines

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Hoskins BJ, Ng K, RexDK. J Pediatr GastroenterolNutr. 2025;81:162‐166. Open Access! Is it time to revisit the need for pediatric polypectomy guidelines?

This commentary/review makes a number of useful points:

  • In adults, there have been important changes in recommendations. Guidelines recommend “cold snare polypectomy (CSP) for small and diminutive polyps (<10 mm) due to its favorable safety profile compared to electrocautery techniques.2”
  • “The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition provides position papers for polyposis syndromes from 2019, including familial adenomatous polyposis (FAP), Peutz–Jeghers syndrome (PJS), and juvenile polyposis syndrome (JPS), which also provide guidance on polypectomy practices.8–10“
  • “No studies have directly compared the safety and efficacy of various polypectomy techniques—such as cold forceps, hot forceps, cold snare, and hot snare methods—in children. As a result, pediatric practices often rely on extrapolated adult data, despite key differences in patient populations.”

My take (borrowed from authors): “Polypectomy is central to pediatric endoscopy, yet evidence-based, pediatric-specific guidelines are lacking.”

Related article: Hoskins BJ, Grabau JM, Rex DK. J Pediatr Gastroenterol Nutr. 2025;81:1311-131. Pediatric endoscopic mucosal resection: a 10-year single-center experience. . https://doi.org/10.1002/jpn3.70194

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Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician.  Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition

Cold vs Hot Polypectomy for Small Polyps

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L-C Chang et al. Ann Intern Med. [Epub 21 February 2023]. doi:10.7326/M22-2189. Cold Versus Hot Snare Polypectomy for Small Colorectal Polyps

In this multicenter randomized open-label, single-blind trial of patients (n=4270) 40 years or older (mean age 62 years) with polyps of 4 to 10 mm, cold snare polypectomy (CSP) was compared with hot snare polypectomy (HSP).

Key findings:

  • Eight patients (0.4%) in the CSP group and 31 (1.5%) in the HSP group had delayed bleeding (w/in 14 days) (risk difference, −1.1% [95% CI, −1.7% to −0.5%]).
  • Severe delayed bleeding (drop in Hgb of 2 g/dL) was also lower in the CSP group (1 [0.05%] vs. 8 [0.4%] events; risk difference, −0.3% [CI, −0.6% to −0.05%])
  • The CSP group had fewer emergency service visits than the HSP group (4 [0.2%] vs. 13 [0.6%] visits
  • Polyp type (in Table 2): 70% were adenomas, 5% were sessile polyps, and 23% were nonneoplastic which includes hyperplastic polyps, inflammatory polyps, and nonsignificant lesions. ~56% had a “polypoid morphology” and ~ 44% had a “nonpolypoid morphology.”
  • “Besides an improved safety profile, another advantage of CSP is its high efficiency. This study’s results showed that the time required for polypectomy is reduced by 26.9% with CSP (difference in mean, -44.0 seconds)”

Why is CSP safer?

“The shallower resection depth in CSP is one of the factors contributing to the lower bleeding risk. Besides the tearing force, electrocautery also applies more energy to the soft tissue… (28). Profound submucosal destruction may occur in 60% of cases, and the muscularis propria may be damaged in 20% of patients receiving HSP; however, all cold resections are limited to the shallow submucosa. Because larger vessels are usually located in the deeper submucosa, the shallow resection depth of CSP causes less arterial injury, thereby reducing the risk for delayed bleeding (29).”

My take: It would be helpful to replicate these findings in children mainly due to differences in polyp types that are found. Nevertheless, this study suggests that it is likely more risky to use cautery for small polyps (“including persons using antiplatelet agents or anticoagulants”).

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Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician.  Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.