Cold snare polypectomy (CSP) has gained increasing relevance during the last years. Due to fewer observed adverse effects and reduced procedure time, the method is already recommended for polyps <10 mm. There is emerging evidence supporting the use of CSP for adenomas and sessile serrated lesions (SSL) >10 mm, but larger randomized controlled trials are still missing. Therefore, the aim of this randomized controlled non-inferiority trial is to compare CSP with HSP for adenomas and SSLs measuring 10-15 mm in terms of complete histological resection rates (R0).

This ongoing randomized controlled non-inferiority trial started data collection in 2022 at a tertiary center in Germany. All consenting colonoscopy patients are screened for polyps according to the inclusion criteria. If a suitable polyp is detected, the polyp is randomized to hot or cold snare polypectomy. The polyp is then resected using a 15 mm hybrid snare (SnareMaster® Plus, Olympus) according to the protocol of the assigned study group. Following resection, four mucosal biopsies are obtained at the resection margin. The primary outcome is the complete resection rate, determined by the absence of adenomatous or SSL tissue in the biopsies. Secondary outcomes include the en bloc resection rate, failure of CSP requiring conversion to HSP, duration of the procedure and the rate of adverse events. The preliminary data were analysed using R version 4.5.0 (R Core Team, 2025).

81 Polyps in 55 patients were removed protocol compliant. The mean size was 11.89 mm, 69.14% (56/81) were adenomas and 30.86% (25/81) were SSL. The complete resection rate by CSP was 88.10% (37/42) and 89.74% (35/39) by HSP. En bloc resection was achieved in 88.10% (37/42) by CSP and 76.92% (30/39) by HSP. In 10.64% (5/47) of cases, CSP was not possible, but after conversion to HSP the resection was successful in all cases. Mean duration of CSP and HSP was 81.32 seconds and 126.64 seconds, respectively. Periprocedural bleeding was defined by persistence >60 seconds that required an endoscopic intervention (e. g. hemoclip) for hemostasis. After CSP, bleeding occurred in 28.57% (12/42) of cases, after HSP in 2.94% (1/34) of cases. None of the periprocedural bleedings were clinically relevant. No delayed bleeding within 30 days or other adverse events occurred.

CSP appears to be non-inferior to HSP in terms of complete resection rate and safety in the removal of adenomas and SSL (10–15 mm), while also being faster.