Cold snare polypectomy versus cold forceps polypectomy for diminutive and small colorectal polyps: a randomized controlled trial

Background: The optimal technique for removal of diminutive or small colorectal polyps is debatable. Objective: To compare the complete resection rates of cold snare polypectomy (CSP) and cold forceps polypectomy (CFP) for the removal of adenomatous polyps <= 7 mm. Design: Prospective randomized controlled study. Setting: A university hospital. Patients: A total of 139 patients who were found to have >= 1 colorectal adenomatous polyps <= 7 mm. Interventions: Polyps were randomized to be treated with either CSP or CFP. After the initial polypectomy, additional EMR was performed at the polypectomy site to assess the presence of residual polyp tissue. Main Outcome Measurements: Absence of residual polyp tissue in the EMR specimen of the polypectomy site was defined as complete resection. Results: Among a total of 145 polyps, 128 (88.3%) were adenomatous polyps. The overall complete resection rate for adenomatous polyps was significantly higher in the CSP group compared with the CFP group (57/59, 96.6% vs 57/69, 82.6%; P = 011). Although the complete resection rates for adenomatous polyps <= 4 mm were not different (27/27, 100% vs 31/32, 96.9%; P = 1.000), the complete resection rates for adenomatous polyps sized 5 to 7 mm was significantly higher in the CSP group compared with the CFP group (30/32, 93.8% vs 26/37, 70.3%; P =.013). Limitations: Single-center study. Conclusion: CSP is recommended for the complete resection of colorectal adenomatous polyps <= 7 mm.