Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy

Table 1 Patients’ baseline characteristics n (%)

	CSP group (n = 102)	HFB group (n = 106)	P value
Age (yr), mean (SD)	69.4 (8.0)	68.9 (7.9)	0.60
Female sex	32 (31.3)	31 (29.2)	0.76
Use of antithrombotic agents	4 (3.9)	3 (2.8)	0.72

CSP: Cold snare polypectomy; HFB: Hot forceps biopsy.

Table 2 Polyps’ characteristics

	CSP group	HFB group	P value
Total No. of polyps	148	135
Polyp size (mm) mean ± SD	4.2 (1.0)	3.8 (1.0)
No. of polyps per patient, mean	1.5	1.3
Location			0.10
Right1/Left2	44/104	53/82
Shape			0.09
Protruded	107	110
Flat	41	25
Histology			0.16
High-grade adenoma	12	3
Low-grade adenoma	124	126
SSA/P	6	4
Hyperplastic polyp	3	2
Other	3	0

¹Located from the cecum to the splenic flexure;

²Located from the splenic flexure to the rectum. SSA/P: Sessile serrated adenoma/polyp; CSP: Cold snare polypectomy; HFB: Hot forceps biopsy.

Table 3 Outcomes and adverse events among the patients

	CSP group (95%CI)	HFB group (95%CI)	P value
Endoscopic evaluation	147/148 = 99.3%	108/135 = 80.0%	< 0.0001
En-bloc resection rate with free cut-margin	(92.3%-100.0%)	(72.3%-86.4%)
Pathologic evaluation	119/148 = 80.4%	64/135 = 47.4%	< 0.0001
Complete resection rate with free cut-margin	(73.1%-86.5%)	(38.8%-56.2%)
Histological tissue injury	2/148 = 1.3%	71/135 = 52.6%	< 0.0001
	(0.2%-4.8%)	(43.8%-61.2%)
Adverse event
Immediate bleeding	13/148 = 8.8%	11/135 = 8.1%	1.00
	(4.8%-14.6%)	(4.1%-14.1%)
Delayed bleeding	0	0
Perforation	0	0

CSP: Cold snare polypectomy; HFB: Hot forceps biopsy.

Table 4 Outcomes and adverse events in terms of the snares used for cold snare polypectomy

	Profile snare (95%CI)	Captivator-II snare (95%CI)	P value
Endoscopic evaluation	88/88 = 100%	59/60 = 98.3%	0.41
En-bloc resection rate with free cut-margin	(95.9%-100.0%)	(91.2%-100.0%)
Pathologic evaluation	75/88 = 85.2%	44/60 = 73.3%	0.09
Complete resection rate with free cut-margin	(76.1%-91.9%)	(60.3%-83.9%)
Histological tissue injury	0/88 = 0%	2/60 = 3.3%	0.16
	(0.0%-4.1%)	(0.4%-11.5%)
Adverse event
Immediate bleeding	9/88 = 10.2%	4/60 = 6.7%	0.56
	(4.8%-18.5%)	(1.8%-16.2%)
Delayed bleeding	0	0
Perforation	0	0

There were no differences in the type or number of polyps in these groups. CSP: Cold snare polypectomy.

Table 5 Results of multivariable logistic regression analysis of the complete resection rate

Variable	Odds ratio (95%CI)	P value
Resection method
CSP/HFB	4.70 (2.68-8.24)	< 0.0001
Location
Left1/Right2	1.24 (0.71-2.17)	0.45
Shape
Flat/protruded	0.94 (0.50-1.78)	0.85
Histology
Non-TA/TA	1.34 (0.44-4.08)	0.61

¹Located from the cecum to the splenic flexure;

²Located from the splenic flexure to the rectum. CSP: Cold snare polypectomy; HFB: Hot forceps biopsy; TA: Tubular adenoma.