Postgraduate Course at DDW: Complete Clinical Updates for Today's Practice

4_Rex Cold vs Hot Polypectomy

Pdf Summary

The document from Indiana University School of Medicine, authored by Douglas K. Rex, examines fundamental questions and techniques in endoscopic resection strategy for colorectal lesions, comparing cold and hot polypectomy methods. <br /><br />Key considerations in polypectomy include whether lesions should be resected with or without electrocautery, and whether en bloc or piecemeal resection is preferable, with options like EMR, FTRD, and ESD discussed for different lesion sizes.<br /><br />**Cold Snaring** is recommended for superficial cuts through submucosa, reducing delayed hemorrhage and perforation risks but increasing recurrence risk for large adenomas. It is cost-effective but poses more immediate bleeding. It's particularly advised for polyps under 10 mm, pedunculated lesions under 10 mm, large SSLs, and flat adenomas under 20 mm.<br /><br />**Hot Snaring** offers deeper cuts, useful for lesions with higher cancer risk, bulky morphologies, large thick-stalked polyps, and lesions that are difficult to transect without electrocautery. However, it increases costs and risks delayed bleeding, thermal injury, and perforation.<br /><br />The document outlines when to employ cold versus hot snaring, emphasizing hot snaring for lesions with high cancer risk or complex structures, while cold techniques are suitable for smaller, simpler lesions.<br /><br />Research highlights include a meta-analysis comparing hot EMR to cold EMR for large non-pedunculated adenomas, showing a higher recurrence with cold EMR. Morphological assessment of lesions, particularly the risk of cancer associated with different types of adenomas, guides the choice of technique.<br /><br />In summary, the document provides guidance on polypectomy strategies, emphasizing lesion characteristics and risks to decide between cold and hot snaring. It underscores the importance of morphology, lesion size, and cancer risk in method selection.

Keywords

endoscopic resection

colorectal lesions

cold polypectomy

hot polypectomy

electrocautery

en bloc resection

piecemeal resection

morphological assessment

cancer risk

Douglas K. Rex