Cold vs Hot Snare Polypectomy for Pedunculated Colorectal Polyps: Endoscopy | July 2026

A randomized controlled trial published in Endoscopy (July 2026) compared cold snare polypectomy (CSP) with hot snare polypectomy (HSP) for small pedunculated colorectal polyps.

Key findings

• CSP eliminated delayed post-polypectomy bleeding (DPPB) and was significantly safer than HSP for pedunculated polyps with heads ≤15 mm and stalks ≤5 mm.
• Immediate bleeding was more common with CSP, but it was generally easy to control endoscopically and did not lead to serious adverse events.
• CSP was faster than HSP, shortening total polypectomy time.

Why this matters

HSP has long been the standard approach for pedunculated polyps, but delayed bleeding remains one of its most important complications. This study was needed because:

• DPPB is a major concern with HSP.
• Evidence for CSP in pedunculated lesions had been limited.
• A safer technique could reduce complications.
• Randomized comparative data were previously lacking.
• The role of CSP in pedunculated polyps needed clarification.

Clinical takeaway

For small pedunculated colorectal polyps—specifically those with:

• polyp head ≤15 mm
• stalk ≤5 mm

Cold snare polypectomy should be considered the preferred technique, because it:

• markedly reduces delayed bleeding risk,
• remains manageable despite more frequent immediate bleeding,
• and improves procedural efficiency.

Important limitation

• Evidence is still insufficient for larger pedunculated polyps, especially those with heads 16–19 mm. More studies are needed in that group.

Bottom line

For pedunculated colorectal polyps with heads ≤15 mm and stalks ≤5 mm, cold snare polypectomy appears safer and faster than hot snare polypectomy. The tradeoff is more immediate bleeding, but this is usually controllable, while the more clinically concerning risk of delayed bleeding is substantially reduced.