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.