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New research · Gastroenterology
Scandinavian journal of gastroenterology · 17h
Meta-analysisScandinavian journal of gastroenterology · 2026

Efficacy and safety of cold snare and hot snare endoscopic mucosal resection in the removal of colorectal polyps: a systematic review and meta-analysis based on RCT studies.

Yihang Liu, Yuqing Lu, Kejia Liu … Chaoyang Wang
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GastroenterologyMeta-analysis

Cold snare mucosal resection had far lower perforation risk than hot snare for colorectal polyps.

Efficacy and safety of cold snare and hot snare endoscopic mucosal resection in the removal of colorectal polyps: a systematic review and meta-analysis based on RCT studies.

Yihang Liu et al. · Scandinavian journal of gastroenterology · 2026
Purpose

To compare the efficacy and safety of cold snare endoscopic mucosal resection (C-EMR) and hot snare endoscopic mucosal resection (H-EMR) for colorectal polyps.

Methods

PubMed, Embase, Cochrane Library and Scopus were systematically searched for randomized controlled trials (RCTs) published from database inception to March 15, 2026.

n = 1466 patients
Results

Perforation (bowel-wall puncture) far less common with cold snare than hot snare removal.

MD -2.30 (95% CI -8.69 to 4.09)
null 0
-8.69
4.09
CI crosses the null - not significant
More results

Overall procedural time showed no significant difference between groups (MD = -2.30 min, 95% CI: -8.69 to 4.09, p = 0.48).

Subgroup analysis revealed C-EMR significantly shortened procedural time for polyps ≤20 mm (MD = -11.53 min, p = 0.004), while H-EMR was faster for polyps >20 mm (MD = 3.89 min, p < 0.001; subgroup interaction p < 0.001).

More results

No significant differences were found in complete resection, en bloc resection, technical success or intraprocedural bleeding rates.

C-EMR had a trend toward higher postoperative recurrence, approaching significance in polyps >20 mm ( p = 0.08).

“
Conclusion · 1 of 2

C-EMR features shorter procedural time and better safety for colorectal polyps ≤20 mm, whereas H-EMR is more suitable for polyps >20 mm.

Conclusion · 2 of 2

Including two landmark 2025 multicenter RCTs, this meta-analysis provides the latest evidence for individualized selection of resection techniques.

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