Mo1621 A MULTICENTRE RANDOMIZED CONTROLLED TRIAL COMPARING THE RESECTION RATE AND COMPLICATIONS FOR COLD AND HOT SNARE POLYPECTOMY FOR 5-9 MM COLORECTAL POLYPS (POLIPEC HOT-COLD)

To compare the outcome of cold snare polypectomy (CSP) vs hot snare polypectomy (HSP) regarding incomplete resection rates, postcolonoscopy abdominal pain and adverse events rates in 5-9mm colorectal polyps. A prospective, multicentre, randomized controlled trial conducted in 7 Spanish Endoscopy units between January and November 2019. Consecutive patients scheduled for colonoscopy were invited to participate. Subjects with at least one 5–9mm polyp were randomized either to CSP or HSP. Polypectomies were performed according to current guidelines, without any substance submucosal injection. Snare types and sizes, likewise ERBE settings in case of HSP group were chosen at the discretion of the endoscopists. Complete resection rates were assessed with at least two biopsy samples taken after the polypectomy in case of macroscopic appearance of complete resection; additional directed biopsies were taken if macroscopic polypoid remains were suspected. Biopsy samples were evaluated by a single experienced pathologist blind to the specimen histological analysis and polypectomy method. Symptoms and adverse effects were assessed by a standardized telephone questionnaire. Differences between proportions of incomplete polypectomies were assessed with the z test of homogeneity. A total of 1437 patients were screened for eligibility, excluding patients with no 5-9 mm polyps, refusal to consent or contraindication for polypectomy, finally including 456 subjects (median age 64.8 (IQR: 57.2-71), 297 (65.1%) males), with 740 eligible polyps (364 assigned to CSP and 376 to HSP). Most frequent indications were colorectal cancer screening (32.5%), symptomatic patients (24.1%) and postpolipectomy follow-up (23.2%). Lesions included are summarized in figure 1. Most frequent histological diagnoses were tubular adenomas with low grade dysplasia (60,8%) and sessile serrated polyps (16.1%). High-grade dysplasia and early cancer were each present in one lesion (0.2%). Incomplete polypectomy rates were 8.6% in CSP group and 6.9% with HSP (p=ns). For postcolonoscopy pain analysis, subjects with polyps 10 mm were excluded. An overview of post procedural pain is summarized in figure 2. Overall adverse events, all of them mild, presented similarly between the CSP and HSP groups (8.8% vs 12%, respectively). Postpolipectomy bleeding rates (0.5% vs 0,4%) presented no differences with only a single case of bleeding related to 5-9mm polypectomies in each group. Other adverse events (meteorism, anal itching) were trivial and homogeneously distributed in both groups CSP is an effective technique, regarding complete polypectomy rates. It allows to avoid electrocautery use, simplifying polypectomy, with better tolerance from patients. Adverse events and complications are comparable, demonstrating technical safety.Fig 2. Postcolonoscopy abdominal painView Large Image Figure ViewerDownload Hi-res image Download (PPT)