{
  "abstract": "Background Complications of endoscopic mucosal resection (EMR) of large colorectal polyps remain a concern.Objective We aimed to compare safety and efficacy of cold EMR (without electrocautery) to hot EMR (with electrocautery) of large colorectal polyps.Design In this multicentre randomised trial, patients with any large (≥20 mm) non-pedunculated colon polyp were assigned to cold or hot EMR (primary intervention), and to submucosal injection with a viscous or non-viscous solution (secondary intervention) following a 2×2 design. The primary outcome was the rate of severe adverse events (SAEs). The secondary outcome was polyp recurrence. In this study, we report results of the primary intervention.Results 660 patients were randomised and analysed. An SAE was observed in 2.1% of patients in the cold EMR group and in 4.3% in the hot EMR group (p=0.10) (per protocol analysis 1.4 vs 5.0%, p=0.017) with fewer perforations following cold EMR (0%) compared with hot EMR (1.6%, p=0.028). Postprocedure bleeding did not differ (1.5% vs 2.2%, p=0.57). The effect of cold resection was independent of the type of submucosal injection solution, polyp size or antithrombotic medications. Recurrence was detected in 27.6% and 13.6% in the cold and hot EMR groups, respectively (p<0.001). Recurrence was not significantly different for 20–29 mm polyps (18.6% vs 13.4%, p=0.24) and for sessile serrated polyps (14.1% vs 8.5%, p=0.33).Conclusion Universal application of cold EMR did not significantly lower SAEs (unless cold EMR could be completed) and doubled the recurrence rate compared with hot EMR.Trial registration details ClinicalTrials.gov, number: NCT03865537.",
  "authors": [
    {
      "affiliations": [
        "Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA",
        "VA Medical Center, White River Junction, Vermont, USA"
      ],
      "name": "Heiko Pohl"
    },
    {
      "affiliations": [
        "Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA"
      ],
      "name": "Douglas K Rex"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Spectrum Health Butterworth Hospital, Grand Rapids, Michigan, USA"
      ],
      "name": "Jeremy Barber"
    },
    {
      "affiliations": [
        "Gastroenterology and Hepatology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA"
      ],
      "name": "Matthew T Moyer"
    },
    {
      "affiliations": [
        "Gastroenterology, Medical University of South Carolina, Charleston, South Carolina, USA"
      ],
      "name": "B Joseph Elmunzer"
    },
    {
      "affiliations": [
        "Gastroenterology, University of Kansas City, Kansas City, Missouri, USA"
      ],
      "name": "Amit Rastogi"
    },
    {
      "affiliations": [
        "Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA"
      ],
      "name": "Stuart R Gordon"
    },
    {
      "affiliations": [
        "Gastroenterology, Spectrum Health Butterworth Hospital, Grand Rapids, Michigan, USA"
      ],
      "name": "Eugene Zolotarevsky"
    },
    {
      "affiliations": [
        "Gastroenterology and Hepatology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA"
      ],
      "name": "John M Levenick"
    },
    {
      "affiliations": [
        "Gastroenterology, Yale New Haven Health System, New Haven, Connecticut, USA"
      ],
      "name": "Harry R Aslanian"
    },
    {
      "affiliations": [
        "Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan, USA"
      ],
      "name": "Mazen Elatrache"
    },
    {
      "affiliations": [
        "Medicine, Centre Hospitalier de L’Universite de Montreal, Montreal, Quebec, Canada"
      ],
      "name": "Daniel von Renteln"
    },
    {
      "affiliations": [
        "Gastroenterology and Hepatology, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA"
      ],
      "name": "Michael B Wallace"
    },
    {
      "affiliations": [
        "Gastroenterology and Hepatology, Mayo Clinic’s Campus in Florida, Jacksonville, Florida, USA"
      ],
      "name": "Bhaumik Brahmbhatt"
    },
    {
      "affiliations": [
        "Gastroenterology and Hepatology, Northwestern University - Chicago Campus, Chicago, Illinois, USA"
      ],
      "name": "Rajesh N Keswani"
    },
    {
      "affiliations": [
        "Gastroenterology and Hepatology, New York University, New York, New York, USA"
      ],
      "name": "Nikhil A Kumta"
    },
    {
      "affiliations": [
        "Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"
      ],
      "name": "Douglas K Pleskow"
    },
    {
      "affiliations": [
        "Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA"
      ],
      "name": "Zachary L Smith"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Sanford USD Medical Center, Sioux Falls, South Dakota, USA"
      ],
      "name": "Mouhanna K Abu Ghanimeh"
    },
    {
      "affiliations": [
        "Gastroenterology, Spectrum Health Butterworth Hospital, Grand Rapids, Michigan, USA"
      ],
      "name": "Stephen Simmer"
    },
    {
      "affiliations": [
        "Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA"
      ],
      "name": "Omid Sanaei"
    },
    {
      "affiliations": [
        "Department for Biomedical Data Science, Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA"
      ],
      "name": "Todd A Mackenzie"
    },
    {
      "affiliations": [
        "Gastroenterology, Henry Ford Health System, Detroit, Michigan, USA"
      ],
      "name": "Cyrus Piraka"
    }
  ],
  "title": "Cold snare endoscopic resection for large colon polyps: a randomised trial",
  "uid": "a7f05526-3cc5-552c-a34e-d81d7bf3b5e8"
}