Key Takeaways
- Clinical Bottom Line
- The Eradication of Thermal Injury
Clinical Bottom Line
| Polypectomy Technique | Electrosurgical Mode | Clinical Application (2026 Standard) |
|---|---|---|
| Cold Snare Polypectomy (CSP) | No heat; relies solely on mechanical wire guillotine. | 100% of diminutive (<5mm) and small (6-9mm) sessile polyps. |
| Hot Snare Polypectomy (HSP) | Blended microprocessor current (EndoCut). | Large flat lesions (>10mm) following submucosal injection, or thick-stalked pedunculated polyps. |
The Eradication of Thermal Injury
The global shift away from utilizing electrocautery to remove small polyps represents one of the most statistically significant improvements in colonoscopy safety. Historically, applying heat to a 4mm flat polyp via a “Hot Biopsy Forcep” or hot snare frequently generated an invisible, deep transmural burn, causing catastrophic delayed perforations 5 to 7 days post-procedure.
Mechanical Force Over Heat
Cold Snare Polypectomy (CSP) entirely eliminates delayed thermal injury. By utilizing a highly rigid, thin braided wire, the endoscopist physically slices through the mucosa and the uppermost layer of the submucosa, capturing the adenoma and a 2mm margin of healthy tissue. While CSP frequently induces a dramatic initial “ooze” of red blood (unlike the clean, charred eschar of HSP), this immediate bleeding is venous, highly superficial, and almost universally self-limiting, rarely requiring hemoclip deployment.
Clinical guidelines summarized by the Gastroscholar Research Team. Last updated: 2026. This article is intended for physicians.
