Key Takeaways
- Clinical Bottom Line
- The Eradication of "Cold Biopsy" Remnants
Clinical Bottom Line
| Polypectomy Technique | Electrosurgical Input | Fellow Competency Marker |
|---|---|---|
| Cold Forceps Avulsion | None. Very high rate of incomplete resection. | Should be universally abandoned for anything larger than 2mm. |
| Cold Snare Polypectomy (CSP) | None. Purely relies on the mechanical guillotine force of a thin stiff wire. | Standard of care for all ademonas 3mm to 9mm; perfect safety profile. |
| Hot Snare Polypectomy (HSP) | Blended microprocessor current (EndoCut). | Reserved exclusively for large lesions (>10mm) or thick-stalked pedunculated polyps. |
The Eradication of “Cold Biopsy” Remnants
Historically, endoscopists frequently utilized simple biopsy forceps to “bite” off small 5mm polyps. This practice resulted in alarmingly high incomplete resection rates (often >30%), leaving behind microscopic rings of adenomatous tissue that silently evolved into interval colon cancers before the patient’s next scheduled colonoscopy.
The Shift to Universal Guillotining
The standard baseline competency for a graduating gastroenterology fellow in 2026 is the rapid, flawless execution of the Cold Snare Polypectomy (CSP) for all diminutive and small polyps (<10mm). CSP utilizes a dedicated, thin-wire stiff snare. The snare is aggressively compressed entirely flat against the mucosa, capturing 1-2mm of completely normal surrounding tissue alongside the polyp. Because no heat is utilized, the risk of delayed post-polypectomy mural burns or thermal perforation drops to zero, and the snare provides an almost perfectly clean, macroscopic resection margin.
Clinical guidelines summarized by the Gastroscholar Research Team. Last updated: 2026. This article is intended for physicians.
