Comparative Effectiveness of Hot Versus Cold Snare Polypectomy of Small Colorectal Polyps

Comparative Effectiveness of Hot Versus Cold Snare Polypectomy of Small Colorectal Polyps. A Randomized Controlled Trial

This study aims to investigate the comparative effectiveness between polyp removal with or without electrical current. The investigators want to include 600 polyps in the trial.

It is known that polyps have the potential to develop to cancer if left in situ, but the investigators do not know the best way to remove them completely.

In this study the investigators want to compare to widely used methods for polyp removal; hot and cold snare polypectomy. There has not been performed any big studies on this subject earlier, but current knowledge indicates that hot polypectomy (i.e. with use of electrical current) is somewhat better with regard to complete resection of polyps compared to cold polypectomy (without electrical current).

In this project the patients will be randomized to either hot or cold polypectomy. The investigators will distribute videos of how the polypectomies should be performed, and a gastroenterologist in the project group will instruct the doctors examining the patients to make sure that everyone performs polypectomy according to current guidelines.

The study is designed as a non-inferiority trial.

Inclusion Criteria:

• Outpatient colonoscopy
• Signed, written informed consent
• At least one flat/sessile polyp sized 4-9 mm identified during colonoscopy

Exclusion Criteria:

• Implanted cardiac electro converter
• Severe comorbidity (NYHA 3-4)
• Known coagulopathy (INR > 1,8) or resent use of any of the new oral anti-coagulant medications
• Platelet count < 100
• Resent use of clopidogrel or other non-acetylsalicylic acid platelet inhibitor (Last dose < 5 days before the procedure)
• Previous biopsy or attempt of polypectomy of the polyp considered for inclusion in the trial