Are we ready for the cold snare revolution?

Cold snare polypectomy (CSP) may eliminate the risk of perforation and cannot lead to the post-polypectomy syndrome that is associated with traditional, or hot snare, polypectomy (HSP) involving electrocautery. Extensive research has documented that the risk of bleeding after CSP for subcentimeter polyps is similar or smaller than that after HSP [1]. Meta-analyses have shown that the incomplete resection rate (IRR) is comparable between the two methods, but varies markedly between the studies (0–25 %), with significant heterogeneity [1] [2]. The quality of evidence has been rated as very low. Some of the variation is probably caused by differences in study settings, with the lowest IRRs coming from academic expert centers. Complete resection of colorectal polyps is of obvious importance. It has been estimated that 20 % of post-colonoscopy cancers may be caused by incompletely removed polyps [3].