Balancing safety and recurrence: pooled analysis of cold snare EMR for large colorectal polyps

We read with great interest the randomised controlled trials (RCTs) by O’Sullivan et al and Pohl et al, which compared the efficacy and safety of cold snare endoscopic mucosal resection (CS-EMR) and hot snare EMR (HS-EMR) for the management of large (≥ 15 mm) non-pedunculated colorectal polyps (LNPCPs).1 2 Both studies indicated a higher risk of residual or recurrent neoplasia with CS-EMR. Importantly, while O’Sullivan et al reported a more favourable safety profile for CS-EMR, Pohl et al found no significant difference in severe adverse events between the techniques. We conducted a pooled analysis to provide more robust and reliable evidence on this critical clinical question.