Evaluation of efficacy and safety of different endoscopic polypectomy techniques for colonic polyps

Abstract

BACKGROUND

Colorectal polypectomy is fundamental to the prevention of colorectal cancer, utilizing several endoscopic techniques. Robust comparative data regarding the efficacy and safety of these modalities in clinical practice are limited.

AIM

To evaluate and compare the efficacy and safety of three endoscopic polypectomy techniques, namely, high-frequency electroresection (HFE), cold snare polypectomy (CSP), and endoscopic mucosal resection (EMR), for the treatment of colonic polyps.

METHODS

This single-center retrospective cohort study included adults who underwent endoscopic resection of pathologically confirmed colorectal polyps at Central Hospital Affiliated to Shandong First Medical University between January 2015 and December 2023. Patients were grouped by technique: HFE (n = 107), CSP (n = 106), and EMR (n = 108). Standardized preoperative, intraoperative, and postoperative protocols were applied. Outcome measures included resection status (en bloc, R0, R1, and Rx), adverse events (immediate/delayed bleeding, perforation, and post-polypectomy coagulation syndrome), postoperative pain (visual analog scale at 1, 3, and 5 hours), and 12-month recurrence rate.

RESULTS

Baseline demographics and polyp characteristics, except for polyp diameter, were comparable among groups. CSP achieved the highest en bloc resection rate, whereas HFE had a higher R0 resection rate. Polyp diameter was largest in the EMR group. Procedure duration was shortest with HFE. Adverse reactions were more frequent with HFE, particularly post-polypectomy bleeding and delayed perforation, whereas CSP demonstrated a superior safety profile and the lowest incidence of complications. Postoperative pain diminished in all groups over time but was consistently low for CSP and EMR. Recurrence rates were significantly higher in the EMR group vs CSP group, with HFE showing intermediate recurrence.

CONCLUSION

CSP offers the best safety profile and lowest recurrence rate among patients undergoing endoscopic resection of colorectal polyps, whereas HFE confers a high R0 resection rate but increased risk of adverse events. EMR remains essential for large polyps despite elevated recurrence. Technique selection should be tailored according to polyp characteristics and patient risk factors to optimize outcomes.

Keywords: Endoscopic polypectomy; Colonic polyps; High-frequency electroresection; Cold snare polypectomy; Endoscopic mucosal resection

Core Tip: This study evaluates the efficacy and safety of three endoscopic polypectomy techniques, high-frequency electroresection, cold snare polypectomy, and endoscopic mucosal resection, for treating colonic polyps. Key findings indicate that cold snare polypectomy offers the best safety profile with the lowest complication rates and recurrence, while high-frequency electroresection achieves a higher R0 resection rate but is associated with more adverse events. Endoscopic mucosal resection remains essential for larger polyps despite higher recurrence rates. These results highlight the importance of selecting the appropriate technique based on polyp characteristics and patient risk factors to optimize outcomes in colorectal cancer prevention.