Ji DH, Guan ZA. Evaluation of efficacy and safety of different endoscopic polypectomy techniques for colonic polyps. World J Gastrointest Surg 2025; 17(9): 110347 [DOI: 10.4240/wjgs.v17.i9.110347]
Corresponding Author of This Article
Zhong-An Guan, PhD, Department of Proctology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, No. 19369 Jingshi Road, Lixia District, Jinan 250014, Shandong Province, China. gza15275319010@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Sep 27, 2025; 17(9): 110347 Published online Sep 27, 2025. doi: 10.4240/wjgs.v17.i9.110347
Evaluation of efficacy and safety of different endoscopic polypectomy techniques for colonic polyps
De-Hui Ji, Zhong-An Guan
De-Hui Ji, The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan 250014, Shandong Province, China
De-Hui Ji, Department of Anorectal Words, Central Hospital Affiliated to Shandong First Medical University, Jinan 250013, Shandong Province, China
Zhong-An Guan, Department of Proctology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, Shandong Province, China
Author contributions: Guan ZA designed the experiments, conducted clinical data collection, performed postoperative follow-up, and recorded the data; Ji DH conducted the collation and statistical analysis, wrote the original manuscript, and revised the paper. Both authors read and approved the final manuscript.
Institutional review board statement: The study protocol was reviewed and approved by the Institutional Review Board and Ethics Committee of Central Hospital Affiliated to Shandong First Medical University.
Informed consent statement: The Ethics Committee of Central Hospital Affiliated to Shandong First Medical University agreed to waive the patient’s informed consent form.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: All data generated or analyzed during this study are included in this published article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhong-An Guan, PhD, Department of Proctology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, No. 19369 Jingshi Road, Lixia District, Jinan 250014, Shandong Province, China. gza15275319010@163.com
Received: June 13, 2025 Revised: July 8, 2025 Accepted: July 30, 2025 Published online: September 27, 2025 Processing time: 103 Days and 1 Hours
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.
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.
