Effectiveness and safety of modified cold snare polypectomy for flat colorectal polyps: A multicenter randomized controlled trial

doi:10.4240/wjgs.119157

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Randomized Controlled Trial

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Jun 27, 2026; 18(6): 119157
Published online Jun 27, 2026. doi: 10.4240/wjgs.119157

Effectiveness and safety of modified cold snare polypectomy for flat colorectal polyps: A multicenter randomized controlled trial

Jian-Hua Chen, Min-Min Chen, Yu Zhang, Li-Lin Lin, Rui Huang, Fen-Nan Tang, Ru-Qi Lin, Su-Yu Chen

Jian-Hua Chen, Min-Min Chen, Yu Zhang, Li-Lin Lin, Rui Huang, Su-Yu Chen, Department of Endoscopy Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian Branch of Fudan University Shanghai Cancer Center, Fuzhou 350014, Fujian Province, China

Fen-Nan Tang, Department of Endoscopy Center, Nantong Health Center, Fuzhou 350014, Fujian Province, China

Ru-Qi Lin, Department of Endoscopy Center, Fuqing Third Hospital, Fuzhou 350014, Fujian Province, China

Co-first authors: Jian-Hua Chen and Min-Min Chen.

Author contributions: Chen JH and Chen MM drafted the manuscript, and they contributed equally to this work as co-first authors; Zhang Y, Lin LL, and Huang R collected the data; Tang FN and Lin RQ conducted the statistical analysis; Chen SY oversaw the study design and multicenter coordination, critically revised the manuscript, and took responsibility for the integrity of the work as a whole. All authors have read and approved the final manuscript.

AI contribution statement: Only ChatGPT was used for language polishing and grammatical refinement during manuscript preparation. No other AI tools (e.g., Grammarly, DeepL) were utilized. All content of the manuscript (abstract, introduction, materials and methods, results, discussion, and conclusion) was independently written by the authors. No text content was generated by AI. ChatGPT was used solely for language polishing of the manuscript; it was not involved in translation, data analysis, or writing assistance. No AI tools participated in the study design, data processing, or interpretation of research findings. No AI-generated images are included in the manuscript.

Supported by the Innovation of Science and Technology, Fujian Province, China, No. 2023Y9414.

Institutional review board statement: The study protocol was approved by the Medical Ethics Committee of Fujian Cancer Hospital (approval No. K2023-310-01).

Clinical trial registration statement: This study was initiated and conducted internally within our department as an investigator-initiated research project. At the time of study design and commencement, it was not registered with a public clinical trial registry, as it was not standard departmental practice for internally initiated, therapeutic studies of this scale and nature. We acknowledge the evolving standards for clinical trial transparency and registration. We hereby declare that all research procedures were performed in accordance with the ethical standards of our institutional review board (IRB) and with the 1964 Helsinki Declaration and its later amendments.

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: The datasets generated and analyzed in the current study are available from the corresponding author upon reasonable request.

Corresponding author: Su-Yu Chen, Department of Endoscopy Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian Branch of Fudan University Shanghai Cancer Center, No. 420 Fuma Road, Fuzhou 350014, Fujian Province, China. endosuyuchen@163.com

Received: January 21, 2026
Revised: January 29, 2026
Accepted: March 5, 2026
Published online: June 27, 2026
Processing time: 151 Days and 5.5 Hours

Abstract

BACKGROUND

Cold snare polypectomy (CSP) is the preferred treatment for sessile colorectal polyps < 10 mm; however, snare slippage during resection of flat lesions (Paris classification 0-IIa) frequently compromises complete en bloc removal. We hypothesized that a modified CSP technique would enhance resection efficacy while preserving procedural safety for flat colorectal polyps measuring 5-9 mm.

AIM

To evaluate the effectiveness and safety of modified CSP for flat colorectal polyps of 5-9 mm.

METHODS

A multicenter randomized controlled trial was conducted from January 2023 to June 2025, enrolling patients with morphologically suitable nonpedunculated colonic polyps measuring 5-9 mm that were removed using CSP or modified CSP. Eligible patients with small flat colorectal polyps were randomly assigned to the modified or conventional group using a random number table. Polyp location, long-axis diameter, en bloc resection rate (defined as macroscopic complete removal in a single piece), endoscopic complete resection rate (defined as the absence of any endoscopically visible residual polyp tissue at the resection site immediately after polypectomy), histopathological findings, and procedure-related complications were compared between the two groups.

RESULTS

A total of 151 patients were enrolled, including 75 patients with 95 polyps in the modified group and 76 patients with 89 polyps in the conventional group. The en bloc resection rate was significantly higher in the modified group than in the conventional group [98.9% (94/95) vs 92.1% (82/89), P = 0.024]. The complete resection rate was 100% in both groups. No significant differences were observed between the two groups with respect to sex, age, polyp location, long-axis diameter, or histopathological type (all P > 0.05).

CONCLUSION

The modified CSP technique demonstrates advantages in the management of Paris classification 0-IIa polyps and represents a novel technical modification for these lesions.

Keywords: Flat colorectal polyps; Cold snare polypectomy; En bloc resection rate; Paris classification 0-IIa polyps; Modified cold snare polypectomy

Core Tip: Snare slippage limits complete en bloc resection during conventional cold snare polypectomy (CSP) for flat colorectal polyps. In this multicenter randomized trial, a modified CSP technique significantly improved en bloc resection rates for Paris 0-IIa polyps measuring 5-9 mm while maintaining a 100% complete resection rate and procedural safety. These findings suggest that modified CSP technique demonstrates advantages in the management of Paris classification 0-IIa polyps and represents a novel technical modification for these lesions.