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World J Gastrointest Surg. Aug 27, 2026; 18(8): 117626
Published online Aug 27, 2026. doi: 10.4240/wjgs.117626
Refined endoscopic technique combined with cold forceps polypectomy for diminutive colorectal polyps
Xue-Man Wang, Qin-Wei Xu, Yu-Zhen Bi, Quan Luo, Bo Lian, Jian Dong, Xin-Tong Jiang, Jun Zhang
Xue-Man Wang, Quan Luo, Bo Lian, Jian Dong, Xin-Tong Jiang, Endoscopy Center, Shaoxing People’s Hospital (The First Affiliated Hospital of Shaoxing University), Shaoxing 312300, Zhejiang Province, China
Qin-Wei Xu, Department of Graduate School, Dalian Medical University, Dalian 116044, Liaoning Province, China
Qin-Wei Xu, Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
Yu-Zhen Bi, Department of Gastroenterology, Chun’an County First People’s Hospital (Zhejiang Provincial People’s Hospital, Chun’an Branch), Hangzhou 311700, Zhejiang Province, China
Jun Zhang, Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310003, Zhejiang Province, China
Co-first authors: Xue-Man Wang and Qin-Wei Xu.
Author contributions: Wang XM and Xu QW designed and wrote the manuscript and they contribute equally to this study as co-first authors; Bi YZ, Luo Q, Lian B, and Dong J performed the research and collected and analyzed the data; Jiang XT and Zhang J prepared all tables, and reviewed and edited the manuscript; all the authors reviewed the manuscript, revised it critically for important intellectual content, and approved the final version for publication.
Supported by Shaoxing Municipal Health and Wellness Science and Technology Plan Project, No. 2024SKY030.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Shaoxing People’s Hospital (Approval No. 2025-YANLI 088-01).
Informed consent statement: Due to the use of de-identified data and the absence of direct human subject involvement, the Ethics Committee waived the requirement of informed consent.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and de-identified dataset are available from the corresponding author at
zhangjun1@hmc.edu.cn upon reasonable request.
Corresponding author: Jun Zhang, Chief Physician, Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), No. 54 Youdian Road, Hangzhou 310003, Zhejiang Province, China.
zhangjun1@hmc.edu.cn
Received: January 27, 2026
Revised: February 26, 2026
Accepted: March 27, 2026
Published online: August 27, 2026
Processing time: 200 Days and 23.9 Hours
BACKGROUND
The most appropriate endoscopic management for small (≤ 5 mm) colorectal adenomas has not yet been well established. Although cold snare polypectomy (CSP) is recommended by the guidelines, cold forceps polypectomy (CFP) remains a popular technique because it is easy to perform. However, previous data have suggested that a modified CFP technique using jumbo biopsy forceps, post-resection narrow-band imaging (NBI), and submucosal injection can yield high en bloc resection rates.
AIM
To assess the performance and safety of the modified CFP-NBI-flush method vs CSP for the management of diminutive colorectal adenomas.
METHODS
This retrospective study included 124 patients harboring 170 eligible diminutive adenomas (≤ 5 mm) who underwent colonoscopy at the Shaoxing People’s Hospital (Shaoxing, China) between November 2023 and December 2024. Polyps were categorized into CFP-NBI-flush (n = 86) and CSP (n = 84) groups according to the technique documented in the endoscopy report. Polyps were used as the unit of analysis for polyp-level outcomes, including recurrence. The primary endpoint was 6-month local recurrence rate, and the secondary endpoints were en bloc resection rate, procedure duration, cost(s), and complications.
RESULTS
Local recurrence rates were 2.6% (2/78) in the CFP-NBI-flush group and 7.5% (6/80) in the CSP group, with no statistical differences (P = 0.277). Despite a higher en bloc resection rate with CSP (92.9% vs 81.4%, P = 0.038), CFP-NBI-flush resulted in shorter procedural duration (median, 32.0 seconds vs 50.5 seconds; P < 0.001), was less expensive (349.7 ± 30.6 CNY vs 398.3 ± 55.1 CNY; P < 0.001), and yielded 100% specimen retrieval (92.9% for CSP; P = 0.013). Immediate bleeding rates (5.8% vs 8.3%, P = 0.563) and other complications (delayed bleeding, perforation) did not differ significantly between the two groups (both 0%). The use of metal clips between the two groups was also similar (5.8% vs 8.3%; P = 0.563).
CONCLUSION
The CFP-NBI-flush technique showed a 6-month local recurrence rate comparable to that of CSP, and offered advantages in terms of procedural efficiency, specimen retrieval, and cost.
Core Tip: Results of the present study revealed that the cold forceps polypectomy (CFP)-narrow-band imaging (NBI)-flush technique was efficacious compared with cold snare polypectomy (CSP) for preventing the recurrence of diminutive colorectal adenomas (≤ 5 mm), while also offering additional advantages in procedural efficiency, cost-effectiveness, and specimen retrieval rate. High-pressure waterjet-assisted mucosal lifting and NBI-guided margin assessment optimized the quality of polyp resection making CFP-NBI-flush a feasible alternative to CSP.
