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A comparison of the resection rate for cold and hot snare polypectomy for 4–9 mm colorectal polyps: a multicentre randomised controlled trial (CRESCENT study)
  1. Takuji Kawamura1,
  2. Yoji Takeuchi2,
  3. Satoshi Asai3,
  4. Isao Yokota4,
  5. Eisuke Akamine3,
  6. Minoru Kato2,
  7. Takuji Akamatsu5,
  8. Kazuhiro Tada6,
  9. Yoriaki Komeda7,
  10. Mineo Iwatate8,
  11. Ken Kawakami9,
  12. Michiko Nishikawa10,
  13. Daisuke Watanabe11,
  14. Atsushi Yamauchi12,
  15. Norimasa Fukata13,
  16. Masaaki Shimatani13,
  17. Makoto Ooi11,
  18. Koichi Fujita10,
  19. Yasushi Sano8,
  20. Hiroshi Kashida7,
  21. Satoru Hirose6,
  22. Hiroyoshi Iwagami5,
  23. Noriya Uedo2,
  24. Satoshi Teramukai4,
  25. Kiyohito Tanaka1,14
  1. 1 Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
  2. 2 Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
  3. 3 Department of Gastroenterology, Tane General Hospital, Osaka, Japan
  4. 4 Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan
  5. 5 Department of Gastroenterology and Hepatology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
  6. 6 Department of Gastroenterology, Bellland General Hospital, Osaka, Japan
  7. 7 Department of Gastroenterology and Hepatology, Kindai University, Osaka, Japan
  8. 8 Gastrointestinal Center, Sano Hospital, Hyogo, Japan
  9. 9 Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
  10. 10 Department of Gastroenterology, Yodogawa Christian Hospital, Osaka, Japan
  11. 11 Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
  12. 12 Division of Gastroenterology and Hepatology, Kitano Hospital, Osaka, Japan
  13. 13 The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
  14. 14 Department of Medical Information, Kyoto Second Red Cross Hospital, Kyoto, Japan
  1. Correspondence to Dr Takuji Kawamura, Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, 602-8026, Japan; kawamurat{at}


Objective To investigate the success rate of cold snare polypectomy (CSP) for complete resection of 4–9 mm colorectal adenomatous polyps compared with that of hot snare polypectomy (HSP).

Design A prospective, multicentre, randomised controlled, parallel, non-inferiority trial conducted in 12 Japanese endoscopy units. Endoscopically diagnosed sessile adenomatous polyps, 4–9 mm in size, were randomly assigned to the CSP or HSP group. After complete removal of the polyp using the allocated technique, biopsy specimens from the resection margin after polypectomy were obtained. The primary endpoint was the complete resection rate, defined as no evidence of adenomatous tissue in the biopsied specimens, among all pathologically confirmed adenomatous polyps.

Results A total of 796 eligible polyps were detected in 538 of 912 patients screened for eligibility between September 2015 and August 2016. The complete resection rate for CSP was 98.2% compared with 97.4% for HSP. The non-inferiority of CSP for complete resection compared with HSP was confirmed by the +0.8% (90% CI −1.0 to 2.7) complete resection rate (non-inferiority p<0.0001). Postoperative bleeding requiring endoscopic haemostasis occurred only in the HSP group (0.5%, 2 of 402 polyps).

Conclusions The complete resection rate for CSP is not inferior to that for HSP. CSP can be one of the standard techniques for 4–9 mm colorectal polyps. (Study registration: UMIN000018328)

  • colorectal neoplasm
  • colonic polyps
  • colonoscopy
  • endoscopy
  • colorectal Cancer

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  • Contributors TK, YT and NU planned the study. IY and ST were statistical advisors. SA, EA, MK, TA, KT, YK, MI, KK, MN, DW, AY, NF, MS, MO, KF, YS, HK, SH and HI had leadership in each institute and collected data. KT organised the study group. TK wrote the manuscript, and all the authors approved the final version of this manuscript.

  • Funding This study was funded by the Investigator Sponsored Research Program of Boston Scientific (ISREND00006).

  • Competing interests This study was funded by the Investigator Sponsored Research Program of Boston Scientific. The funder paid for statistical analysis, construction of electronic data collecting system and English proofreading service. However, the funder was not involved in the study design, recruitment, analysis plan or interpretation of data.

  • Ethics approval Institutional Review Board of each participating centre.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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