Efficacy and Safety of Cold Snare Polypectomy in Intensive Downstaging Polypectomy for Colorectal Polyps in Patients with Familial Adenomatous Polyposis

Intensive downstaging polypectomy (IDP) has emerged as an alternative strategy for managing colorectal polyps in patients with familial adenomatous polyposis (FAP), aiming to endoscopically control the disease in those who delay or refuse colectomy. This study evaluated the safety and efficacy of cold snare polypectomy (CSP) compared to hot snare polypectomy (HSP) and hot biopsy (HB) in patients with FAP undergoing IDP. This retrospective study included patients diagnosed with FAP who underwent IDP between September 2012 and March 2024 at Hiroshima University Hospital. The patients were divided into two groups: CSP (October 2022 onward) and HOT (HSP and HB; 2012-2022). Outcomes assessed included adverse events, resection time per polyp, total procedure time, number of polyps removed per procedure, and R0 resection rate. A total of 185 treatment sessions were performed in 32 patients. The CSP group had a significantly shorter resection time per lesion and a higher number of polyps removed per procedure compared to the HOT group. The incidence of adverse events was significantly lower in the CSP group. Immediate bleeding occurred in 10 cases in the HOT group, while no such events were observed in the CSP group. Additionally, delayed bleeding and perforation were each observed in two cases in the HOT group, whereas neither event occurred in the CSP group. CSP is a safe and efficacious method for polyp removal in patients with FAP undergoing IDP, offering shorter resection time and fewer adverse events compared to HSP and HB.