Efficacy and safety of cold snare and hot snare endoscopic mucosal resection in the removal of colorectal polyps: a systematic review and meta-analysis based on RCT studies.

Abstract

Objective: To compare the efficacy and safety of cold snare endoscopic mucosal resection (C-EMR) and hot snare endoscopic mucosal resection (H-EMR) for colorectal polyps.

Methods: PubMed, Embase, Cochrane Library and Scopus were systematically searched for randomized controlled trials (RCTs) published from database inception to March 15, 2026. Data were extracted independently by two investigators, and methodological quality was assessed using the Cochrane Risk of Bias tool. All outcomes were pooled with a random-effects model via RevMan software.

Results: Eight RCTs involving 1466 patients were included. Overall procedural time showed no significant difference between groups (MD = -2.30 min, 95% CI: -8.69 to 4.09, p = 0.48). Subgroup analysis revealed C-EMR significantly shortened procedural time for polyps ≤20 mm (MD = -11.53 min, p = 0.004), while H-EMR was faster for polyps >20 mm (MD = 3.89 min, p < 0.001; subgroup interaction p < 0.001). No significant differences were found in complete resection, en bloc resection, technical success or intraprocedural bleeding rates. C-EMR had a trend toward higher postoperative recurrence, approaching significance in polyps >20 mm (p = 0.08). For safety, C-EMR had significantly lower risks of perforation (RR = 0.11, p = 0.01) and delayed bleeding (RR = 0.46, p = 0.02). .

Conclusion: C-EMR features shorter procedural time and better safety for colorectal polyps ≤20 mm, whereas H-EMR is more suitable for polyps >20 mm. Including two landmark 2025 multicenter RCTs, this meta-analysis provides the latest evidence for individualized selection of resection techniques.