Cold Snare Polypectomy: Why Forceps and Hot Biopsy Fail

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Cold Snare Polypectomy: Why Forceps and Hot Biopsy Fail

You find a 5 mm sessile polyp in the transverse colon. The patient is on active anticoagulation. You want to resect it quickly, so you reach for the biopsy forceps or hot biopsy. This choice increases the risk of leaving adenomatous tissue behind. The key to achieving complete R0 resection is simple: use a cold snare.

In this two-minute video segment from the EndoCollab course library, Prof. Klaus Monkemuller covers the rationale for cold snare polypectomy. He explains why biopsy forceps fail on polyps larger than 3 mm, and why hot biopsy has been retired from clinical practice.

Biopsy Forceps: The Risk of Incomplete Resection

Studies show that incomplete resection rates for small polyps remain high, ranging from 14% to 30%. This is highly dependent on the endoscopist. When you use biopsy forceps on a 4 mm or 5 mm polyp, you are tearing the mucosa rather than cutting it. This leads to leftover tissue at the margins. These remnants are often mislabeled as recurrence on follow-up colonoscopy.

Prof. Monkemuller recommends limiting cold biopsy forceps to tiny lesions under 3 mm in size. For any polyp 4 mm or 5 mm, a cold snare is required to capture the entire lesion with a clear mucosal margin.