内镜下粘膜切除术（EMR）是≥20mm无蒂结直肠息肉的标准治疗方法。最近，有人提出，通过减少不良事件 (AE)，无电流息肉切除术（冷切除）可能优于使用切割/凝固电流的标准技术（热切除），但缺少随机试验的证据。涉及19个中心的随机对照多中心试验，≥20mm的无蒂结直肠息肉被随机分配至冷或热EMR。主要结局是主要 AE（穿孔或内窥镜后出血）。在次要结局主要 AE 亚类中，息肉切除术后综合征和残留腺瘤最为相关。 2021 年至 2023 年期间，363 名患者（48.2% 女性）的 396 颗息肉被纳入意向治疗分析。主要 AE 发生率在冷组中为 1.0%，在热组中为 7.9%（p=0.001；比值比 [OR] 0.12 [95%-CI：0.03-0.54]）。冷组的穿孔率和内镜后出血率显着较低，分别为 0% vs. 3.9% (p=0.007) 和 1.0% vs. 4.4% (p=0.040)。息肉切除术后综合征的发生频率相似（3.1% vs. 4.4%，p=0.490）。冷切除后，残留腺瘤的发现率更高，分别为 23.7% 和 13.8% (p=0.020；OR 1.94 [95%-CI: 1.12-3.38])。在多变量分析中，病灶直径≥4cm是主要AE（OR 3.37）和残留腺瘤（OR 2.47）以及残留腺瘤的高度不典型增生/癌症（OR 2.92）的独立预测因子。带蒂结直肠息肉似乎比热 EMR 安全得多，但代价是残留腺瘤率较高。进一步的研究必须确认息肉大小和组织学在多大程度上可以确定个体化治疗方法（试验编号：DRKS00025170）。版权所有 © 2024 AGA Institute。由爱思唯尔公司出版。保留所有权利。

Endoscopic mucosal resection (EMR) is standard therapy for non-pedunculated colorectal polyps ≥20mm. Recently, it has been suggested that polyp resection without current (cold resection) may be superior to the standard technique using cutting/coagulation current (hot resection) by reducing adverse events (AE), but evidence from a randomized trial is missing.In this randomized-controlled multicentric trial involving 19 centers, non-pedunculated colorectal polyps ≥20mm were randomly assigned to cold or hot EMR. Primary outcome was major AE (perforation or post-endoscopic bleeding). Among secondary outcomes major AE subcategories, postpolypectomy-syndrome and residual adenoma were most relevant.Between 2021 and 2023, 396 polyps in 363 patients (48.2% female) were enrolled for the intention-to-treat analysis. Major AE occurred in 1.0 % in the cold and in 7.9% in the hot group (p=0.001; Odds ratio [OR] 0.12 [95%-CI: 0.03-0.54]). Rates for perforation and post-endoscopic bleeding were significantly lower in the cold group with 0% vs. 3.9% (p=0.007) and 1.0% vs. 4.4% (p=0.040). Postpolypectomy-syndrome occurred with similar frequency (3.1% vs. 4.4%, p=0.490). After cold resection, residual adenoma was found more frequently, with 23.7% vs. 13.8% (p=0.020; OR 1.94 [95%-CI: 1.12-3.38]). In multivariable analysis, lesion diameter of ≥4cm was an independent predictor both for major AE (OR 3.37) and residual adenoma (OR 2.47), and high-grade dysplasia/cancer for residual adenoma (OR 2.92).Cold resection of large non-pedunculated colorectal polyps appears considerably safer than hot EMR, however at the cost of a higher residual adenoma rate. Further studies have to confirm to which extent polyp size and histology can determine an individualized approach (Trial number: DRKS00025170).Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.