Cold snare polypectomy versus hot snare polypectomy for small pedunculated polyps: a cost-effectiveness analysis - 31/10/25

Doi : 10.1016/j.gie.2025.09.005

Sneh Sonaiya, MD ¹, Raj Patel, MD ², Dushyant Singh Dahiya, MD ³, Shahryar Khan, MD ⁴, Charmy Parikh, MD ⁵, Mark Stasiewicz, MD ¹, Pranav D. Patel, MD ⁶, Kyaw Min Tun, DO ⁷, Bradley Confer, MD ⁶, Harshit S. Khara, MD ⁶, Sumant Inamdar, MD ⁸, Vignan Manne, MD ⁹, Babu P. Mohan, MD ^10,¹¹, Douglas G. Adler, MD ^12,^⁎
¹ Department of Internal Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA
² Department of Internal Medicine, St Mary Medical Center, Langhorne, Pennsylvania, USA
³ Department of Gastroenterology, Hepatology and Motility, University of Kansas School of Medicine, Kansas City, Kansas, USA
⁴ Department of Hospital Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
⁵ Department of Internal Medicine, Mercy Catholic Medical Center, Darby, Pennsylvania, USA
⁶ Department of Gastroenterology and Hepatology, Geisinger Health, Danville, Pennsylvania, USA
⁷ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
⁸ Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
⁹ Department of Gastroenterology and Hepatology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
¹⁰ University of Central Florida School of Medicine, Orlando, Florida, USA
¹¹ Orlando Gastroenterology PA, Orlando, Florida, USA
¹² Gastroenterology & Hepatology, Centura Health at Porter Adventist Hospital, Denver, Colorado, USA

^∗Corresponding author: Douglas G. Adler, MD, Gastroenterology & Hepatology, Advent Health at Porter Adventist Hospital, 2525 S Downing St, Denver, Colorado 80210, USA.Gastroenterology & HepatologyAdvent Health at Porter Adventist Hospital2525 S Downing StDenverColorado80210USA

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 31 October 2025

Abstract

Background and Aims

For small colorectal polyps, cold snare polypectomy (CSP) carries a higher risk of immediate postpolypectomy bleeding (IPPB) compared with hot snare polypectomy (HSP), but is associated with a significantly lower risk of delayed postpolypectomy bleeding (DPPB). Given these trade-offs, we evaluated the cost-effectiveness of CSP versus HSP for small (4-10 mm), pedunculated colorectal polyps.

Methods

Cost-effectiveness analysis was conducted over a 2-week time horizon using a decision tree model, based on the Multicenter Randomized Taiwan Cold Polypectomy Study and published literature. Incremental cost-effectiveness ratio (ICER) was calculated for a base case patient undergoing CSP versus HSP, with analysis performed using TreeAge Pro Healthcare 2024.

Results

IPPB was defined as perioperative bleeding requiring clipping, whereas DPPB referred to bleeding within 2 weeks requiring transfusion or endoscopic intervention. DPPB was evaluated at the patient level (386 participants: 192 CSP, 194 HSP), and IPPB at the polyp level (647 polyps: 306 CSP, 341 HSP). In the base case (61.8-year-old with a ≤10 mm pedunculated polyp), CSP versus HSP yielded an ICER of $35,684/quality-adjusted life year (QALY). Sensitivity analyses showed CSP remained cost-effective when IPPB risk after CSP was <21.64% or DPPB risk with HSP exceeded 0.76%.

Conclusions

CSP is cost-effective compared with HSP for small pedunculated polyps at a willingness-to-pay threshold of $100,000/QALY. Despite a higher IPPB risk, CSP's lower DPPB risk underlies its favorable economic profile. Our findings support CSP as the preferred technique for small pedunculated polyps, while emphasizing that patient- and polyp-specific clinical factors should be considered alongside cost-effectiveness in practice.

Le texte complet de cet article est disponible en PDF.

Abbreviations : AGA, CEAC, CMS, CPT, CSP, DPPB, ESGE, HSP, ICE, ICER, IPPB, PFS, PSA, QALY, TACOS, WTP