Cold Snare Piecemeal Resection vs Cold Snare Endoscopic Mucosal Resection

NCT ID: NCT06462521

Last Updated: 2025-12-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ENROLLING_BY_INVITATION

Clinical Phase

NA

Total Enrollment

570 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-09-06

Study Completion Date

2028-07-31

Brief Summary

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The study will compare the use of cold snare piecemeal resection (CSPR) vs cold endoscopic mucosal resection (Cold EMR). The study will include two cohorts: one cohort for conventional adenomas 10-19mm in size and one cohort for serrated lesions 10mm or larger.

Detailed Description

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Conditions

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Colon Cancer Colon Polyp Colon Adenoma Serrated Polyp

Keywords

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Polyp Resection Cold Snare Cold Endoscopic Mucosal Resection (Cold EMR) Cold Snare Piecemeal Resection (CSPR) Colonoscopy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Cold Snare Piecemeal Resection (CSPR)

Conventional adenomas sized 10-19mm or serrated lesions 10mm or larger found during colonoscopy will be removed using CSPR technique.

Group Type EXPERIMENTAL

Cold Snare Piecemeal Resection (CSPR)

Intervention Type PROCEDURE

Qualifying polyps randomized to Cold Snare Piecemeal Resection (CSPR) will be removed using cold snare techniques (no electrocautery, no submucosal injection.)

Cold Snare Endoscopic Mucosal Resection (Cold EMR)

Conventional adenomas sized 10-19mm or serrated lesions 10mm or larger found during colonoscopy will be removed using Cold EMR technique.

Group Type EXPERIMENTAL

Cold Snare Endoscopic Mucosal Resection (Cold EMR)

Intervention Type PROCEDURE

Qualifying polyps randomized to Cold Snare Endoscopic Mucosal Resection (Cold EMR) will be removed using cold snare techniques (no electrocautery, with submucosal injection.)

Interventions

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Cold Snare Piecemeal Resection (CSPR)

Qualifying polyps randomized to Cold Snare Piecemeal Resection (CSPR) will be removed using cold snare techniques (no electrocautery, no submucosal injection.)

Intervention Type PROCEDURE

Cold Snare Endoscopic Mucosal Resection (Cold EMR)

Qualifying polyps randomized to Cold Snare Endoscopic Mucosal Resection (Cold EMR) will be removed using cold snare techniques (no electrocautery, with submucosal injection.)

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. ≥ 18 years of age
2. Presenting for a screening, surveillance, diagnostic, or therapeutic colonoscopy
3. Found to have:

* a sessile serrated lesion or hyperplastic polyp ≥ 10 mm during procedure (Serrated Cohort) or
* a 10-19 mm conventional adenoma during procedure (Adenoma Cohort)
4. Ability to provide informed consent

Exclusion Criteria

1. Pedunculated or semi-pedunculated polyps (as defined by Paris Classification type Ip or Isp)
2. Polyps confirmed to be anything other than:

* sessile serrated lesion or hyperplastic polyp on histologic diagnosis (Serrated Cohort) or
* conventional adenoma on histologic diagnosis (Adenoma Cohort)
3. Patients with Ulcerative Colitis or Crohn's disease
4. Polyps with features suggestive of submucosal invasion
5. Polyps that are not able to be removed endoscopically due to location (e.g. extending into appendiceal orifice or diverticulum)
6. Patients with a known or suspected diagnosis of any of the following polyposis syndromes with known genetic mutations:

* Familial Adenomatous Polyposis Syndrome
* MUTYH associated Polyposis Syndrome
* Juvenile Polyposis Syndrome
* Cowden's Syndrome
* Peutz-Jeghers Syndrome
7. Subjects whose colonoscopy procedure is not able to be completed due to bowel prep precluding polyp identification.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Rush University Medical Center

OTHER

Sponsor Role collaborator

University of Colorado, Denver

OTHER

Sponsor Role collaborator

John D. Dingell VA Medical Center

FED

Sponsor Role collaborator

White River Junction Veterans Affairs Medical Center

FED

Sponsor Role collaborator

University of Kansas Medical Center

OTHER

Sponsor Role collaborator

Vancouver Coastal Health

OTHER_GOV

Sponsor Role collaborator

Université de Montréal

OTHER

Sponsor Role collaborator

University of Alabama at Birmingham

OTHER

Sponsor Role collaborator

Indiana University

OTHER

Sponsor Role lead

Responsible Party

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John J. Guardiola

Assistant Professor of Clinical Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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John J Guardiola, MD

Role: PRINCIPAL_INVESTIGATOR

Indiana University

Locations

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Indiana University

Indianapolis, Indiana, United States

Site Status

Countries

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United States

References

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Kaltenbach T, Anderson JC, Burke CA, Dominitz JA, Gupta S, Lieberman D, Robertson DJ, Shaukat A, Syngal S, Rex DK. Endoscopic Removal of Colorectal Lesions-Recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2020 Mar;158(4):1095-1129. doi: 10.1053/j.gastro.2019.12.018. Epub 2020 Feb 11. No abstract available.

Reference Type BACKGROUND
PMID: 32122632 (View on PubMed)

von Renteln D, Djinbachian R, Benard F, Barkun AN, Bouin M, Bouchard S, Deslandres E, Panzini B, Sidani S, Leduc R, Jobse BC, Pohl H. Incomplete resection of colorectal polyps of 4-20 mm in size when using a cold snare, and its associated factors. Endoscopy. 2023 Oct;55(10):929-937. doi: 10.1055/a-1978-3277. Epub 2022 Nov 14.

Reference Type BACKGROUND
PMID: 36377124 (View on PubMed)

McWhinney CD, Vemulapalli KC, El Rahyel A, Abdullah N, Rex DK. Adverse events and residual lesion rate after cold endoscopic mucosal resection of serrated lesions >/=10 mm. Gastrointest Endosc. 2021 Mar;93(3):654-659. doi: 10.1016/j.gie.2020.08.032. Epub 2020 Sep 3.

Reference Type RESULT
PMID: 32891621 (View on PubMed)

Rex DK, Anderson JC, Pohl H, Lahr RE, Judd S, Antaki F, Lilley K, Castelluccio PF, Vemulapalli KC. Cold versus hot snare resection with or without submucosal injection of 6- to 15-mm colorectal polyps: a randomized controlled trial. Gastrointest Endosc. 2022 Aug;96(2):330-338. doi: 10.1016/j.gie.2022.03.006. Epub 2022 Mar 12.

Reference Type RESULT
PMID: 35288147 (View on PubMed)

Kimoto Y, Sakai E, Inamoto R, Kurebayashi M, Takayanagi S, Hirata T, Suzuki Y, Ishii R, Konishi T, Kanda K, Negishi R, Takita M, Ono K, Minato Y, Muramoto T, Ohata K. Safety and Efficacy of Cold Snare Polypectomy Without Submucosal Injection for Large Sessile Serrated Lesions: A Prospective Study. Clin Gastroenterol Hepatol. 2022 Feb;20(2):e132-e138. doi: 10.1016/j.cgh.2020.10.053. Epub 2020 Nov 2.

Reference Type RESULT
PMID: 33152541 (View on PubMed)

Mangira D, Raftopoulos S, Vogrin S, Hartley I, Mack A, Gazelakis K, Nalankilli K, Trinh A, Metz AJ, Appleyard M, Grimpen F, Elliott T, Brown G, Moss A. Effectiveness and safety of cold snare polypectomy and cold endoscopic mucosal resection for nonpedunculated colorectal polyps of 10-19 mm: a multicenter observational cohort study. Endoscopy. 2023 Jul;55(7):627-635. doi: 10.1055/a-2029-9539. Epub 2023 Feb 7.

Reference Type RESULT
PMID: 36750222 (View on PubMed)

Gupta S, Lieberman D, Anderson JC, Burke CA, Dominitz JA, Kaltenbach T, Robertson DJ, Shaukat A, Syngal S, Rex DK. Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2020 Mar;158(4):1131-1153.e5. doi: 10.1053/j.gastro.2019.10.026. Epub 2020 Feb 7. No abstract available.

Reference Type RESULT
PMID: 32044092 (View on PubMed)

Other Identifiers

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20831

Identifier Type: -

Identifier Source: org_study_id