The edition · Gastroenterology & Hepatology
Cold snare resection of large colorectal polyps cut major complications to a third, but doubled residual adenoma
An individual patient data analysis of four trials sets out which large polyps suit cold resection. Also: AGA practice advice on MetALD, an international consensus on colorectal cancer risk in MASLD, and Rome V confirms that four in ten adults meet criteria for a gut-brain disorder.
The edition in brief
Pooling individual data from four randomised trials of 1,509 large (20 mm or more) non-pedunculated colorectal polyps, cold snare resection had fewer major adverse events than hot snare EMR (1.7% vs 5.9%; OR 0.26) but more than twice the residual or recurrent adenoma (26.5% vs 12.8%); the gap was smallest for sessile serrated lesions and largest for adenomas with high-grade dysplasia. An AGA clinical practice update on metabolic dysfunction- and alcohol-associated liver disease (MetALD) advises defining it by weekly alcohol grams, screening for alcohol use at least yearly, advising abstinence, staging fibrosis with FIB-4 then elastography, interpreting stiffness cautiously during active drinking, and avoiding bariatric surgery. A 35-expert Delphi consensus agreed that MASLD is associated with higher colorectal cancer risk and supported earlier, risk-adapted screening. The Rome V global survey of 28,771 adults in 15 countries found 40.9% met criteria for at least one disorder of gut-brain interaction, matching Rome IV.
AGA practice advice on MetALD: count the grams, ask every year, and stage fibrosis in two steps
In steatotic liver disease, quantify alcohol in grams per week at every annual review, advise stopping, and stage fibrosis with FIB-4 then elastography.
International experts agree MASLD raises colorectal cancer risk and support earlier screening
Check that patients with MASLD are up to date with colorectal cancer screening, and do not dismiss bowel symptoms.
Rome V: four in ten adults worldwide met criteria for a disorder of gut-brain interaction
Diagnose disorders of gut-brain interaction positively with Rome V criteria; they affect about 40% of adults.
Tattoo and photograph every large polyp resection site
Tattoo, photograph and document every large polyp resection so the scar can be found and checked at surveillance.
Large colorectal polyps: cold snare is safer, but recurrence doubled — choose by histology
For large non-pedunculated polyps, use cold snare for sessile serrated lesions and high-bleeding-risk patients, and hot EMR for large adenomas, especially with suspected high-grade dysplasia.
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