{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T02:50:10Z","timestamp":1791600610829,"version":"4.3.4"},"reference-count":24,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"abstract":"ABSTRACT<\/jats:title>\n \n Background and Aim<\/jats:title>\n Incomplete resection after cold snare polypectomy (CSP) remains a concern. CSP may sometimes require a forcible pull (\u201cforced CSP\u201d), which increases the incomplete resection rate (IRR). Submucosal injection before CSP (SI\u2010CSP) may facilitate resection and reduce IRR. We compared SI\u2010CSP with CSP for 3\u20139\u2009mm polyps using an approach avoiding forced CSP.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This randomized controlled trial enrolled patients aged 40\u201379\u2009years undergoing screening or surveillance colonoscopy with at least one 3\u20139\u2009mm adenomatous or sessile serrated lesion. They were randomized in a 1:1 ratio into the SI\u2010CSP and CSP groups. If resection without forced CSP was not feasible, the procedure was converted to endoscopic mucosal resection (EMR). The primary outcome was the IRR, assessed by additional biopsies of the margins.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Overall, 340 polyps from 340 patients were analyzed. Baseline characteristics were comparable between the groups. In the intention\u2010to\u2010treat analysis, the IRRs were low and similar between the SI\u2010CSP and CSP groups (0% vs. 1%,\n p<\/jats:italic>\n \u2009=\u20091). SI\u2010CSP was associated with a lower EMR conversion rate (1% vs. 12%,\n p<\/jats:italic>\n \u2009<\u20090.001), but median procedural time was longer (77\u2009s vs. 54\u2009s,\n p<\/jats:italic>\n \u2009<\u20090.001). EMR conversion occurred exclusively for 6\u20139\u2009mm polyps.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Avoiding forced CSP, with conversion to EMR when necessary, results in very low IRRs for SI\u2010CSP and CSP in 3\u20139\u2009mm colorectal polyps. Compared with CSP, SI\u2010CSP does not reduce the IRR but reduces conversion to EMR. However, SI\u2010CSP requires a longer procedural time and additional resources for submucosal injection.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n Thai Clinical Trials Registry TCTR20240805001<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jgh.70799","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T02:17:39Z","timestamp":1791598659000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cold Snare Polypectomy Versus Cold Snare Polypectomy With Submucosal Injection for 3\u20139\u2009mm Colorectal Polyps: A Randomized Controlled Trial"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1042-8476","authenticated-orcid":false,"given":"Sukit","family":"Pattarajierapan","sequence":"first","affiliation":[{"name":"Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine Chulalongkorn University Bangkok Thailand"},{"name":"King Chulalongkorn Memorial Hospital, The Thai Red Cross Society Bangkok Thailand"},{"name":"Center of Excellence in Colorectal Disease, Department of Surgery, Faculty of Medicine Chulalongkorn University Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ponpapat","family":"Surapat","sequence":"additional","affiliation":[{"name":"Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine Chulalongkorn University Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supaphat","family":"Kongsupapsiri","sequence":"additional","affiliation":[{"name":"Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine Chulalongkorn University Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Papanun","family":"Methakittrakoon","sequence":"additional","affiliation":[{"name":"Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine Chulalongkorn University Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naruemon","family":"Wisedopas","sequence":"additional","affiliation":[{"name":"Department of Pathology, Faculty of Medicine Chulalongkorn University Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natcha","family":"Wanpiyarat","sequence":"additional","affiliation":[{"name":"King Chulalongkorn Memorial Hospital, The Thai Red Cross Society Bangkok Thailand"},{"name":"Department of Pathology, Faculty of Medicine Chulalongkorn University Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8721-4372","authenticated-orcid":false,"given":"Nathawadee","family":"Lerttanatum","sequence":"additional","affiliation":[{"name":"King Chulalongkorn Memorial Hospital, The Thai Red Cross Society Bangkok Thailand"},{"name":"Department of Pathology, Faculty of Medicine Chulalongkorn University Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supakij","family":"Khomvilai","sequence":"additional","affiliation":[{"name":"Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine Chulalongkorn University Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"209","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung H.","year":"2021","journal-title":"CA: A Cancer Journal for Clinicians"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"1977","DOI":"10.1056\/NEJM199312303292701","article-title":"Prevention of Colorectal Cancer by Colonoscopic Polypectomy","volume":"329","author":"Winawer S. 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K.","year":"2022","journal-title":"Gastrointestinal Endoscopy"},{"key":"e_1_2_11_16_1","doi-asserted-by":"crossref","first-page":"1848","DOI":"10.14309\/ajg.0000000000002329","article-title":"Impact of Submucosal Saline Injection During Cold Snare Polypectomy for Colorectal Polyps Sized 3\u20139\u2009mm: A Multicenter Randomized Controlled Trial","volume":"118","author":"Mou Y.","year":"2023","journal-title":"American Journal of Gastroenterology"},{"key":"e_1_2_11_17_1","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1007\/s00384-022-04136-4","article-title":"Randomized Controlled Trial Investigating Use of Submucosal Injection of EverLift in Rates of Complete Resection of Non\u2010Pedunculated 4\u20139\u2009mm Polyps","volume":"37","author":"Wei M. 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