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Not yet recruitingNCT06970808Cold-SNAPSUpdated May 14, 2025

Cold Snare Versus Cold Forceps Polypectomy for Small Lesions

An interventional study of Sampling from the resection margins in Colorectal Adenoma and Colorectal Lesions, sponsored by Azienda USL Modena. Not yet recruiting at 1 site in Italy. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2025-05-14.

Sponsored by Azienda USL Modena · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
312
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

The goal of this clinical trial is to compare the efficacy and the safety of a new device for cold forceps polypectomy (CFP)- a special jumbo forceps- to cold snare polypectomy (CSP) for small colorectal lesions, without adding peri- or post-procedural risks to the patient.

The main questions it aims to answer are:

  • Does the cold forceps guarantee a complete endoscopic resection rate?
  • How many adverse events could the jumbo forceps reduce in comparison to CSP?
  • Does the lesion retrieval rate increase?
  • Does the polypectomy duration decrease? Participants will be randomized to one or to the other group when a polypoid or non-polypoid lesion is identified. If multiple polyps are found in the same patient, they will be removed using the same polypectomy technique.

If polypectomy cannot be performed using the indicated technique, a crossover will be done according to the best practice of care principles.

Read the detailed description

The study is a Multicenter, Prospective, Randomized, Controlled Study. It is designed as a non-inferiority trial to assess whether the efficacy in polypectomy of the new jumbo cold forceps is non-inferior to that of the cold snare.

The investigators hypothesize a less number of adverse events with CFP, an increased lesion retrieval rate and a less duration of the polypectomy procedure.

All patients will be contacted, 30 days post-polypectomy, by blinded medical staff assessing for possible complications.

All consecutive patients with polyp lesions can be enrolled, the participation is voluntary and randomization will be performed using the "minimization technique".

02

Conditions studied

  • Colorectal Adenoma
  • Colorectal Lesions

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Keywords

  • Cold forceps polypectomy
  • Colonoscopy
  • Cold snare polypectomy
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
Yes

Inclusion criteria

  • Patients aged ≥ 18 years;
  • Ability to provide informed consent;
  • Presence of at least one colorectal polypoid/non-polypoid lesion \< 10 mm

Exclusion criteria

Exclusion Criteria:

  • Primary or secondary coagulopathy;
  • Improper interruption of dual antiplatelet therapy and/or antiplatelet therapy with P2Y12 receptor antagonists (clopidogrel, prasugrel, ticagrelor) and/or anticoagulant therapy;
  • Chronic inflammatory bowel diseases;
  • Inpatients undergoing colonoscopy;
  • Colonoscopy as part of regional colorectal cancer screening;
  • Pregnancy or breastfeeding
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
312 participants (estimated)

Study arms

  • Active comparator
    Cold snare polypectomy group

    For CSP, a 10 mm cold snare will be used (cold snare, Boston Scientific Corporation®, Marlborough, Massachusetts and cold snare, Meditalia S.A.S.®, Palermo, Italy); for CFP, a dedicated forceps will be used (Leviathan® cold forceps, 10 mm opening; Meditalia S.A.S., Palermo, Italy)

    Device: Sampling from the resection margins

  • Experimental
    Cold forceps polypectomy group

    For CFP, Leviathan® will be used (Meditalia S.A.S., Palermo, Italy). The opening jaw reaches a 10 mm diameter, and the central section of each jaw has an enlarged diameter up to 3.6 mm compared to the oval axis, enhancing its capacity

    Device: Sampling from the resection margins

Interventions

  • DeviceSampling from the resection margins

    After polypectomy, the base will be irrigated and assessed by the endoscopist, who may also use virtual or vital chromoendoscopy, if needed. Any residual adenomatous tissue will be removed using the same technique. To confirm the completeness of each polypectomy, two biopsies will be taken from the resection margins for polyps ≤ 5 mm, and three biopsies for polyps 6-9 mm, using standard biopsy forces.

05

What researchers measure

Primary outcomes

  1. Incomplete resection rate

    Compare the rate of incomplete endoscopic resection (IER) of CFP and CSP, defined as the presence of residual adenomatous tissue in the biopsy samples of the margins or after the visual assessment of the resection base.

    Time frame: Immediately after the procedure and immediately after the histological evaluation of the biopsy samples

Secondary outcomes

  1. Adverse events

    Intraprocedural bleeding (i.e., post-polypectomy "spurting" or "oozing" bleeding lasting more than one minute of observation, requiring hemostatic interventions) and delayed bleeding (within 30 days of the procedure, requiring a second endoscopic treatment and/or hospitalization); perforation (intraprocedural or delayed), defined as grade III (damage to the muscular layer with recognition of the "target sign") or grade IV/V (full-thickness perforation of the bowel wall with or without contamination, respectively) according to the Sydney Classification. All patients will be contacted, 30 days post-polypectomy, by blinded medical staff assessing for possible complications (rectal bleeding, abdominal pain, hospitalization due to perforation/bleeding, etc.)

    Time frame: Up to 30 days after the procedure

  2. Lesion retrieval rate

    Lesion retrieval rate, in relation to the resection site

    Time frame: During the polypectomy

  3. Polypectomy duration

    Polypectomy duration evaluated in seconds: the time will be calculated from the exit of the device from endoscopic channel to the lesion retrieval. Cold forceps polypectomy is assumed to have a shorter procedural time, reducing the overall colonoscopy duration, improving patient compliance, and reducing the sedation required, with fewer risks related to sedation

    Time frame: During the polypectomy

06

Study locations

1 site
  • AUSL Modena
    Carpi, Modena 41012, Italy
07

References and documents

Individual participant data

Plan to share: Undecided

No publications or documents are linked to this record.

08

Registry details

Key details

Study ID
NCT06970808
Lead sponsor
Azienda USL Modena
Responsible party
Dr. Mauro Manno (Gastroenterology and Endoscopy Unit director, Azienda USL Modena) — Principal investigator
First posted
May 14, 2025
Start date
Dec 2025 (estimated)
Primary completion
Oct 2027 (estimated)
Completion
Dec 2027 (estimated)
Last update
May 14, 2025

Study contacts

Noemi Gualandi
Contact
gualandinoemi@gmail.com
+39 059659500
Mauro Manno
principal investigator · AUSL Modena

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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