For a study, researchers sought to compare procedures for recurring adenoma in ≥1, 4 to 6 mm polyps, efficiency, and side events and define methodological parameters for a final trial. The research was conducted as a randomized controlled trial. Outpatients with polyps measuring greater than equal to 1, 4, to 6 mm were randomly assigned to 1 of 3 groups: cold forceps (CF), cold snare (CS), or hot snare (HS). During surveillance colonoscopy, the polypectomy site was marked with SPOT to assess for recurrence at the original polypectomy site. Investigators examined patient rejection, participation, ineligibility; retention; recurrent neoplasia; and sample size for a final trial to establish feasibility. About 353 patients were randomly assigned to 1 of the 3 polypectomy procedures, with 260 (73.6%) completing the initial colonoscopy (mean age 57 years, 50.4 % women), and 91, 87, and 82 patients receiving CF, CS, and HS polypectomy, respectively. CF, CS, and HS took 198.8, 58.5, and 96.8 seconds for polyp resection; CS and HS took less time than CF (P<0.001). About 164 people (63.1%) had their surveillance colonoscopy completed. With CF, there were 9 (14.5%) polyp recurrences, 5 (9.6%) with CS, and 0 (0%) with HS. Although the relative risks of recurrence with CF and CS polypectomy were 1.84 and 1.65, respectively, when compared to HS, neither was statistically significant. Polypectomy is the CS, and HS takes less time than the CF. Recurrent neoplasia may be less likely after HS polypectomy. Conducting a randomized controlled trial with polyp recurrence as the endpoint was difficult because of the high dropout rate.