Objective To compare the efficacy and safety of cold‑endoscopic mucosal resection (C-EMR) and hot-endoscopic mucosal resection (H-EMR) for the treatment of colorectal polyps sized 10-20mm. Methods Patients who underwent colonoscopy at the Gastrointestinal Endoscopy Center of the Eighth Affiliated Hospital, Sun Yat-sen University from January 2022 to January 2023 were selected as the research subjects. Patients meeting the inclusion criteria with at least one 10-20 mm, Paris type Ⅰs, type Ⅱa polyp were selected. They were divided into C-EMR group (no high-frequency current treatment) and H-EMR group (high-frequency electrical polyp removal) based on the random number table method. The main outcome measures were the complete resection rate of polyps, the incidence of postoperative complications (bleeding, perforation and infection), and the recurrence rate of polyps in the two groups. Secondary outcomes were the procedure time and cost-effectiveness. Results A total of 209 eligible polyps were found in 209 patients, 105 in the C-EMR group (105 patients) and 104 in the H-EMR group (104 patients). There was no significant difference in the complete removal rate of polyps [91.4% (96/105) VS 95.2% (99/104), χ²=1.184, P=0.276], the recurrence rate of polyps [2.9% (3/105) VS 1.9% (2/104), χ²=0.195, P=0.683] or the incidence of complications [5.7% (6/105) VS 1.9% (2/104), χ²=2.040, P=0.280] between the C-EMR group and the H-EMR group. Compared with H-EMR group, the operation time of C-EMR group was shorter (5.26±2.41 min VS 9.34±5.63 min, t=-8.478, P<0.001), and the number of titanium clips used was fewer (2.55±0.94 VS 3.94±1.14, t=-9.623, P<0.001), and the differences between the two groups were statistically significant. The cost of polypectomy was lower in the C‑EMR group than that in the H‑EMR group (2 720±452 yuan VS 3 031±293 yuan), but the difference was not stastistically significant （t=-5.896， P=0.651）.Conclusion C-EMR demonstrates non-inferior efficacy and safety in treating 10-20 mm colorectal polyps compared with H-EMR. Widespread adoption of C-EMR may lead to reduced healthcare costs and expenditures.