Background and Study Aims: To assess whether a cold biopsy from a diminutive rectal adenoma followed by destruction with bipolar (gold probe) electrocoagulation using large probes and high power setting would be a safe and efficient alternative to conventional monopolar hot biopsy forceps (MHBF). To the best of our knowledge, this is the only prospective randomised study that compares the technique of cold biopsy followed by bipolar electrocoagulation with that of MHBF. Patients and Methods: Eligible patients were those undergoing colonoscopy, fulfilling the criteria of additional clearing colonoscopy and having at least one suspected rectal adenoma <5mm. At the time of endoscopy patients were randomized to receive treatment for their diminutive rectal polyps either with cold biopsy followed by repeated gold probe electrocoagulation (Group A) using a 10 Fr catheter with setting 8 (40W) for 1 second or with MHBF (Group B). These patients were followed up with a colonoscopy at 2-4 months. Cases in which the histology of the removed diminutive rectal polyps was not neoplastic were excluded from the study group. Results: A total number of 24 (15 males, 9 females, mean age:56 years) patients were included in group A and 26 (14 males, 12 females, mean age:61 years) in group B. At follow up colonoscopy residual adenoma tissue in the rectum was found in 2 patients of group A (8.3%) and in 4 of Group B (15.3%) (p>0.4). No complications related to colonoscopy or endoscopic treatments in both groups occurred. Conclusions: Our data suggest that the use of cold biopsy followed by bipolar electrocoagulation using large probes and high power setting for destroying diminutive rectal adenoma is at least similarly effective and safe as MHBF.