Bleeding Risk With Cold Snare Polypectomy of ≤10 mm Pedunculated Colon Polyps

Abstract

Objectives: Pedunculated polyps (PPs) in the colon are usually resected with hot snare polypectomy to prevent immediate postpolypectomy bleeding (IPPB). This study aimed to evaluate the safety of CSP of <10 mm PPs. Materials and Methods: Patients undergoing colonoscopy from February 18, 2019, to April 24, 2020, and were found to have at least 1 ≤10 mm PP resected with CSP were included prospectively in a continuous quality improvement project to assess the risk of IPPB and delayed postpolypectomy bleeding. Polyp location, size, and pathology, as well as the method of resection, were recorded. In addition, we assessed the occurrence and severity of IPPB and the need for intervention. Results: We found 239 eligible polyps in 182 patients. The mean (SD) age was 58.8 (8.3) years, and 61% were males. IPPB occurred in 72 of 239 polyps, corresponding to a per-polyp bleeding percentage of 30.1% and in 65 of 182 patients, equating to a per-patient bleeding rate of 35.7%. We successfully treated bleeding by endoscopic hemostasis in 57%; the remaining 31 polyps (43%) did not require endoscopic intervention. There was no association between IPPB with age, gender, or use of aspirin or antithrombotic agents. In the bivariate model, polyp size and pathology were not associated with the risk of IPPB. Right-sided polyps were associated with a reduced risk of IPPB in the bivariate model by 61% (odds ratio=0.39; 95% confidence interval, 0.21-0.74; P=0.0057). In the multivariate model, choking the polyp base decreased the likelihood of IPPB by 97% (odds ratio=0.03; 95% confidence interval, 0.00-0.86; P=0.0459). There were no instances of delayed bleeding, perforation, or postpolypectomy syndrome. Conclusions: CSP can be used for resection of ≤10 mm PPs. It is associated with a lower risk of immediate bleeding than the common perception among gastroenterologists.

Cold Snare Polypectomy in Small (<10 mm) Pedunculated Colorectal Polyps

“…Six studies including 1025 patients (1111 polyps with a mean size 4 to 8.5 mm) were analyzed and included in the final study. [12][13][14][15][16][17] 116 and 995 polyps were removed with HSP and CSP, respectively. Details of patient characteristics, polyp location, size, and outcomes are further summarized in Tables 1, 2.…”

Audit of hemostatic clip use after colorectal polyp resection in an academic endoscopy unit

“…degree by squeezing the ensnared tissue for a few seconds before transection [22]. Anecdotally, this seems to create less immediate bleeding than rapid cold transection.…”

Performing High-Quality, Safe, Cost-Effective, and Efficient Basic Colonoscopy in 2023: Advice From Two Experts

“…Approximately 90% of all colorectal polyps are #10 mm, and nearly all of these can now be removed by cold snaring, including pedunculated lesions (83,84). Cold snare is recommended for polyps ,1 cm by the United States Multi Society Task Force on Colorectal Cancer and the European Society of Gastrointestinal Endoscopy based on comparable rates of complete resection when compared with hot snaring and a large body of evidence that cold resection is safer than hot resection, which was recently directly proven for polyps #10 mm in a large randomized trial (85).…”

“…For pedunculated lesions less than 10 mm, grasping the mucosa along the colon wall below the stalk and squeezing the tissue for a few seconds before transection seems to reduce immediate bleeding (83). For larger pedunculated lesions resected with electrocautery, we favor resection low on the stalk using forced coagulation current, followed by clip placement on the defect after transection.…”