Comparison of postpolypectomy bleeding events between cold snare polypectomy and hot snare polypectomy for small colorectal lesions: a large-scale propensity score–matched analysis

Takamaru, Hiroyuki; Saito, Yutaka; Hammoud, Ghassan M.; Mizuguchi, Yasunori; Cho, Hourin; Sekiguchi, Masau; Yamada, Masayoshi; Sakamoto, Taku; Matsuda, Takahisa

doi:10.1016/j.gie.2021.12.017

Cited by 17 publications

(22 citation statements)

References 30 publications

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“…Of the remaining 1205 studies, 23 met our inclusion criteria and were included in our analysis. [11][12][13][14][15][16][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] These studies included a total of 27 588 lesions, with 13 462 in the CSP group and 14 126 in the HSP group. Nineteen [11][12][13][14][15][16][19][20][21][22][23][24][25][26][27][28][29][30][31] of the included studies were full articles, and four [32][33][34][35] were abstract.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis of cold snare polypectomy and hot snare polypectomy for colorectal polyps

Niu

Bapaye

Zhang

et al. 2023

J of Gastro and Hepatol

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Background and AimCold snare polypectomy (CSP) has become increasingly utilized to resect colorectal polyps, given its efficacy and safety. This study aims to compare CSP and hot snare polypectomy (HSP) for resecting small (< 10 mm) and large (10–20 mm) colorectal lesions.MethodsRelevant publications were obtained from Cochrane Library, Embase, Google Scholar, PubMed, and Web of Science databases. The publication search was limited by English‐language and human studies. Pooled mean difference and odds ratios (ORs) were calculated for outcomes of interest.ResultsTwenty‐three studies were included in this meta‐analysis. Pooled OR of delayed post‐polypectomy bleeding (DPPB) in the CSP group versus the HSP group was 0.29 (P = 0.0001, I2 = 29%). Subgroup analysis according to lesion size showed a significant reduction in the DPPB rate in lesion sizes 10–20 mm (pooled OR 0.08, P = 0.003, I2 = 0%) and < 10 mm (pooled OR 0.35, P = 0.001, I2 = 27%). Pooled OR of major bleeding in the CSP group was 0.23 (P = 0.0004, I2 = 0%). Subgroup analysis by lesion size revealed a significant decrease in the rate of major bleeding in the CSP group for both lesion sizes 10–20 mm (pooled OR 0.11, P = 0.04) and < 10 mm (pooled OR 0.26, P = 0.003). Complete resection, en bloc resection, and recurrence rate were comparable in the two groups.ConclusionsCold snare polypectomy was associated with a lower rate of DPPB and lower risk of major bleeding compared with HSP in both small and large polyps. CSP should be considered as the polypectomy technique of choice for colorectal polyps.

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Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis of cold snare polypectomy and hot snare polypectomy for colorectal polyps

Niu

Bapaye

Zhang

et al. 2023

J of Gastro and Hepatol

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“…15 A safety study of CSP that included 1015 lesions reported that 193 lesions measuring 6-9 mm could be resected without increasing the bleeding rate. 16 Takamaru et al 17 also compared 2135 lesions treated with CSP and HSP and, after background adjustment using propensity score matching, found that HSP had a higher risk of postpolypectomy bleeding than CSP (odds ratio [OR] 6.0; 95% CI 1. 34-26.8).…”

Section: Current Indications For Cspmentioning

confidence: 99%

Colorectal cold snare polypectomy: Current standard technique and future perspectives

Ishibashi

Suzuki

Nagai

et al. 2022

Digestive Endoscopy

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It has been shown that resection of adenomatous colorectal polyps can reduce mortality due to colorectal cancer. In daily clinical practice, simpler and safer methods of colorectal polypectomy have been sought to enable endoscopists to resect all detected lesions. Among these, cold snare polypectomy (CSP) is widely used in clinical practice because of its advantages in shortening procedure time, reducing delayed bleeding risk, and lowering treatment costs, while maintaining a similar complete resection rate for lesions smaller than 10 mm when compared to conventional hot snare polypectomy. This review introduces the findings of previous studies that investigated the efficacy and safety of the CSP procedure for nonpedunculated polyps smaller than 10 mm, and describes technical points to remember when practicing CSP based on the latest evidence, including using a thin wire snare specifically designed for CSP, and observing the surrounding mucosa of the resection site with chromoendoscopy or image‐enhanced endoscopy to ensure that there is no residual lesion. This review also describes the potential of expanding the indication of CSP as a treatment for lesions larger than 10 mm, those with pedunculated morphology, those located near the appendiceal orifice, and for patients under continuous antithrombotic agent therapy. Finally, the perspective on optimal treatments for recurrent lesions after CSP is also discussed, despite the limited related evidence and data.

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“…Its increasing popularity stems not only from cost effectiveness, but its excellent safety profile for complete resection of smaller colorectal polyps. In a recent retrospective analysis of 5,371 patients who underwent cold versus hot snare polypectomy for colorectal lesions less than 10 mm in diameter, PPB was at least five times more likely for hot snare compared to cold snare resection [15 ▪▪ ]. This increased risk may have been driven by the rate of delayed PPB in hot snare resection due to thermal injury to the colonic mucosa by electrocautery.…”

Section: Safe Colonoscopymentioning

confidence: 99%

Safe, efficient, and effective screening colonoscopy

Dornblaser

Gross

2022

Current Opinion in Gastroenterology

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Purpose of reviewColorectal cancer continues to be one of the most common causes of cancer-related death. Widespread dissemination of screening colonoscopy in the United States has led to a significant reduction in the incidence and mortality. Here we review current literature with an aim to highlight recent improvements in the safety, efficiency, and effectiveness of screening colonoscopy.Recent findingsColon capsule endoscopy is an emerging noninvasive method to capture images of colonic mucosa for select patients with appreciable sensitivity for polyp detection. Recent literature supports the use of the novel oral anticoagulant apixaban over other anticoagulants to reduce the risk of gastrointestinal bleeding related to colonoscopy. Cold snare polypectomy for smaller lesions and prophylactic clipping following resection of large polyps in the proximal colon may reduce the rate of delayed bleeding. Novel methods and devices for improving bowel preparation continue to emerge. Mechanical attachment devices and artificial intelligence represent recent innovations to improve polyp detection.SummaryClinicians should be aware of relevant data and literature that continue to improve the quality and safety of screening colonoscopy and incorporate these findings into their clinical practice.

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Comparison of postpolypectomy bleeding events between cold snare polypectomy and hot snare polypectomy for small colorectal lesions: a large-scale propensity score–matched analysis

Cited by 17 publications

References 30 publications

Systematic review and meta‐analysis of cold snare polypectomy and hot snare polypectomy for colorectal polyps

Systematic review and meta‐analysis of cold snare polypectomy and hot snare polypectomy for colorectal polyps

Colorectal cold snare polypectomy: Current standard technique and future perspectives

Safe, efficient, and effective screening colonoscopy

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