Safety of Cold Snare Polypectomy in Patients Receiving Treatment with Antithrombotic Agents

Arimoto, Jun; Chiba, Hideyuki; Ashikari, Keiichi; Fukui, Ryo; Anan, Hideyuki; Tachikawa, Jun; Suto, Takuma; Kawano, Naoya; Niikura, Toshihiro; Kuwabara, Hiromichi; Nakaoka, Michiko; Kato, Shingo; Ida, Tomonori; Morohashi, Taiki; Goto, Tetsuhiro; Nakajima, Atsushi

doi:10.1007/s10620-019-5469-1

Cited by 36 publications

(37 citation statements)

References 40 publications

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“…Moreover, due to the difficulty of performing a detailed histological evaluation of the smooth muscle (SM) layer in specimens resected by CSP, CSP should not be used for lesions with the possibility of SM invasion, such as when cancer is strongly suspected, or for ''flat and depressedtype'' lesions even when they are B 5 mm in size [41]. It has been reported that lesion \ 10 mm in size can be safely resected by CSP (using a dedicated snare) in patients taking antithrombotic agents [37,[42][43][44].…”

Section: Cq How Should Hyperplastic Polyps Be Managed?mentioning

confidence: 99%

Evidence-based clinical practice guidelines for management of colorectal polyps

et al. 2021

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Background The Japanese Society of Gastroenterology (JSGE) published ‘‘Daicho Polyp Shinryo Guideline 2014′’ in Japanese and a part of this guideline was published in English as “Evidence-based clinical practice guidelines for management of colorectal polyps” in the Journal of Gastroenterology in 2015. A revised version of the Japanese-language guideline was published in 2020, and here we introduce a part of the contents of revised version. Methods The guideline committee discussed and drew up a series of clinical questions (CQs). Recommendation statements for the CQs were limited to items with multiple therapeutic options. Items with established conclusions that had 100% agreement with previous guidelines (background questions) and items with no (or old) evidence that are topics for future research (future research questions: FRQs) were given descriptions only. To address the CQs and FRQs, PubMed, ICHUSHI, and other sources were searched for relevant articles published in English from 1983 to October 2018 and articles published in Japanese from 1983 to November 2018. The Japan Medical Library Association was also commissioned to search for relevant materials. Manual searches were performed for questions with insufficient online references. Results The professional committee created 18 CQs and statements concerning the current concept and diagnosis/treatment of various colorectal polyps, including their epidemiology, screening, pathophysiology, definition and classification, diagnosis, management, practical treatment, complications, and surveillance after treatment, and other colorectal lesions (submucosal tumors, nonneoplastic polyps, polyposis, hereditary tumors, ulcerative colitis-associated tumors/carcinomas). Conclusions After evaluation by the moderators, evidence-based clinical practice guidelines for management of colorectal polyps were proposed for 2020. This report addresses the therapeutic related CQs introduced when formulating these guidelines.

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Section: Cq How Should Hyperplastic Polyps Be Managed?mentioning

confidence: 99%

Evidence-based clinical practice guidelines for management of colorectal polyps

et al. 2021

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“…As previously mentioned, the presence of antithrombotic medications (APAs, warfarin, DOACs) further adds complexity to determining the safety of CSP and HSP and the rates of associated immediate and delayed PPB. Several studies [39][40][41] and a prospective, multicenter, randomized controlled trial 42 have shown the safety of CSP for subcentimeter nonpedunculated polyps (<10 mm) in the presence of continued use of APAs, warfarin, and DOACs with no increased risk of delayed PPB compared with HSP, 43 even when multiple antithrombotic agents 44 were continued.…”

Section: Prevention Of Post-polypectomy Bleedingmentioning

confidence: 99%

Endoscopic Management of Post-Polypectomy Bleeding

Gutta

Gromski

2020

Clin Endosc

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Post-polypectomy bleeding (PPB) is one of the most common complications of endoscopic polypectomy. There are multiple risk factors related to patient and polyp characteristics that should be considered. In most cases, immediate PPB can be effectively managed endoscopically when recognized and managed promptly. Delayed PPB can manifest in a myriad of ways. In severe delayed PPB, resuscitation for hemodynamic stabilization should be prioritized, followed by endoscopic evaluation and therapy once the patient is stabilized. Future areas of research in PPB include the risks of direct oral anticoagulants and of specific electrosurgical settings for hot-snare polypectomy vs. cold-snare polypectomy, benefits of closure of post-polypectomy mucosal defects using through-the-scope clips, and prospective comparative evaluation of newer hemostasis agents such as hemostatic spray powder and over-the-scope clips.Clin Endosc 2020;53:302-310

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“…As a result of checking the full text during the second screening, 5 articles were excluded. The reasons for exclusion were as follows: retrospective analysis [20,21] (n = 2); comparison with hot forceps biopsy [22] (n = 1); comparison with a suction pseudopolyp technique [23] (n = 1); and nonrandomized controlled trial [24] (n = 1). Finally, 12 randomized controlled trials [13][14][15][25][26][27][28][29][30][31][32][33]] and 3 prospective observational studies [4,16,17] were extracted.…”

Section: Study Selectionmentioning

confidence: 99%

Indications for Cold Polypectomy Stratified by the Colorectal Polyp Size: A Systematic Review and Meta-Analysis

Kawamura

Takeuchi

Yokota

et al. 2020

J Anus Rectum Colon

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Objectives: Cold polypectomy (CP) is widely used because of its safety profile. This systematic review and meta-analysis aimed to clarify the indications for CP based on polyp size. Methods: We searched PubMed and the Cochrane Library for randomized controlled trials that compared cold snare polypectomy (CSP) and other procedures for polyps ! 10 mm. Large-scale prospective observational studies were also searched to assess delayed bleeding rates. The studies were integrated to assess the risk ratio for incomplete resection rates according to polyp size. The Cochrane risk of bias tool was used to evaluate the study bias. The certainty of cumulative evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system. Results: We found 280 articles and reviewed their eligibility. We selected and extracted 12 randomized controlled trials and 3 prospective observational studies. The risk ratio of incomplete resection of polyps ! 10 mm using CSP compared with hot snare polypectomy (HSP) was 1.36 (95% confidence interval [CI], 0.92-2.01). The risk ratio for incomplete removal using CSP compared with cold forceps polypectomy (CFP) was 0.50 (95% CI, 0.31-0.82). For polyps ! 3 mm, the risk ratio of CSP compared with CFP was 1.40 (95% CI, 0.39-4.95). Certainty of cumulative evidence was considered low. No delayed bleeding after CP was reported after the treatment of 3446 polyps. Conclusions: CSP and HSP may result in the same complete resection rates for polyps ! 10 mm. For polyps ! 3 mm, CFP and CSP may have the same resection rates (PROSPERO registration number: CRD 42019122132).

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Safety of Cold Snare Polypectomy in Patients Receiving Treatment with Antithrombotic Agents

Cited by 36 publications

References 40 publications

Evidence-based clinical practice guidelines for management of colorectal polyps

Evidence-based clinical practice guidelines for management of colorectal polyps

Endoscopic Management of Post-Polypectomy Bleeding

Indications for Cold Polypectomy Stratified by the Colorectal Polyp Size: A Systematic Review and Meta-Analysis

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