Bleeding Risk of Cold Versus Hot Snare Polypectomy for Pedunculated Colorectal Polyps Measuring 10 mm or Less: Subgroup Analysis of a Large Randomized Controlled Trial

Author:

Tseng Cheng-Hao12ORCID,Chang Li-Chun3ORCID,Wu Jia-Ling4ORCID,Chang Chi-Yang56,Chen Chi-Yi7ORCID,Chen Peng-Jen8ORCID,Shun Chia-Tung9ORCID,Hsu Wen-Feng10,Chen Yen-Nien10ORCID,Chen Chieh-Chang3ORCID,Huang Tien-Yu8,Tu Chia-Hung3ORCID,Chen Mei-Jyh3,Chou Chu-Kuang7ORCID,Lee Ching-Tai211,Chen Po-Yueh6,Lin Jaw-Town12,Wu Ming-Shiang3,Chiu Han-Mo3ORCID

Affiliation:

1. Department of Gastroenterology and Hepatology, E-Da Cancer Hospital, Kaohsiung, Taiwan;

2. Department of Gastroenterology and Hepatology, I-Shou University, Kaohsiung, Taiwan;

3. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan;

4. Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan;

5. Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei, Taiwan;

6. School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan;

7. Department of Internal Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan;

8. Division of Gastroenterology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan;

9. Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan;

10. Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan;

11. Department of Gastroenterology and Hepatology, E-Da Hospital, Kaohsiung, Taiwan.

Abstract

INTRODUCTION: Concerns regarding bleeding remain in cold snare polypectomy (CSP) for small pedunculated (0-Ip) polyps. The aim of this study was to compare the risk of CSP and hot snare polypectomy (HSP) for such lesions. METHODS: Data on 0-Ip colorectal polyps ≤10 mm were extracted from a large, pragmatic, randomized trial. Immediate postpolypectomy bleeding (IPPB), defined as the perioperative use of a clip for bleeding, was evaluated through polyp-level analysis. Delayed postpolypectomy bleeding (DPPB), defined as bleeding occurring within 2 weeks postoperatively, was assessed at the patient-level among patients whose polyps were all ≤10 mm, including at least one 0-Ip polyp. RESULTS: A total of 647 0-Ip polyps (CSP: 306; HSP: 341) were included for IPPB analysis and 386 patients (CSP: 192; HSP: 194) for DPPB analysis. CSP was associated with a higher incidence of IPPB (10.8% vs 3.2%, P < 0.001) but no adverse clinical events. The procedure time of all polypectomies was shorter for CSP than for HSP (123.0 ± 117.8 vs 166.0 ± 237.7 seconds, P = 0.003), while the procedure time of polypectomies with IPPB were similar (249.8 ± 140.2 vs 227.4 ± 125.9 seconds, P = 0.64). DPPB was observed in 3 patients (1.5%) in the HSP group, including one patient (0.5%) with severe bleeding, but not in the CSP group. DISCUSSION: Despite CSP being associated with more IPPB events, it could be timely treated without adverse outcomes. Notably, no delayed bleeding occurred in the CSP group. Our findings support the use of CSP for 0-Ip polyps ≤ 10 mm.

Funder

E-Da Hospital

E-Da Cancer Hospital

Publisher

Ovid Technologies (Wolters Kluwer Health)

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