Cold snare polypectomy tied to lower bleeding risk

A recent study has shown the safety of cold snare polypectomy (CSP) for the resection of ≤10 mm pedunculated polyps (PPs). In addition, CSP appears to contribute to a reduced risk of immediate bleeding relative to the common perception among gastroenterologists.

The research team prospectively included patients who had undergone colonoscopy between 18 February 2019 and 24 April 2020 and had at least one ≤10 mm PP resected with CSP in a continuous quality improvement project to examine the risk of immediate postpolypectomy bleeding (IPPB) and delayed postpolypectomy bleeding.

The team recorded the polyp size, location, and pathology, as well as the method of resection. They also assessed the occurrence and severity of IPPB and the need for intervention.

A total of 182 patients (mean age 58.8 years, 61 percent male) were recruited, with 239 eligible polyps. Of these polyps, 72 had IPPB. This equated to a per-polyp bleeding percentage of 30.1 percent. Specifically, IPPB occurred in 65 patients, corresponding to a per-patient bleeding rate of 35.7 percent.

Bleeding was successfully treated by endoscopic haemostasis in 57 percent of polyps, while the remaining 31 polyps (43 percent) did not need endoscopic intervention. IPPB was not significantly associated with age, gender, or use of aspirin or antithrombotic agents.

Likewise, IPPB did not correlate with polyp size and pathology in the bivariate model. However, right-sided polyps were associated with a 61-percent (odds ratio [OR], 0.39, 95 percent confidence interval [CI], 0.21‒0.74; p=0.0057) lower risk of IPPB.

Multivariate analysis revealed the association of choking the polyp base with a 97-percent (OR, 0.03, 95 percent CI, 0.00‒0.86; p=0.0459) reduced IPBB risk. Notably, no delayed bleeding, perforation, or postpolypectomy syndrome occurred.

“PPs in the colon are usually resected with hot snare polypectomy to prevent IPPB,” the researchers said.