Evaluation of complications related to therapeutic colonoscopy using the bipolar snare

The complications with therapeutic colonoscopy reported to date have been associated with the monopolar snare, and the frequency of complications related to use of the bipolar snare is uncertain. This study aimed too investigate the incidence of bleeding and perforation associated with the bipolar snare and to identify the risk factors for bleeding.

Between October 2001 and December 2008, all patients with colorectal polyps treated using the bipolar snare were enrolled in this retrospective study. Clinical data were assembled from an electronic database. The incidence of bleeding and perforation was investigated, and the risk factors for bleeding also were determined using multivariate analysis.

This study collected 4,719 patients with 10,513 lesions. Perforation occurred for eight patients (0.17%) and bleeding in 66 patients (1.4%). Age younger than 60 years was a significant risk factor for bleeding (P < 0.01). The incidence of bleeding was significantly higher for lesions 10 mm or larger than for lesions smaller than 10 mm (P < 0.001). In terms of macroscopic type, pedunculated lesions bled significantly more often than lesions of other shapes (P < 0.001). Lesions in the rectum bled significantly more frequently (P < 0.001) than lesions at other sites. High-grade dysplasia and invasive cancer developed bleeding significantly more often than other histologic types (P < 0.001). Multivariate analysis showed that age younger than 60 years (odds ratio [OR], 2.42), lesion size of 10 mm or larger (OR, 2.60), pedunculated shape (OR, 3.40), and rectal location (OR, 3.55) were significant risk factors.

The complication rates for the bipolar snare appear to be comparable with those for the monopolar snare based on comparison of the results reported in the literature. Age (<60 years), lesion size (≥ 10 mm), macroscopic type (pedunculated), and lesion location (rectum) are independent risk factors for bleeding.