Bleeding Risk of Cold Versus Hot Snare Polypectomy for Pedunculated Colorectal Polyps Measuring 10 mm or Less:...

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Colorectal Cancer Prevention

Background:

• Bleeding risks associated with cold snare polypectomy (CSP) for small, pedunculated (0-Ip) colorectal polyps are a concern.
• Comparing CSP with hot snare polypectomy (HSP) is crucial for determining optimal endoscopic techniques.

Purpose of the Study:

• To compare the incidence of immediate and delayed postpolypectomy bleeding between CSP and HSP for small (0-Ip) colorectal polyps ≤10 mm.
• To evaluate the safety and efficacy of CSP versus HSP in managing these specific polyp types.

Main Methods:

• A pragmatic, randomized trial dataset was analyzed for 0-Ip colorectal polyps ≤10 mm.
• Immediate postpolypectomy bleeding (IPPB) was assessed by perioperative clip use for bleeding.
• Delayed postpolypectomy bleeding (DPPB) was evaluated at the patient-level within two weeks postoperatively.

Main Results:

• Cold snare polypectomy (CSP) showed a higher incidence of immediate postpolypectomy bleeding (IPPB) (10.8% vs. 3.2%, P < 0.001) but without adverse events.
• Procedure time was shorter for CSP (123.0 ± 117.8s) compared to HSP (166.0 ± 237.7s, P = 0.003).
• No delayed postpolypectomy bleeding (DPPB) occurred in the CSP group, whereas 1.5% of patients in the HSP group experienced DPPB (one severe).

Conclusions:

• Cold snare polypectomy (CSP) is a safe and effective endoscopic technique for 0-Ip polyps ≤10 mm.
• CSP demonstrates a favorable safety profile, particularly regarding the absence of delayed bleeding.
• The findings support the expanded use of CSP for managing small, pedunculated colorectal polyps.