Adverse Events after Different Endoscopic Resection Procedures for Small and Intermediate-Sized Colorectal Polyps

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Colorectal Cancer Prevention

Background:

• Cold snare polypectomy (CSP) and underwater endoscopic mucosal resection (UEMR) are newer techniques for colorectal polyp removal.
• Adverse event profiles for CSP, UEMR, and conventional endoscopic mucosal resection (EMR)/hot snare polypectomy (HSP) require clarification.
• Comparative outcome analysis is essential for selecting appropriate polypectomy methods.

Purpose of the Study:

• To compare the safety and efficacy of CSP, EMR/HSP, and UEMR for small and intermediate-sized colorectal polyps.
• To identify clinical factors associated with adverse events after different polypectomy techniques.
• To guide the appropriate clinical choice of polypectomy method based on outcomes.

Main Methods:

• Retrospective examination of patients undergoing CSP, EMR/HSP, or UEMR for colorectal polyps (April 2017-June 2020).
• Primary outcomes assessed: adverse event rates (delayed bleeding, perforation) and recurrence rates.
• Analysis of clinical factors influencing adverse events.

Main Results:

• No significant differences in delayed bleeding (0% vs 0.2% vs 0.6%) or perforation (0% vs 0.1% vs 0%) among CSP, EMR/HSP, and UEMR.
• Recurrence rates were significantly higher for UEMR (1.3%) compared to CSP (0.3%) and EMR/HSP (0.09%) (p < 0.01).
• Oral anticoagulants identified as a risk factor for delayed bleeding.

Conclusions:

• CSP, EMR/HSP, and UEMR exhibit comparable safety profiles regarding adverse events for small-to-intermediate colorectal polyps.
• UEMR demonstrated a higher polyp recurrence rate than CSP and EMR/HSP.
• The findings support careful selection of polypectomy technique, considering the higher recurrence risk with UEMR.