Safety Profile of Low-Power Pure-Cut Hot Snare Polypectomy for 10-14 mm Nonpedunculated Colorectal Neoplasms

The reported rate of delayed bleeding (DB) after hot snare polypectomy (HSP) for 10-19-mm polyps is 2.1%-2.8%, which is non-negligible. We hypothesized that a low-power pure-cut current (LPPC) yields a lower risk of DB than a coagulation current, and we evaluated the safety of LPPC HSP for colorectal polyps.

In this retrospective, observational study, consecutive patients who underwent LPPC HSP for nonpedunculated colorectal neoplasms sized 10-14 mm at two Japanese institutions from December 2018 to March 2022 were evaluated. We analyzed the treatment outcomes of LPPC HSP and compared the DB rate of LPPC HSP with that of the historical control of HSP, which was set as 2.1% based on a previous meta-analysis.

A total of 339 patients (410 lesions sized 10-14 mm) were identified. The en bloc and R0 resection rates were 94.9% and 86.7%, respectively. Immediate bleeding requiring hemostasis developed in four lesions (1.0%). No perforations occurred. DB occurred in two patients; both had to be admitted but were conservatively managed without endoscopic hemostasis or blood transfusion. The DB rate was 0.6% for patients and 0.5% for lesions. LPPC HSP was associated with a 71.4% lower risk of DB than the historical control, with a power of 80.4% and a two-sided significance level of 0.1.

Considering its safety profile and resectability, LPPC HSP has the potential to supersede conventional resection methods. It may also be feasible for patients taking antithrombotic agents, who have a higher risk of DB.