Risk of Delayed Bleeding after Cold Snare Polypectomy in Patients with Antithrombotic Therapy

Abstract Background and study aims Despite widespread use of cold snare polypectomy (CSP), the R0 resection rate is not well documented. We perform extended CSP, resecting polyps with a > 1 mm circumferential margin. The aim of this study is to compare the R0 resection rate of extended CSP with conventional CSP and to assess safety. Patients and methods From April 2014 to September 2016, 712 non-pedunculated colorectal polyps, < 10 mm in size, resected using CSP from 316 patients were retrospectively analyzed. Results We divided lesions into conventional CSP (n = 263) and extended CSP groups (n = 449). The baseline characteristics of these two groups were not significantly different in univariate or multivariate analyses. Sessile polyps comprised 94 % (668/712), and the remaining were flat-elevated polyps. Mean size of polyps (±standard deviation) was 4.2 ± 1.5 mm. The most frequent pathology was low grade adenoma (97 %, 689/712). The R0 resection rate was significantly higher in the extended CSP group (439/449 [98 %]) than in the conventional CSP group (222/263 [84 %], P < 0.001). There was no delayed bleeding or perforation in either group (conventional CSP group, 0/263, 95 % confidence interval: 0.0 – 1.4 % and extended CSP group, 0/449, 95 % confidence interval: 0.0 – 0.8 %). Conclusions Extended CSP results in a higher R0 resection rate compared with conventional CSP. Extended CSP did not result in a higher rate of delayed bleeding or perforation. Extended CSP is a safe and promising procedure for endoscopic resection of non-pedunculated colorectal polyps < 10 mm in size

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THE SAFETY OF COLD SNARE POLYPECTOMY (CSP) ON ANTITHROMBOTIC THERAPY

10.1055/s-0039-1681267 ◽

2019 ◽

Author(s):

Y Kimoto ◽

K Ohata ◽

Y Minato ◽

T Nakao ◽

N Konishi ◽

...

Keyword(s):

Antithrombotic Therapy ◽

Cold Snare Polypectomy ◽

Snare Polypectomy

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Cold snare polypectomy for non-pedunculated colon polyps greater than 1 cm

Endoscopy International Open ◽

10.1055/s-0043-101696 ◽

2017 ◽

Vol 05 (03) ◽

pp. E184-E189 ◽

Cited By ~ 35

Author(s):

Cyrus Piraka ◽

Ahmed Saeed ◽

Akbar Waljee ◽

Ajish Pillai ◽

Ryan Stidham ◽

...

Keyword(s):

Adverse Events ◽

Bowel Perforation ◽

Colonic Polyps ◽

Similar Efficacy ◽

Colon Polyps ◽

Polyp Size ◽

Delayed Bleeding ◽

Cold Snare Polypectomy ◽

Snare Polypectomy

Abstract Background and study aims Colonic polyps > 1 cm in size are commonly managed using hot polypectomy techniques. The most frequent adverse events (delayed bleeding, post-polypectomy syndrome, and perforation) are related to electrocautery-induced injury. We hypothesized that cold resection of large polyps may have similar efficacy and improved safety compared to hot polypectomy. Our aims were to evaluate efficacy and safety of piecemeal cold snare resection of colonic polyps > 1 cm. Patients and methods Patients undergoing lift and piecemeal cold snare polypectomy of non-pedunculated colon polyps > 1 cm from October 2013 to September 2015 were identified retrospectively. Efficacy was defined by the absence of residual adenomatous tissue at endoscopic follow-up. Adverse events (AEs), including post-procedural bleeding, bowel perforation, or post-procedural pain requiring hospitalization were assessed by chart review and telephone follow-up. Results Seventy-three patients underwent piecemeal cold snare polypectomy for 94 colon polyps > 1 cm with 56 of 73 patients completing follow-up on 72 polyps. Residual or recurrent adenoma was found in 7 cases (9.7 %). Median polyp size was significantly greater in those with residual/recurrent adenoma (37.1 vs. 19.1 mm, P < .0001). There were no AEs among all 73 patients enrolled. Conclusions Piecemeal cold snare resection of colon polyps > 1 cm is feasible, safe and efficacious when compared to published hot polypectomy data. Additional observational and randomized comparative effectiveness studies are necessary to demonstrate comparable adenoma eradication and improved safety advantage over existing hot snare polypectomy techniques.

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The efficacy and safety of cold snare polypectomy for the patients with colorectal polyps under antithrombotic therapy

Progress of Digestive Endoscopy ◽

10.11641/pde.94.1_36 ◽

2019 ◽

Vol 94 (1) ◽

pp. 36-40

Author(s):

Yoshiaki Kimoto ◽

Ken Ohata ◽

Tomomi Nakao ◽

Rindo Ishii ◽

Takafumi Konishi ◽

...

Keyword(s):

Antithrombotic Therapy ◽

Colorectal Polyps ◽

Efficacy And Safety ◽

Cold Snare Polypectomy ◽

Snare Polypectomy

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Wide-field piecemeal cold snare polypectomy of large sessile serrated polyps without a submucosal injection is safe

Endoscopy ◽

10.1055/s-0043-121219 ◽

2017 ◽

Vol 50 (03) ◽

pp. 248-252 ◽

Cited By ~ 25

Author(s):

David Tate ◽

Halim Awadie ◽

Farzan Bahin ◽

Lobke Desomer ◽

Ralph Lee ◽

...

Keyword(s):

Adverse Events ◽

Standard Of Care ◽

Wide Field ◽

High Definition ◽

Submucosal Injection ◽

Delayed Bleeding ◽

Serrated Polyps ◽

Cold Snare Polypectomy ◽

Snare Polypectomy

Abstract Background and study aims Large series suggest endoscopic mucosal resection is safe and effective for the removal of large (≥ 10 mm) sessile serrated polyps (SSPs), but it exposes the patient to the risks of electrocautery, including delayed bleeding. We examined the feasibility and safety of piecemeal cold snare polypectomy (pCSP) for the resection of large SSPs. Methods Sequential large SSPs (10 – 35 mm) without endoscopic evidence of dysplasia referred over 12 months to a tertiary endoscopy center were considered for pCSP. A thin-wire snare was used in all cases. Submucosal injection was not performed. High definition imaging of the defect margin was used to ensure the absence of residual serrated tissue. Adverse events were assessed at 2 weeks and surveillance was planned for between 6 and 12 months. Results 41 SSPs were completely removed by pCSP in 34 patients. The median SSP size was 15 mm (interquartile range [IQR] 14.5 – 20 mm; range 10 – 35 mm). The median procedure duration was 4.5 minutes (IQR 1.4 – 6.3 minutes). There was no evidence of perforation or significant intraprocedural bleeding. At 2-week follow-up, there were no significant adverse events, including delayed bleeding and post polypectomy syndrome. First follow-up has been undertaken for 15 /41 lesions at a median of 6 months with no evidence of recurrence. Conclusions There is potential for pCSP to become the standard of care for non-dysplastic large SSPs. This could reduce the burden of removing SSPs on patients and healthcare systems, particularly by avoidance of delayed bleeding.

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