IMMEDIATE AND DELAYED BLEEDING AFTER COLD SNARE POLYPECTOMY: A PROSPECTIVE SINGLE-ARM TRIAL

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

Download Full-text

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.

Download Full-text

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.

Download Full-text

Risk of delayed bleeding before and after implementation of cold snare polypectomy in a screening colonoscopy setting

Endoscopy International Open ◽

10.1055/a-0810-0439 ◽

2019 ◽

Vol 07 (02) ◽

pp. E232-E238 ◽

Cited By ~ 4

Author(s):

Li-Chun Chang ◽

Chia-Tung Shun ◽

Wen-Feng Hsu ◽

Chia-Hong Tu ◽

Chieh-Chang Chen ◽

...

Keyword(s):

Multivariate Analysis ◽

Outcome Measurement ◽

Small Sample ◽

University Hospital ◽

Screening Colonoscopy ◽

Severe Bleeding ◽

Delayed Bleeding ◽

Before And After ◽

Cold Snare Polypectomy ◽

Snare Polypectomy

Abstract Background and study aims Cold snare polypectomy (CSP) is considered to be effective in reducing risk of delayed bleeding but randomized trials fail to support this owing to the small sample size. The current study aimed to compare risk of delayed bleeding before and after implementation of CSP in a screening colonoscopy setting. Patients and methods This study retrospectively analyzed a prospectively maintained screening colonoscopy database in a university hospital in Taiwan. We compared the rate of delayed bleeding before and after implementation within similar periods (18 months and 15 months) and the respective number of polypectomies (1,304 and 1,255) performed to remove small and diminutive polyps. The main outcome measurement was delayed bleeding within the two periods. Multivariate analysis was performed to adjust for major confounders. Results A total of 1,304 and 1,225 subjects received hot snare polypectomy (HSP) and CSP in two separate periods, respectively. Compared with the HSP, the CSP had a lower rate of delayed bleeding (0.1 % vs. 1.1 %, P < 0.001), severe bleeding (0 % vs. 0.7 %, P < 0.01), need for second-look colonoscopy (0 % vs. 0.8 %, P < 0.01), and emergency service visits (0.1 % vs. 1.0 %, P < 0.01). Total procedure time (12.60 ± 11.45 vs. 16.48 ± 14.27 min/person, P < 0.01) and duration of hospital stay (1.18 ± 0.50 vs. 1.53 ± 5.78 hour/person, P < 0.03) were also shorter after CSP implementation. Multivariate analysis showed that HSP was an independent risk factor for delayed bleeding after adjusting for age, gender, and number of polyps (adjusted odds ratio 14.4;95 % confidence interval = 1.88 – 110.6). Conclusion Implementation of CSP significantly reduces risk of delayed bleeding associated with removing small and diminutive polyps in screening colonoscopy.

Download Full-text

Piecemeal cold snare polypectomy versus conventional endoscopic mucosal resection for large sessile serrated lesions: a retrospective comparison across two successive periods

Gut ◽

10.1136/gutjnl-2020-321753 ◽

2020 ◽

pp. gutjnl-2020-321753

Author(s):

W Arnout van Hattem ◽

Neal Shahidi ◽

Sergei Vosko ◽

Imogen Hartley ◽

Kaushali Britto ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Mucosal Resection ◽

Standard Of Care ◽

Technical Success ◽

Delayed Bleeding ◽

Historical Comparison ◽

Mucosal Resection ◽

Cold Snare Polypectomy ◽

Serrated Lesions ◽

Snare Polypectomy

ObjectiveLarge (≥20 mm) sessile serrated lesions (L-SSL) are premalignant lesions that require endoscopic removal. Endoscopic mucosal resection (EMR) is the existing standard of care but carries some risk of adverse events including clinically significant post-EMR bleeding and deep mural injury (DMI). The respective risk-effectiveness ratio of piecemeal cold snare polypectomy (p-CSP) in L-SSL management is not fully known.DesignConsecutive patients referred for L-SSL management were treated by p-CSP from April 2016 to January 2020 or by conventional EMR in the preceding period between July 2008 and March 2016 at four Australian tertiary centres. Surveillance colonoscopies were conducted at 6 months (SC1) and 18 months (SC2). Outcomes on technical success, adverse events and recurrence were documented prospectively and then compared retrospectively between the subsequent time periods.ResultsA total of 562 L-SSL in 474 patients were evaluated of which 156 L-SSL in 121 patients were treated by p-CSP and 406 L-SSL in 353 patients by EMR. Technical success was equal in both periods (100.0% (n=156) vs 99.0% (n=402)). No adverse events occurred in p-CSP, whereas delayed bleeding and DMI were encountered in 5.1% (n=18) and 3.4% (n=12) of L-SSL treated by EMR, respectively. Recurrence rates following p-CSP were similar to EMR at 4.3% (n=4) versus 4.6% (n=14) and 2.0% (n=1) versus 1.2% (n=3) for surveillance colonoscopy (SC)1 and SC2, respectively.ConclusionsIn a historical comparison on the endoscopic management of L-SSL, p-CSP is technically equally efficacious to EMR but virtually eliminates the risk of delayed bleeding and perforation. p-CSP should therefore be considered as the new standard of care for L-SSL treatment.

Download Full-text

Pedunculated colorectal polyps with heads ≤ 1 cm in diameter can be resected using cold snare polypectomy

Acta Gastro Enterologica Belgica ◽

10.51821/84.3.008 ◽

2021 ◽

Vol 84 (3) ◽

Author(s):

T Kudo ◽

A Horiuchi ◽

I Horiuchi ◽

M Kajiyama ◽

A Morita ◽

...

Keyword(s):

En Bloc Resection ◽

Bloc Resection ◽

Colorectal Polyps ◽

En Bloc ◽

Delayed Bleeding ◽

Total Procedure Time ◽

Cold Snare Polypectomy ◽

Immediate Bleeding ◽

Total Procedure ◽

Snare Polypectomy

Background and study aims : Cold snare polypectomy (CSP) is not recommended for the resection of pedunculated colorectal polyp. The aim of this study was to examine the adequacy of CSP compared to hot snare polypectomy (HSP) for the complete resection of pedunculated polyps with heads ≤ 1 cm in diameter. Patients and methods : This was a retrospective study of a cohort of consecutive outpatients who had resection of pedunculated polyps with heads 6-10 mm in diameter using either dedicated CSP or HSP from 2014 through 2019. The primary outcome measure was occurrence of delayed bleeding. Secondary outcome measures included total procedure time, en bloc resection rate, immediate bleeding, and number of clips used. Results : 415 patients with 444 eligible polyps were enrolled; the CSP group (363 patients; 386 polyps) and HSP group (52 patients; 58 polyps). Patient characteristics, polyp characteristics and en bloc resection rate were similar between groups. The mean total procedure time and mean number (range) of hemostatic clips/patient used were significantly lower with CSP than with HSP (18± 8 min vs. 25± 9 min, P<0.001; 1.1 ± 0.6 (1-3) vs.3.1 ± 1.6 (1-5), respectively, P<0.001). Delayed bleeding occurred significantly less frequently in the CSP, 0% (0/363 vs.3.8% (2/52) in the HSP group (P<0.001), although immediate bleeding was significantly higher in CSP than HSP (84% (325/386) vs. 12% (7/58), P<0.001). Conclusion : Pedunculated colorectal polyps with heads ≤ 1 cm can be removed using CSP, which has several advantages over HSP.

Download Full-text