Is Submucosal Injection Helpful in Cold Snare Polypectomy for Small Colorectal Polyps?

Abstract

Background/Aims: Cold snare polypectomy (CSP) is an effective method of polyp removal for small colorectal polyps. However, the effect of submucosal injection in cold snare endoscopic mucosal resection (CS-EMR) for small polyps is unclear. Therefore, this study aimed to evaluate the effect of submucosal injection in CS-EMR for small polyps. Methods: Between 2018 and 2019, 100 consecutive small colorectal polyps (5-10 mm) were identified in 58 patients. The first 50 consecutive polyps were removed by CS-EMR, and the remaining 50 were removed by CSP. Demographic data, clinical data, endoscopic findings, procedure times, complication rates, and pathology data were collected. Results: No difference in the complete resection rate was observed between the CS-EMR and CSP groups. A total of 9 polyps showed post-polypectomy bleeding (7 had immediate bleeding, 1 had delayed bleeding, and 1 had both immediate and delayed bleeding). No difference in the bleeding rate was observed between the two groups. In multivariate analysis, warfarin (odds ratio [OR], 42.334; 95% confidence interval [CI], 1.006-1,781.758) and direct-acting oral anticoagulants (OR, 35.244; 95% CI, showed a significantly increased risk of bleeding. Conclusions: The effect of submucosal injection in CSP was not significant for small colorectal polyps. Clin Endosc 2021 Feb 9.

The Risk of Postpolypectomy Bleeding in Patients Receiving Direct Oral Anticoagulants compared to Warfarin or Nonanticoagulation: A Systematic Review with Meta-Analysis

“…Ultimately, 12 studies were included (Fig. 1 and Table I) [9][10][11][12][13][14][15][16][17][18][19][20]. None of these studies reported receiving industry funding.…”

“…The sample size of these studies ranged between 55 and 605,044. Of the 12 studies, 10 studies were retrospective cohort studies [9,[11][12][13][14][15][16][17][18]20], one was a prospective cohort study [10], and one was a randomized controlled trial (RCT) [19]. Three studies were conducted in China [14,16,18], two were conducted in the USA [9,10], and the others were conducted in Japan [11-13, 15, 17, 19, 20].…”

“…Of the 12 studies, 10 studies were retrospective cohort studies [9,[11][12][13][14][15][16][17][18]20], one was a prospective cohort study [10], and one was a randomized controlled trial (RCT) [19]. Three studies were conducted in China [14,16,18], two were conducted in the USA [9,10], and the others were conducted in Japan [11-13, 15, 17, 19, 20]. Six studies investigated the prevalence of PPB among patients receiving DOACs and those without anticoagulation [9-12, 16, 18].…”

“…Six studies investigated the prevalence of PPB among patients receiving DOACs and those without anticoagulation [9-12, 16, 18]. Furthermore, four studies mentioned the withdrawal timing of DOACs [10,11,12,18]. Regarding the types of DOACs, six studies included dabigatran, rivaroxaban, apixaban, and edoxaban [11-14, 17, J Gastrointestin Liver Dis, December 2022 Vol.…”

“…It remains unclear whether DOACs could raise the risk of PPB. In addition, DOACs were not always discontinued in accordance with ESGE guidelines before endoscopic polypectomy [10][11][12]. Therefore, based on these contradictory results, we carried out this systematic review and meta-analysis to assess the risk of PPB in patients receiving DOACs treatment and to further provide high-level evidence-based medical proof for the application of DOACs in polypectomy.…”