Prospective, randomized comparison of 2 methods of cold snare polypectomy for small colorectal polyps

Background: The cold polypectomy (CP) technique has been increasingly used in recent years. However, there have been few studies about post-polypectomy bleeding (PPB) in patients who underwent CP and who were on antithrombotic drugs. The objective of this study was to determine the safety of CP in patients on antithrombotic medication. Methods: The subjects were patients who underwent CP in our hospital between April 2014 and March 2016. PPB rates were examined in relation to the use of antithrombotic medication. Results: CP was performed to remove 2,466 polyps in 1,003 patients. There were 549 polyps (22.3%) in186 patients in the antithrombotic group and 1,917 polyps (77.7%) in 817 patients in the non-antithrombotic group. PPB occurred in 0.55% (3/549) of patients in the antithrombotic group and in 0.10% (2/1,917) of patients in the non-antithrombotic group, showing no significant difference (p = 0.07). Patients in the antithrombotic group in whom PPB occurred included 1 aspirin user with 1 polyp and 1 aspirin plus clopidogrel user with 2 polyps. No PPB occurred in patients on other antithrombotic agents or receiving heparin bridging. There was no significant difference between PPB rates in patients with small polyps (6–9 mm) in the antithrombotic and non-antithrombotic groups, but there was a significant difference between PPB rates in the 2 groups for patients with diminutive group (1–5 mm). Conclusion: CP is a safe procedure even in patients on antithrombotic medication.

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“…Some recent studies have shown that a dedicated snare is useful, indicating that the choice of device is also important [27, 28]. …”

Section: Discussionmentioning

confidence: 99%

Safety of Cold Polypectomy for Colorectal Polyps in Patients on Antithrombotic Medication

et al. 2018

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“…From 1992 to 2016, several studies on CSP have been published . Most studies had a relatively small sample size (<300 polyps) and targeted small polyps (<10 mm in diameter).…”

Section: Discussionmentioning

confidence: 99%

“…For bowel preparation, patients followed a low‐residue diet and took 10 mL sodium picosulfate 1 day before the examination followed by 1.0 L high concentrated polyethylene glycol solution (Moviprep; Ajinomoto Pharma Co., Ltd, Tokyo, Japan) with ≥0.5 L water on the morning of the day of examination . CSP was carried out as reported previously, using three types of snare, including the Exacto cold snare (US Endoscopy, Mentor, OH, USA), Captivator II (15 mm; Boston Scientific, Marlborough, MA, USA), and Dualoop (Medico's Hirata Inc., Osaka, Japan) . In the event of immediate bleeding after resection that continued for >2 min during excision, endoscopic clipping was carried out.…”

Section: Methodsmentioning

confidence: 99%

Histopathological analysis of cold snare polypectomy and its indication for colorectal polyps 10–14 mm in diameter

Hirose

Yoshida

Murakami

et al. 2017

Digestive Endoscopy

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“…Aside from randomized trials, an increasing number of uncontrolled cohort studies suggest that cold snare polypectomy is safe and effective for up to 10 mm polyps. 46, 50, 52 …”

Section: Introductionmentioning

confidence: 99%

“…Specialized fine wire snares to facilitate cold resection have been introduced. 52, 53 A first randomized trial compared the use of a dedicated cold snare with a standard snare for cold resection of up to 10 mm polyps and found a lower incomplete resection rate with using a dedicated cold snare (9 vs. 21%). 52 …”

Section: Introductionmentioning

confidence: 99%

Polyp Resection - Controversial Practices and Unanswered Questions

Renteln

Pohl

2017

Clinical and Translational Gastroenterology

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Detection and complete removal of precancerous neoplastic polyps are central to effective colorectal cancer screening. The prevalence of neoplastic polyps in the screening population in the United States is likely >50%. However, most persons with neoplastic polyps are never destined to develop cancer, and do not benefit for finding and removing polyps, and may only be harmed by the procedure. Further 70–80% of polyps are diminutive (≤5 mm) and such polyps almost never contain cancer. Given the questionable benefit, the high-cost and the potential risk changing our approach to the management of diminutive polyps is currently debated. Deemphasizing diminutive polyps and shifting our efforts to detection and complete removal of larger and higher-risk polyps deserves discussion and study. This article explores three controversies, and emerging concepts related to endoscopic polyp resection. First, we discuss challenges of optical resect-and-discard strategy and possible alternatives. Second, we review recent studies that support the use of cold snare resection for ≥5 mm polyps. Thirdly, we examine current evidence for prophylactic clipping after resection of large polyps.

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Prospective, randomized comparison of 2 methods of cold snare polypectomy for small colorectal polyps

Abstract: NCT02036047.)

Cited by 136 publications

References 14 publications

Safety of Cold Polypectomy for Colorectal Polyps in Patients on Antithrombotic Medication

Safety of Cold Polypectomy for Colorectal Polyps in Patients on Antithrombotic Medication

Histopathological analysis of cold snare polypectomy and its indication for colorectal polyps 10–14 mm in diameter

Polyp Resection - Controversial Practices and Unanswered Questions

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