Prospective Randomized Comparison of Cold Snare Polypectomy and Conventional Polypectomy for Small Colorectal Polyps

Abstract

Background and Aim: The ideal method to remove small colorectal polyps is unknown. We compared removal by colon snare transection without electrocautery (cold snare polypectomy) with conventional electrocautery snare polypectomy (hot polypectomy) in terms of procedure duration, difficulty in retrieving polyps, bleeding, and post-polypectomy symptoms. Methods: Patients with colorectal polyps up to 8 mm in diameter were randomized to polypectomy by cold snare technique (cold group) or conventional polypectomy (conventional group). The principal outcome measures were abdominal symptoms within 2 weeks after polypectomy. Secondary outcome measures were the rates of retrieval of colorectal polyps and bleeding. Results: Eighty patients were randomized: cold group, n = 40 (101 polyps) and conventional group, n = 40 (104 polyps). The patients’ demographic characteristics and the number and size of polyps removed were similar between the two techniques. Procedure time was significantly shorter with cold polypectomy vs. conventional polypectomy (18 vs. 25 min, p < 0.0001). Complete polyp retrieval rates were identical [96% (97/101) vs. 96% (100/104)]. No bleeding requiring hemostasis occurred in either group. Abdominal symptoms shortly after polypectomy were more common with conventional polypectomy (i.e. 20%; 8/40) than with cold polypectomy (i.e. 2.5%; 1/40; p = 0.029). Conclusion: Cold polypectomy was superior to conventional polypectomy in terms of procedure time and post-polypectomy abdominal symptoms. The two methods were otherwise essentially identical in terms of bleeding risk and complete polyp retrieval. Cold polypectomy is therefore the preferred method for removal of small colorectal polyps.

Cold snare polypectomy versus hot snare polypectomy in endoscopic treatment of small polyps

“…In the same study, although there was no relationship between the localization of polyps, the incidence of the risk of bleeding was related to the size of the polyps (6-9 mm) and the use of an antiplatelet agent. In another study, bleeding was not observed in patients who were not using an antiplatelet agent (15). In our study, there was no perforation, and in both groups, one patient had bleeding that required endoscopic treatment.…”

“…Therefore, these parameters were thought to affect the real time of the polypectomy. Unlike in another study (15), only the polypectomy time was measured in this study. The mean polypectomy time was significantly shorter with cold snare polypectomy versus hot snare polypectomy (p<0.001).…”

Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer

“…Th is relates entirely to the high prevalence of these lesions because increasing polyp size and proximal colon location are the major risk factors for bleeding per individual resected polyp ( 71 ). Cold resection techniques are eff ective and nearly devoid of clinically signifi cant bleeding risk and can be generally advised for nonpedunculated lesions <1 cm in size ( 72 ). Despite these risks, colonoscopy is the preferred approach to management of any benign colorectal polyp regardless of size or location because the alternative of surgical resection has higher mortality and cost compared with colonoscopy ( 73,74 ).…”

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

“…Fujiya et al [1] showed by a meta-analysis that the average procedural time for CP was significantly shorter than that for hot polypectomy (HP) group. Several studies have shown that post-polypectomy bleeding (PPB) is less common with CP than with conventional polypectomy [2-4]; however, there have been few studies about PPB in patients who underwent to CP and who were taking antithrombotic drugs. According to the 2012 update of the Japanese guidelines for periprocedural management of patients taking antithrombotic medications issued by the Japan Gastroenterological Endoscopy Society [5], procedures with a low risk of hemorrhage may be performed with a short interruption or continuation of antithrombotic medication.…”