Risk Factors of Delayed Bleeding After Cold Snare Polypectomy for Colorectal Polyps: A Multicenter Study

Inagaki, Yoshikazu; Yoshida, Naohisa; Fukumoto, Kohei; Kassai, Kyoichi; Inoue, Ken; Hirose, Ryohei; Dohi, Osamu; Okuda, Takashi; Hasegawa, Daisuke; Okuda, K; Ogiso, Kiyoshi; Motoyoshi, Takayuki; Yoriki, Hiroyuki; Murakami, Takaaki; Itoh, Yoshito

doi:10.1007/s10620-021-07119-7

Cited by 12 publications

(18 citation statements)

References 29 publications

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“…A previous retrospective study showed that there was no significant difference in the incidence of delayed bleeding among patients who did and did not receive antithrombotic drugs 4 . However, another report revealed that posterior hemorrhage was more common in patients receiving oral antithrombotic medication 5 . Although one study examined only direct oral anticoagulants, the findings suggest that the risk of posterior bleeding can be reduced by discontinuing medication on the day of the procedure 6 .…”

Section: Discussionmentioning

confidence: 99%

“… 4 However, another report revealed that posterior hemorrhage was more common in patients receiving oral antithrombotic medication. 5 Although one study examined only direct oral anticoagulants, the findings suggest that the risk of posterior bleeding can be reduced by discontinuing medication on the day of the procedure. 6 Guidelines from the Japan Gastroenterological Endoscopy Society allow endoscopic procedures, especially CSP to be performed if anticoagulants are rested for 24 h. 7 However, aspirin can be continued.…”

Section: Discussionmentioning

confidence: 99%

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Large submucosal hematoma after cold snare polypectomy for colorectal adenoma

et al. 2022

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Cold snare polypectomy (CSP), for the treatment of colorectal polyps, has become widespread due to its low incidence of adverse events compared to that of endoscopic procedures such as endoscopic mucosal resection. However, we experienced a case of large hematoma development shortly after CSP for a colorectal adenoma despite no bleeding during the procedure. The patient underwent CSP for a 7‐mm type Isp lesion in the ascending colon. She returned the following day because of hematochezia. Computed tomography showed a 70‐mm, high‐intensity mass in the ascending colon, consistent with the large hematoma that was detected by colonoscopy. Although the patient initially had right‐sided abdominal pain, it gradually improved with conservative treatment. The hematoma decreased in size, and she was discharged 20 days after emergency admission. Although CSP can be a favorable alternative to more invasive procedures and is expected to be performed more frequently, adverse events, such as that described in this case, should be anticipated.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Large submucosal hematoma after cold snare polypectomy for colorectal adenoma

et al. 2022

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“…However, CSP allows for faster wound healing after excision compared to HSP 31 . In a large Japanese multicenter observational study, among 18,007 patients who underwent CSP, delayed bleeding occurred in only 26 patients (0.14%), but antiplatelet use (OR 4.521; 95% CI 1.817–11.249) and anticoagulant use (OR 7.866; 95% CI 20.63–29.988) were considered independent risk factors 45 . Antithrombotic drugs include antiplatelet agents, warfarin, and direct‐acting oral anticoagulants (DOACs), and it can be inferred from several reports that the bleeding risk after CSP varies with the type of drug.…”

Section: Possibility Of Expanding the Indication For Cspmentioning

confidence: 99%

“…However, CSP allows for faster wound healing after excision compared to HSP. 31 45 Antithrombotic drugs include antiplatelet agents, warfarin, and direct-acting oral anticoagulants (DOACs), and it can be inferred from several reports that the bleeding risk after CSP varies with the type of drug. A multicenter RCT conducted in Japan successfully demonstrated that CSP for subcentimeter polyps without discontinuation of warfarin or DOACs was safer than HSP with heparin bridging.…”

Section: Possibility Of Expanding the Indication For Cspmentioning

confidence: 99%

Colorectal cold snare polypectomy: Current standard technique and future perspectives

Ishibashi

Suzuki

Nagai

et al. 2022

Digestive Endoscopy

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It has been shown that resection of adenomatous colorectal polyps can reduce mortality due to colorectal cancer. In daily clinical practice, simpler and safer methods of colorectal polypectomy have been sought to enable endoscopists to resect all detected lesions. Among these, cold snare polypectomy (CSP) is widely used in clinical practice because of its advantages in shortening procedure time, reducing delayed bleeding risk, and lowering treatment costs, while maintaining a similar complete resection rate for lesions smaller than 10 mm when compared to conventional hot snare polypectomy. This review introduces the findings of previous studies that investigated the efficacy and safety of the CSP procedure for nonpedunculated polyps smaller than 10 mm, and describes technical points to remember when practicing CSP based on the latest evidence, including using a thin wire snare specifically designed for CSP, and observing the surrounding mucosa of the resection site with chromoendoscopy or image‐enhanced endoscopy to ensure that there is no residual lesion. This review also describes the potential of expanding the indication of CSP as a treatment for lesions larger than 10 mm, those with pedunculated morphology, those located near the appendiceal orifice, and for patients under continuous antithrombotic agent therapy. Finally, the perspective on optimal treatments for recurrent lesions after CSP is also discussed, despite the limited related evidence and data.

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“…CSP has fewer adverse events than other polypectomy techniques [7,8], and it is now widely practiced. Increased delayed postpolypectomy bleeding (DPPB) rate in CSP has been reported in patients using antithrombotic drugs [9][10][11], and in such cases, CSP may not always be safe. As the number of patients taking antithrombotic drugs is increasing owing to the aging population [12,13], CSP is also being increasingly performed on those on antithrombotic medications.…”

Section: Introductionmentioning

confidence: 99%

Safety of Cold Snare Polypectomy during Continuous Use of Antithrombotic Drugs for Delayed Post-Polypectomy Bleeding: A Pilot Study

Hayasaka¹,

Yamashita²,

Matsui³

et al. 2023

Dig Dis

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Background: Cold snare polypectomy is a high-risk endoscopic procedure with a low delayed post-polypectomy bleeding rate. However, it is unclear whether delayed post-polypectomy bleeding rates increase during continuous antithrombotic treatment. This study aimed to determine the safety of cold snare polypectomy during continuous antithrombotic treatment. Methods: This single-center, retrospective cohort study enrolled patients who underwent cold snare polypectomy during antithrombotic treatment between January 2015 and December 2021. Patients were divided into continuation and withdrawal groups based on whether they continued with antithrombotic drugs or not. Propensity score matching was performed using age, sex, Charlson comorbidity index, hospitalization, scheduled treatment, type of antithrombotic drugs used, multiple medications used, indication for antithrombotic drugs, and gastrointestinal endoscopist qualifications. The delayed polypectomy bleeding rates were compared between the groups. Delayed polypectomy bleeding was defined as the presence of blood in stools and requiring endoscopic treatment or a decrease in hemoglobin level by 2 g/dL or more. Results: The continuation and withdrawal groups included 134 and 294 patients, respectively. Delayed polypectomy bleeding was observed in 2 patients (1.5%) and 1 patient (0.3%) in the continuation and withdrawal groups, respectively (p = 0.23), before propensity score matching, with no significant difference. After propensity score matching, delayed polypectomy bleeding was observed in 1 patient (0.9%) in the continuation group but not in the withdrawal group, with no significant difference. Conclusion: Cold snare polypectomy during continuous antithrombotic treatment did not significantly increase delayed post-polypectomy bleeding rates. Therefore, this procedure may be safe during continuous antithrombotic treatment.

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Risk Factors of Delayed Bleeding After Cold Snare Polypectomy for Colorectal Polyps: A Multicenter Study

Cited by 12 publications

References 29 publications

Large submucosal hematoma after cold snare polypectomy for colorectal adenoma

Large submucosal hematoma after cold snare polypectomy for colorectal adenoma

Colorectal cold snare polypectomy: Current standard technique and future perspectives

Safety of Cold Snare Polypectomy during Continuous Use of Antithrombotic Drugs for Delayed Post-Polypectomy Bleeding: A Pilot Study

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