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Randomized Controlled Trial
. 2024 Nov 1;119(11):2233-2240.
doi: 10.14309/ajg.0000000000002847. Epub 2024 May 9.

Bleeding Risk of Cold Versus Hot Snare Polypectomy for Pedunculated Colorectal Polyps Measuring 10 mm or Less: Subgroup Analysis of a Large Randomized Controlled Trial

Cheng-Hao Tseng  1   2 , Li-Chun Chang  3 , Jia-Ling Wu  4 , Chi-Yang Chang  5   6 , Chi-Yi Chen  7 , Peng-Jen Chen  8 , Chia-Tung Shun  9 , Wen-Feng Hsu  10 , Yen-Nien Chen  10 , Chieh-Chang Chen  3 , Tien-Yu Huang  8 , Chia-Hung Tu  3 , Mei-Jyh Chen  3 , Chu-Kuang Chou  7 , Ching-Tai Lee  2   11 , Po-Yueh Chen  6 , Jaw-Town Lin  1   2 , Ming-Shiang Wu  3 , Han-Mo Chiu  3
Affiliations
Randomized Controlled Trial

Bleeding Risk of Cold Versus Hot Snare Polypectomy for Pedunculated Colorectal Polyps Measuring 10 mm or Less: Subgroup Analysis of a Large Randomized Controlled Trial

Cheng-Hao Tseng et al. Am J Gastroenterol. .

Abstract

Introduction: Concerns regarding bleeding remain in cold snare polypectomy (CSP) for small pedunculated (0-Ip) polyps. The aim of this study was to compare the risk of CSP and hot snare polypectomy (HSP) for such lesions.

Methods: Data on 0-Ip colorectal polyps ≤10 mm were extracted from a large, pragmatic, randomized trial. Immediate postpolypectomy bleeding (IPPB), defined as the perioperative use of a clip for bleeding, was evaluated through polyp-level analysis. Delayed postpolypectomy bleeding (DPPB), defined as bleeding occurring within 2 weeks postoperatively, was assessed at the patient-level among patients whose polyps were all ≤10 mm, including at least one 0-Ip polyp.

Results: A total of 647 0-Ip polyps (CSP: 306; HSP: 341) were included for IPPB analysis and 386 patients (CSP: 192; HSP: 194) for DPPB analysis. CSP was associated with a higher incidence of IPPB (10.8% vs 3.2%, P < 0.001) but no adverse clinical events. The procedure time of all polypectomies was shorter for CSP than for HSP (123.0 ± 117.8 vs 166.0 ± 237.7 seconds, P = 0.003), while the procedure time of polypectomies with IPPB were similar (249.8 ± 140.2 vs 227.4 ± 125.9 seconds, P = 0.64). DPPB was observed in 3 patients (1.5%) in the HSP group, including one patient (0.5%) with severe bleeding, but not in the CSP group.

Discussion: Despite CSP being associated with more IPPB events, it could be timely treated without adverse outcomes. Notably, no delayed bleeding occurred in the CSP group. Our findings support the use of CSP for 0-Ip polyps ≤ 10 mm.

Trial registration: ClinicalTrials.gov NCT03373136.

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Conflict of interest statement

Guarantor of the article: Han-Mo Chiu, MD, PhD.

Specific author contributions: L.C.C., H.M.C., C.T.S., M.S.W.: conception and design. C.Y.C., L.C.C., C.Y.C., Y.N.C., H.M.C., C.K.C., W.F.H., T.Y.H., C.T.L., C.T.S., C.H.T., C.H.T.: analysis and interpretation of the data. C.H.T., H.M.C.: drafting of the article. All authors: critical revision for important intellectual content. C.Y.C., C.Y.C., H.M.C., W.F.H.: statistical expertise.

Financial support: This study was supported by E-DA Hospital (EDAHS111029), (EDAHS112026) and E-DA Cancer Hospital (EDCHP111002) (EDCHP112008) in part. The original TAiwan COld polypectomy Study (TACOS) was partially supported by Boston Scientific Corporation. The funding source had no role in the study design, data analysis, preparation of manuscript, or the decision to submit this paper for publication.

Potential competing interests: H.M.C.: Speaker: Boston Scientific, Olympus Medical, Fujifilm Medical System. C.H.T.: Speaker: Roche, Eisai, Merck Sharp & Dohme. L.C.C.: Speaker: Boston Scientific. Other authors: None to declare.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
CSP and HSP techniques for pedunculated colon polyp ≤10 mm. In CSP (a–e), (b) grasping wide mucosal base around the polyp, and (c) catching the lesion for 10–30 seconds, according to operator preference, to decrease blood inflow (choking method). In HSP (f–j), (g) snaring the middle portion of the stalk, and (h) gently pulling the lesion away from the base before resection with electrocautery to avoid deeper thermal injury. CSP, cold snare polypectomy; HSP, hot snare polypectomy.
Figure 2.
Figure 2.
Selection of polyps and participants. (a) Enrolling participants with all polyps ≤10 mm, including at least one 0-Ip lesion, (b) Shifting to HSP for challenging polyp resection during the initial CSP attempt, (c) HSP utilized in the CSP group for challenging polyp resection during the initial CSP attempt, (d) Inadvertent CSP before electrocautery in the HSP group. CSP, cold snare polypectomy; HSP, hot snare polypectomy; TACOS, TAiwan COld polypectomy Study.
Figure 3.
Figure 3.
Immediate and delayed bleeding outcomes of CSP and HSP. CSP, cold snare polypectomy; DPPB, delayed postpolypectomy bleeding; HSP, hot snare polypectomy; IPPB, immediate postpolypectomy bleeding.
See this image and copyright information in PMC

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