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The following is a summary of “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,” published in the November 2024 issue of Gastroenterology by Tseng et al.    

Cold snare polypectomy (CSP) for small pedunculated colorectal polyps (0-Ip) ≤10 mm raises concerns about bleeding risks.  

Researchers conducted a retrospective study comparing the bleeding risk of CSP and hot snare polypectomy (HSP) for small pedunculated colorectal polyps (0-Ip) ≤10 mm.  

They extracted data on 0-Ip colorectal polyps ≤10 mm from a large, pragmatic, randomized trial. Immediate postpolypectomy bleeding (IPPB), defined as the perioperative use of a clip for bleeding, was analyzed through polyp-level analysis. Delayed postpolypectomy bleeding (DPPB), defined as bleeding occurring within 2 weeks, was assessed at the patient level among patients whose polyps were all ≤10 mm, including at least one 0-Ip polyp (CSP: 306; HSP: 341 for IPPB; CSP: 192; HSP: 194 for DPPB).  

The results showed 647 0-Ip polyps (CSP: 306; HSP: 341) for IPPB analysis and 386 patients (CSP: 192; HSP: 194) for DPPB analysis, CSP was linked with a higher incidence of IPPB (10.8% vs. 3.2%, P<0.001), but no adverse clinical events occurred. The procedure time of all polypectomies was shorter for CSP than HSP (123.0 ± 117.8 vs. 166.0 ± 237.7 seconds, P=0.003), while the procedure time of polypectomies with IPPB was 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 1 patient (0.5%) with severe bleeding, but not in the CSP group. 

They concluded that CSP for small pedunculated polyps ≤10 mm was safe and effective, with a higher incidence of immediate bleeding but no delayed bleeding.  

Source: journals.lww.com/ajg/fulltext/2024/11000/bleeding_risk_of_cold_versus_hot_snare_polypectomy.21.aspx