Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In this randomized controlled trial, cold snare polypectomy (CSP) reduced the risk of delayed post-polypectomy bleeding compared to hot snare polypectomy (HSP).

2. Compared to HSP, CSP also reduced the frequency of emergency service visits related to delayed bleeding.

Evidence Rating Level: 1 (Excellent)

Study Rundown:

Polypectomy performed during colonoscopies is a crucial procedure for preventing colorectal cancer. HSP using electrocautery has been conventionally used to remove polyps in this context. Though, it is important to note that up to 39% of arteries in the submucosa receive a thermal injury during this procedure. This complication increases the risk of subsequent delayed bleeding. Accordingly, CSP has been developed to address these adverse events. In this procedure, small polyps are removed by snare through mechanical transection without any electrocautery. However, there is a gap in knowledge as to understanding the superiority of CSP over HSP in reducing delayed bleeding. In summary, this study found that CSP reduced the risk for mild and severe delayed bleeding events after polypectomy as compared to HSP. This study was limited by insufficient statistical power in determining the safety of CSP in patients administered periprocedural antithrombotic agents. Nevertheless, these study’s findings are significant, as they demonstrate that CSP significantly reduces the risk for delayed polypectomy bleeding as compared to HSP for the removal of small colorectal polyps.

Relevant Reading: Continuous Anticoagulation and Cold Snare Polypectomy Versus Heparin Bridging and Hot Snare Polypectomy in Patients on Anticoagulants With Subcentimeter Polyps

In-Depth [randomized controlled trial]:

This multicenter randomized controlled trial was conducted at six medical centers in Taiwan. Patients aged 40 years or older in whom at least one polyp of 4 to 10 mm was detected during screening or surveillance colonoscopy were eligible for the study. Patients who had a contraindication to colonoscopy or polypectomy or with inadequate bowel preparation were excluded from the study. The primary outcome measured was bleeding that developed within two weeks after the patient left the endoscopy unit. Rectal bleeding with spontaneous cessation was defined as mild bleeding. Conversely, bleeding with a reduction in hemoglobin concentration of 20 g/L or more compared with baseline, the requirement for blood transfusion, or colonoscopic hemostasis was considered as severe delayed bleeding. Outcomes in the primary analysis were assessed via Kaplan Meier plots and log-rank tests to compare differences between the CSP and HSP groups. Based on the primary analysis, eight patients in the CSP group and 31 in the HSP group had delayed bleeding (risk difference, -1.1%; 95% Confidence Interval [CI], -1.7% to -0.5%). Severe delayed bleeding was also lower in the CSP group (1 [0.05%] vs. 8 [0.4%] events; risk difference, -0.3%; 95% CI, -0.6% to -0.05%). When comparing emergency service visits, the CSP group had fewer emergency department visits than the HSP group (4 [0.2%] vs. 13 [0.6%] visits; risk difference, -0.4%; 95% CI, -0.8% to -0.04%). Overall, this study found that compared to HSP, CSP for small colorectal polyps significantly reduces the risk of delayed post-polypectomy bleeding in both mild and severe cases.

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