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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(06): E745-E752
DOI: 10.1055/a-1813-1019
Original article

Cold snare polypectomy of colorectal polyps ≤ 10 mm on clopidogrel: Australian and New Zealand randomized controlled trial

Shara Ket
 1   Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
 2   Monash University, Central Clinical School, Melbourne, Victoria, Australia
,
Douglas Tjandra
 3   Department of Gastroenterology, Melbourne Health, Victoria, Australia
,
David G. Hewett
 4   Department of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Queensland
,
Ammar O. Kheir
 4   Department of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Queensland
 5   Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
 6   Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
,
Andrew J. Metz
 6   Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
,
Alan Moss
 7   Department of Endoscopic Services, Western Health, Melbourne, Victoria, Australia
 8   Department of Medicine – Western Health, Melbourne Medical School, The University of Melbourne, Victoria, Australia
,
Ravinder Ogra
 9   Middlemore Hospital, Auckland, New Zealand
,
William Tam
10   Royal Adelaide Hospital, South Australia, Australia
11   University of Adelaide, South Australia, Australia
12   Calvary North Adelaide Hospital, South Australia, Australia
,
Spiro Raftopoulos
13   Sir Charles Gairdner Hospital, Western Australia
14   Peel Health Campus, Western Australia
,
John Reynolds
15   Biostatistics Consulting Platform, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
,
Robyn Secomb
 1   Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
,
Lauren Cavalieri
16   Eastern Health, Victoria, Australia
,
Paul Urquhart
16   Eastern Health, Victoria, Australia
,
Peter R. Gibson
 1   Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
 2   Monash University, Central Clinical School, Melbourne, Victoria, Australia
,
Gregor Brown
 1   Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
 2   Monash University, Central Clinical School, Melbourne, Victoria, Australia
17   Epworth Hospital, Richmond, Victoria, Australia
› Author AffiliationsPhD scholarship for Dr Shara Ket

TRIAL REGISTRATION: Randomised controlled trial at http://www.anzctr.org.au/
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Cold snare polypectomy of colorectal polyps ≤ 10 mm on clopidogrel: Australian and New Zealand randomized controlled trialEndosc Int Open 2022; 10(06): C8-C8
DOI: 10.1055/a-1969-9645

Abstract

Background and study aims Optimal peri-colonoscopic management of clopidogrel remains unclear. Cold snare polypectomy is safe and effective for removing polyps ≤ 10 mm and clips can control intraprocedural bleeding. We conducted a randomized controlled trial to compare continuation of clopidogrel versus temporary replacement of clopidogrel with aspirin for routine colonoscopy using cold snare polypectomy for polyps ≤ 10 mm.

Patients and methods Between August 2016 and August 2019, consenting participants at 12 centers were randomized to continuation of clopidogrel as a single or dual antiplatelet agent, or to temporarily take aspirin alone from 7 days prior to 2 days after routine colonoscopy. Endoscopists were blinded to group allocation. Cold snare polypectomy was used to remove polyps ≤ 10 mm, with endoscopic clips applied if intraprocedural bleeding continued for > 2 minutes. Follow-up was performed on Day 30. The trial was stopped early due to delayed patient enrollment.

Results Two hundred seventy-six consecutive polyps ≤ 10 mm were removed from 107 patients. Of the patients, 61.7 % were male with a median age of 69 years (interquartile range [IQR] 63 to 76.75). Fifty-nine patients continued on clopidogrel and 48 temporarily took aspirin instead. One hundred thirty-four polyps were removed from 49 patients who continued on clopidogrel vs 142 from 43 patients temporarily took aspirin instead (P = 0.33). Intraprocedural bleeding requiring clips occurred in 11 of 49 patients who continued on clopidogrel and in two of 43 patients who temporarily took replacing with aspirin instead (P = 0.02). More post-procedural minor bleeding was seen in the aspirin arm (six of 43 vs one of 49; P = 0.03). One patient in each arm had acute coronary syndrome, which was medically managed. None of the patients had clinically significant post-procedural bleeding.

Conclusions Continuation of clopidogrel in patients undergoing cold snare polypectomy for colorectal polyps ≤ 10 mm does not appear to increase the rate of clinically significant postpolypectomy bleeding. It is associated with an increase in intraprocedural bleeding, which can be successfully treated with clips.



Publication History

Received: 10 June 2021

Accepted after revision: 30 March 2022

Accepted Manuscript online:
30 March 2022

Article published online:
10 June 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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