RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0043-105578
Cold snare polypectomy reduced delayed postpolypectomy bleeding compared with conventional hot polypectomy: a propensity score-matching analysis
Publikationsverlauf
submitted 21. August 2016
accepted after revision 10. Februar 2017
Publikationsdatum:
23. Juni 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00025476/201707/lookinside/thumbnails/694_10-1055-s-0043-105578-1.jpg)
Abstract
Background and study aims Cold snare polypectomy (CSP) for small colorectal polyps has lower incidence of adverse events, especially delayed postpolypectomy bleeding (DPPB). However, few data are available on comparisons of the incidence of DPPB of CSP and hot polypectomy (HP). The aim of this study was to evaluate the incidence of DPPB after CSP and compare it with that of HP. A propensity score model was used as a secondary analysis.
Patients and methods This was a retrospective cohort study conducted in a single municipal hospital. We identified 539 patients with colorectal polyps from 2 mm to 11 mm in size who underwent CSP (804 polyps in 330 patients) or HP (530 polyps in 209 patients) between July 2013 and June 2015.
Results There were no cases of DPPB in the CSP group. Conversely, DPPB occurred in 4 patients (1.9 %) after HP, resulting in a significant difference between the CSP and HP groups (0.008 % vs 0 %, P = 0.02). Propensity score-matching analysis created 402 matched pairs, yielding a significantly higher DPPB rate in the HP group than CSP group (0.02 % vs 0 %, P = 0.04). However, significantly more patients in the CSP group had unclear horizontal margins that precluded assessment (83 vs 38 cases, P < 0.001). The retrieval failure rate was significantly higher in the CSP group than in the HP group (3 % vs 0.7 %, P = 0.01).
Conclusions DPPB was less frequent with CSP than HP, as selected by the propensity score-matching model. Our findings indicate that CSP is recommended polypectomy in daily clinical setting. However, special care should be taken during polyp retrieval and horizontal margin assessment, and these issues could be taken into account in follow-up after CSP.
-
References
- 1 World Health Organization. The global burden of disease: 2004 update.
- 2 Ferlay J, Soerjomataram I, Ervik M. et al. Cancer Incidence and Mortality Worldwide. IARC CancerBase No. 11. GLOBOCAN. 2012
- 3 Vogelstein B, Fearon ER, Hamilton SR. et al. Genetic alterations during colorectal-tumor development. N Engl J Med 1988; 319: 525-532
- 4 Zauber AG, Winawer SJ, O’Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
- 5 Levin TR, Zhao W, Conell C. et al. Complications of colonoscopy in an integrated health care delivery system. Ann Intern Med 2006; 145: 880-886
- 6 Sorbi D, Norton I, Conio M. et al. Postpolypectomy lower GI bleeding: descriptive analysis. Gastrointest Endosc 2000; 51: 690-696
- 7 Watabe H, Yamaji Y, Okamoto M. et al. Risk assessment for delayed hemorrhagic complication of colonic polypectomy: polyp-related factors and patient-related factors. Gastrointest Endosc 2006; 64: 73-78
- 8 Zhang Q, An S li, Chen Z yu. et al. Assessment of risk factors for delayed colonic post-polypectomy hemorrhage: a study of 15553 polypectomies from 2005 to 2013. PLoS One 2014; 9: e108290
- 9 Sonnenberg A. Management of delayed postpolypectomy bleeding: a decision analysis. Am J Gastroenterol 2012; 107: 339-342
- 10 Choung BS, Kim SH, Ahn DS. et al. Incidence and risk factors of delayed postpolypectomy bleeding: a retrospective cohort study. J Clin Gastroenterol 2014; 48: 784-789
- 11 Tappero G, Gaia E, De Giuli P. et al. Cold snare excision of small colorectal polyps. Gastrointest Endosc 1992; 38: 310-313
- 12 Waye JD. New methods of polypectomy. Gastrointest Endosc Clin N Am 1997; 7: 413-422
- 13 Uno Y, Obara K, Zheng P. et al. Cold snare excision is a safe method for diminutive colorectal polyps. Tohoku J Exp Med 1997; 183: 243-249
- 14 Ichise Y, Horiuchi A, Nakayama Y. et al. Prospective randomized comparison of cold snare polypectomy and conventional polypectomy for small colorectal polyps. Digestion 2011; 84: 78-81
- 15 Takeuchi Y, Yamashina T, Matsuura N. et al. Feasibility of cold snare polypectomy in Japan: A pilot study. World J. Gastrointest Endosc 2015; 7: 1250-1256
- 16 Repici A, Hassan C, Vitetta E. et al. Safety of cold polypectomy for < 10 mm polyps at colonoscopy : a prospective multicenter study. Endoscop 2012; 44: 27-31
- 17 Horiuchi A, Nakayama Y, Kajiyama M. et al. Removal of small colorectal polyps in anticoagulated patients: a prospective randomized comparison of cold snare and conventional polypectomy. Gastrointest Endosc 2014; 79: 417-423
- 18 Park S-K, Ko BM, Han JP. et al. A prospective randomized comparative study of cold forceps polypectomy by using narrow-band imaging endoscopy versus cold snare polypectomy in patients with diminutive colorectal polyps. Gastrointest Endosc 2016; 83: 527-532
- 19 Paspatis GA, Tribonias G, Konstantinidis K. et al. A prospective randomized comparison of cold vs hot snare polypectomy in the occurrence of postpolypectomy bleeding in small colonic polyps. Colorectal Dis 2011; 13: 345-348
- 20 Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika 1983; 70: 41-55
- 21 von Elm E, Altman DG, Egger M. et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007; 147: 573-577
- 22 Workshop P in the P. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. Gastrointest. Endosc 2003; 58: 3-43
- 23 Sawhney MS, Salfiti N, Nelson DB. et al. Risk factors for severe delayed postpolypectomy bleeding. Endoscopy 2008; 40: 115-119
- 24 Hui AJ, Wong RM, Ching JY. et al. Risk of colonoscopic polypectomy bleeding with anticoagulants and antiplatelet agents: analysis of 1657 cases. Gastrointest Endosc 2004; 59: 44-48
- 25 Witt DM, Delate T, McCool KH. et al. Incidence and predictors of bleeding or thrombosis after polypectomy in patients receiving and not receiving anticoagulation therapy. J Thromb Haemost 2009; 7: 1982-1989
- 26 Acosta RD, Abraham NS, Chandrasekhara V. et al. The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointest Endosc 2016; 83: 3-16
- 27 Veitch AM, Vanbiervliet G, Gershlick AH. et al. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Endoscopy 2016; 48: 385-402
- 28 ingh M, Mehta N, Murthy UK. et al. Postpolypectomy bleeding in patients undergoing colonoscopy on uninterrupted clopidogrel therapy. Gastrointest. Endosc 2010; 71: 998-1005
- 29 Gandhi S, Narula N, Mosleh W. et al. Meta-analysis: colonoscopic post-polypectomy bleeding in patients on continued clopidogrel therapy. Aliment. Pharmacol. Ther 2013; 37: 947-952
- 30 Lee CK, Shim J-J, Jang JY. Cold snare polypectomy vs. Cold forceps polypectomy using double-biopsy technique for removal of diminutive colorectal polyps: a prospective randomized study. Am. J. Gastroenterol 2013; 108: 1593-1600
- 31 Kim JS, Lee B-I, Choi H. et al. Cold snare polypectomy versus cold forceps polypectomy for diminutive and small colorectal polyps: a randomized controlled trial. Gastrointest. Endosc 2015; 81: 741-747
- 32 Pohl H, Srivastava A, Bensen SP. et al. Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology 2013; 144: 74-80
- 33 Saito D, Hayashida M, Miura M. et al. A comparative study between cold nare polypectomy and endoscopic mucosal resection for resection of colorectal polyps. (In Japanese with English abstract.). Gastroenterol. Endosc 2016; 58: 32-37
- 34 Komeda Y, Suzuki N, Sarah M. et al. Factors associated with failed polyp retrieval at screening colonoscopy. Gastrointest. Endosc 2013; 77: 395-400
- 35 Fernandes C, Pinho R, Ribeiro I. et al. Risk factors for polyp retrieval failure in colonoscopy. United Eur. Gastroenterol. J 2015; 3: 387-392
- 36 Deenadayalu VP, Rex DK. Colon polyp retrieval after cold snaring. Gastrointest. Endosc 2005; 62: 253-256
- 37 Liaquat H, Rohn E, Rex DK. Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions. Gastrointest. Endosc 2013; 77: 401-407
- 38 Matsumoto M, Fukunaga S, Saito Y. et al. Risk factors for delayed bleeding after endoscopic resection for large colorectal tumors. Jpn. J. Clin. Oncol 2012; 42: 1028-1034
- 39 Zhang Q-S, Han B, Xu J-H. et al. Clip closure of defect after endoscopic resection in patients with larger colorectal tumors decreased the adverse events. Gastrointest. Endosc 2015; 82: 904-909
- 40 Shioji K, Suzuki Y, Kobayashi M. et al. Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy. Gastrointest. Endosc 2003; 57: 691-694
- 41 Boustière C, Veitch A, Vanbiervliet G. et al. Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2011; 43: 445-461
- 42 Matsumoto M, Kato M, Oba K. et al. Multicenter randomized controlled study to assess the effect of prophylactic clipping on post-polypectomy delayed bleeding. Dig. Endosc 2016; 28: 570-576
- 43 Dokoshi T, Fujiya M, Tanaka K. et al. A randomized study on the effectiveness of prophylactic clipping during endoscopic resection of colon polyps for the prevention of delayed bleeding. Biomed Res. Int 2015; 02: 1-6