Indiana University School of Medicine Indianapolis, Indiana
Tooba Tariq, MD1, Hala Fatima, MD1, Khaled Abdeljawad, MD1, Ashley C. Gilmore, MD2, Hak Nam Kim, MD1, John Tang, MD1; 1Indiana University School of Medicine, Indianapolis, IN; 2Indiana University School of Medicine, Carmel, IN
Introduction: Pedunculated colorectal polyps can be resected using hot snare polypectomy (HSP) or cold snare polypectomy (CSP). HSP may cause adverse events such as post polypectomy bleeding (PPB) and perforation. Cold snare polypectomy has recently gained attention because of shorter procedure times and lesser risk of adverse events. The aim of this study is to determine the occurrence of post-polypectomy bleeding (both immediate and delayed) after CSP of polyps ranging from 1 to 10 mm. Methods: This a retrospective study. Patients undergoing outpatient colonoscopy with at least one ≤ 10-mm polyp removed with CSP were included. Maneuvers performed by endoscopists to reduce risk of bleeding and occurrence of immediate and delayed bleeding was recorded. Categorical variables were described using frequencies and percentages. Chi-square and Fisher's exact test were used to compare categorical variables. Results: A total of 210 eligible polyps in 159 patients (14.5 % on anticoagulants or antiplatelet agents) were removed using CSP. The mean age of the patients included was 58.5 years and 60.4% were males. the 210 polyps, 18 (8.6%) were < 4 mm and 191 (91.4%) were 4-10 mm. All polyps were resected ensnaring a wide base around the stalk. Choking of polyp base before resection was performed in 171 (81.4%) and vigorous washing after resection was done in 51(24.2%) polyps. Immediate PPB occurred in 66 (41.5%) polyps, corresponding to a per-polyp bleeding percentage of 31.4%. The bleeding in the majority was mild oozing in 53 (80.3%), dripping in 6 (9%) and brisk bleeding in 5 (7.5%) polyps. There was no association between polyp size, pathology or location with immediate PPB (p >0.). Bleeding was successfully treated by endoscopic hemostasis (clipping) in 40 (60.6%) cases and 26 (39.3%) cases required no further medical intervention. There were no instances of delayed bleeding.
Discussion: The data show that the CSP technique is safe, effective and quick for patients with pedunculated polyps up to 1 cm and is associated with a low rate of PPB. Maneuvers like wide base resection and choking before resection may help reduce risk of immediate post polypectomy bleeding.
Disclosures: Tooba Tariq indicated no relevant financial relationships. Hala Fatima indicated no relevant financial relationships. Khaled Abdeljawad indicated no relevant financial relationships. Ashley Gilmore indicated no relevant financial relationships. Hak Nam Kim indicated no relevant financial relationships. John Tang indicated no relevant financial relationships.