Evaluation of cold snare polypectomy for small pedunculated (Ip) polyps with thin stalks: a prospective clinical feasibility study

Abstract

Background

Although the use of cold snare polypectomy (CSP) has spread rapidly, no prospective studies evaluating the safety of CSP for pedunculated (Ip) polyps have been carried out.

Aim

We performed this study to provide an accurate evaluation of the safety of CSP for Ip polyps.

Methods

This is a prospective study (UMIN000035687). From January 2019 to February 2021, the safety of CSP for use on Ip polyps <10 mm with thin stalks was evaluated at our hospital. The primary outcome measure was the incidence of bleeding (delayed post-polypectomy bleeding (DPPB) and immediate bleeding).

Results

During the study period, 89 consecutive patients (including 92 colonoscopies and 114 polyps) were prospectively enrolled. The en-bloc resection rate was 100%. The rate of DPPB after CSP was 0%, however, DPPB after conversion to HSP occurred in 1 case (33.3% (1/3)). The rate of immediate bleeding during CSP was 28.9% (33/114). Polyps with diameters ≥6 mm (OR (95% CI): 2.77 (1.041–7.376); p = .041) were extracted as independent risk factors for immediate bleeding during CSP for Ip polyps. In all, 104 (91.2%) polyps were low-grade adenomas, and the percentage of cases with negative pathological margins was 96.5% (110/114).

Conclusions

CSP for Ip polyps was safe and had good outcomes. We believe that Ip polyps could be included as an indication for CSP, and that CSP may become the next step in the ‘cold revolution.’ To confirm our results and verify CSP’s inclusion in future guidelines, prospective, randomized studies are necessary.

Keywords:

• Cold snare polypectomy
• pedunculated (Ip) polyp
• delayed post polypectomy bleeding

Acknowledgments

The authors thank the staff of the participating institutions for their support in recruiting eligible patients and the patients who participated in this study.

Disclosure statement

The authors report no conflict of interest. No support from any organization was received for the submitted work; there were no financial relationships with any organizations that might have had an interest in the submitted work in the previous three years, and there are no other relationships or activities to declare that could have potentially influenced the outcomes of the submitted work.

Author contributions

JA, HC and TG conceived of the study. JA, HC, AH, JT, NO, TS, NK, TN, HK, MN, TI and TM performed the CSP. JA, KY, DY, HC, AH, JT, NO, TS, NK, TN, HK, MN and TI recruited the study participants. Analysis and interpretation of the data was conducted by JA and HC. All the authors have read the final manuscript and approve of its submission for publication.

Additional information

Funding

This study received no external funding. There was no sponsor for this study.