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Cold snare polypectomy urged for patients on anticoagulants
Cold snare polypectomy is recommended for removal of small colorectal polyps in anticoagulated patients because it resulted in less delayed bleeding requiring hemostasis when compared with conventional polypectomy, according to new research.
Investigators in Japan enrolled 70 anticoagulated patients with colorectal polyps at least 10 mm in diameter from March to December 2012. Patients were randomly assigned to polypectomy with cold snare (n=35, 78 polyps) or conventional polypectomy (n=35; 81 polyps) without warfarin discontinuation.
Delayed bleeding (within 2 weeks) was the primary outcome measure, and secondary outcome measures were immediate bleeding and rate of colorectal polyp retrieval.
Conventional polypectomy procedures resulted in more incidence of immediate bleeding (23%) compared with cold polypectomy (5.7%) (P=.042).
Fourteen percent of patients in the conventional group required endoscopic hemostasis (P=.027), while no delayed bleeding was reported in the cold snare group. Investigators reported similar rates (94% vs. 93%) of complete polyp retrieval between cold snare and conventional methods. In addition, the cold snare group demonstrated fewer histologically demonstrated injured arteries (22% vs 39%; P=.023).
“Because it has been reported that removal of small polyps by cold snaring is associated with a low rate of adverse events, we hypothesized that cold snaring of small polyps could be done without stopping warfarin,” researcher Akira Horiuchi, MD, Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan, said in a press release. “This hypothesis was based on our belief that rebleeding is frequently related to damage to the submucosal vessels caused by the electrocautery in conventional polypectomy and that the cold snaring technique, without electrocautery, would cause minimal damage to the submucosal layer and thus delayed bleeding would be uncommon despite continuation of anticoagulation.”
Disclosure: The researchers report no relevant financial disclosures.