Cold Snare Polypectomy of Pedunculated Polyps ≤10 mm: Choking Stalk for ≥10 Seconds Before Resection Reduces Immediate Bleeding
Douglas K. Rex, MD, MASGE, reviewing Fatima H, et al. J Clin Gastroenterol 2022 Apr 13.
Cold snare polypectomy is now accepted as safer than hot resection of lesions ≤10 mm in size, though it is still widely believed that electrocautery should be used for pedunculated lesions.
This was a prospective, uncontrolled assessment of resection of 239 pedunculated colorectal polyps ≤10 mm removed with a dedicated 10-mm cold snare. Polyps were grasped very low on the base and “choked” in 83.1% of cases. There was immediate bleeding, defined as continued bleeding for 30 seconds, in 72 polyps (30.1%).
In a multivariate analysis, choking the polyp base for at least 10 seconds decreased the likelihood of immediate bleeding by 97%. In the cases that bled, 43% required no intervention. Of the remainder, 39 required clipping and 2 were cauterized with a hot snare tip.
COMMENTAs the use of cold snare polypectomy for small pedunculated polyps is worked out, this study presents the useful observation that squeezing the stalk for at least 10 seconds before transection reduces immediate bleeding. Additional investigation of techniques other than clipping to stop persistent bleeding is also warranted.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Fatima H, Tariq T, Gilmore A, et al. Bleeding risk with cold snare polypectomy of ≤10 mm pedunculated colon polyps. J Clin Gastroenterol 2022 Apr 13. (Epub ahead of print) (https://doi.org/10.1097/mcg.0000000000001699)
