Comparison of postpolypectomy bleeding events between cold snare polypectomy and hot snare polypectomy for small colorectal lesions: a large-scale propensity score–matched analysis

Post written by Hiroyuki Takamaru, MD, PhD, from the Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.


We analyzed more than 12,000 colorectal lesions treated by cold snare polypectomy and 2400 treated by hot snare polypectomies. The rate of postpolypectomy bleeding after cold snare polypectomy was .1% compared with .5% after hot snare polypectomy.

Next, we compared the bleeding rate between cold and hot snare polypectomy after adjusting for the background of the lesions using propensity score matching.

We found that postpolypectomy bleeding remained less frequent after adjustment in cold snare polypectomy (.1%) versus hot snare polypectomy (.6%).

Recently, an increasing number of colorectal polyps have been resected by cold snare polypectomy. Before the procedure, we usually explain to the patients that bleeding after polypectomy is extremely rare. However, I have come across several patients with or without antithrombotic agents who showed postpolypectomy bleeding after cold snare polypectomy. This was the starting point of this study.

Future research is needed to clarify the difference between the kind of snares used for resection, and whether endoscopic clippings are required for cold snare polypectomy, along with the details regarding the patients’ comorbidities and intake of antithrombic agents. This would enable studies with robust real-world data and provide us an in-depth understanding of the various endoscopic performances.

Takamaru_figureRepresentative case of postpolypectomy bleeding requiring endoscopic hemostasis after cold snare polypectomy (CSP). A 0-IIa lesion (4 mm in diameter) was treated using CSP. Hematochezia was observed at 1 day after the procedure, and an emergency colonoscopy was performed. Active bleeding was detected in the mucosal defect.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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