Post written by Tae-Geun Gweon, MD, from the Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea, Seoul, South Korea.
Polypectomy is a procedure associated with a high risk of bleeding. Guidelines recommend uninterrupted aspirin use during polypectomy, whereas cessation of clopidogrel 5 to 7 days before polypectomy is recommended.1 2 The cold snare resection (CSR) technique is considered safer than conventional polypectomy using electrocoagulation for postpolypectomy bleeding.
We performed a multicenter prospective cohort study including continuous clopidogrel and aspirin users (≤3 days of interruption) who underwent polypectomy in 5 academic hospitals in South Korea. We hypothesized that the risk of bleeding associated with CSR in clopidogrel users is not inferior to that in aspirin users.
Among the 263 patients (clopidogrel, n = 129; aspirin, n = 134), 509 cases of polypectomies were performed. The rate of delayed bleeding per patient in the clopidogrel and aspirin groups was 0.8% and 0.7%, respectively, meeting noninferiority (rate difference, .03%; 95% CI, –2.07% to 2.13%). Immediate bleeding was defined as bleeding requiring hemostasis within 2 minutes after polypectomy, with risk factors including female sex, end-stage renal disease, submucosal injection prior to resection, and polyp size ≥5 mm.
This multicenter prospective study demonstrated the safety of CSR in patients treated with uninterrupted clopidogrel and aspirin. Well-designed studies with a larger number of participants are required to validate the results of this study.
Grade of intraprocedural bleeding. A, Grade 1, no bleeding. B, Grade 2, minor bleeding that decreased over 2 minutes. C, Grade 3, major bleeding that did not decrease or increase. D, Grade 4, active bleeding (spurting).
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- Veitch AM, Radaelli F, Alikhan R, et al. Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update. Gut 2021;70:1611-28. ↩︎
- Chan FKL, Goh KL, Reddy N, et al. Management of patients on antithrombotic agents undergoing emergency and elective endoscopy: joint Asian Pacific Association of Gastroenterology (APAGE) and Asian Pacific Society for Digestive Endoscopy (APSDE) practice guidelines. Gut 2018;67:405-17. ↩︎
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