Cold Resection Techniques Safe for Removing Colorectal Polyps ≤9 mm

Many endoscopists use cold resection techniques for removal of diminutive polyps, and cold polypectomy using mini-snares has been reported as safe for removal of polyps ≤7 mm.

In a prospective, multicenter trial involving 823 patients, researchers in Italy explored the use of cold resection techniques in 1015 consecutive polyps <10 mm. Patients were excluded if they were receiving an anticoagulant or clopidogrel. Sixteen percent of participants were taking an antiplatelet agent (aspirin or ticlopidine). Participants were telephoned at 7 and 30 days postprocedure to determine delayed complications.

Mean polyp size was 4.7 mm; 822 polyps were ≤5 mm, and 193 were 6 to 9 mm. Overall, biopsy forceps were used in 63.4% of cases and cold snares in 36.6%; for polyps measuring 6 to 9 mm, 8.8% were removed with forceps and 91.2% with a snare. Eighteen participants (2.2%) had immediate postpolypectomy bleeding that required intervention. The rate of such bleeding was higher in individuals taking antiplatelet agents than in those not taking such agents (6.2% vs. 1.4%) and after removal of lesions measuring 6 to 9 mm than after removal of diminutive polyps (4.1% vs. 1.2%). In multivariate analysis, receipt of antiplatelet agents and larger polyp size were the only independent predictors of immediate bleeding. Endoscopic hemostasis was successful in all cases: by use of clip positioning in 11 patients, epinephrine injection in 5, and combined therapy in 2. No patients experienced delayed bleeding or other complications.