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

Abstract

Background and Aims

Cold snare polypectomy (CSP), a safe procedure for removing colon polyps, has a low prevalence of postpolypectomy bleeding (PPB). Previous studies have failed to demonstrate differences in PPB rates between CSP and hot snare polypectomy (HSP), possibly because of their small sample sizes. This study analyzed PPB rates after CSP and HSP.

Methods

This was a retrospective analysis of colorectal lesions (diameter <10 mm) treated using endoscopic resection at our institution between January 2015 and December 2019. Resections were performed using CSP or HSP, depending on the endoscopist's preference. Endoscopic and histological findings were recorded in the endoscopic database at our institution. Propensity score (PS) matching was performed to match patient age, lesion size, macroscopic features, location of the lesions, and antithrombotic agent use. The CSP and HSP groups were compared to determine the adverse event (PPB) rates.

Results

The CSP and HSP groups included 12,928 and 2,408 lesions (total of 5,371 patients), respectively. The univariate analysis revealed that the overall prevalence of PPB after HSP was higher than that after CSP (Odds ratio [OR], 5.39; 95% confidence interval [CI], 2.50–11.60). After PS matching (2,135 lesions/group), the prevalence of PPB after HSP remained higher than that after CSP (OR, 6.0; 95% CI, 1.34–26.8).

Conclusions

For colorectal lesions <10 mm in diameter, the risk of PPB after CSP is significantly lower than that after HSP, after PS matching. CSP for lesions <10 mm could be safely performed compared with HSP.