Cold Snare Polypectomy in Pedunculated Polyps: A Prospective Analysis

Abstract

Introduction: Cold snare polypectomy (CSP) is the preferred technique for resection of colorectal polyps < 10mm in size. Past studies reported clip placement after CSP of pedunculated polyps in 6-84% of lesions. In this study, we conducted a prospective analysis of CSP for pedunculated polyps evaluating immediate and delayed bleeding as well as tracking technical aspects such as clip placement and other techniques to induce hemostasis. Methods: In this prospective, single-center, single endoscopist study of outpatients with pedunculated polyps removed using CSP, all pedunculated lesions ≤ 10 mm in size were removed by CSP. Pedunculated lesions 11-20mm in size were removed by CSP at the discretion of the endoscopist, primarily if the stalk was considered thin. In the later portion of the study, the practice of squeezing the polyp for several seconds before resection was adopted. Immediate bleeding was considered bleeding at a sufficient rate that it could not be ignored and required either intervention or a recheck after continuing with the examination for a few minutes. Results: Between 04/02/2021 and 08/27/2024, 317 pedunculated polyps were removed by CSP from 201 patients. 86% of patients were white and 66% were male. Immediate bleeding occurred after resection of 54 polyps (17%). Water jet tamponade was used in 72% of actively bleeding lesions and direct pressure with the colonoscope tip to stop bleeding was used in 24%. Clips were placed after only 2.5% of all resections. No significant difference in the rate of immediate bleeding was found between polyps ≤ 10mm and polyps > 10mm in size (p=0.8306) and rates of clip placement were similar between polyps ≤10mm and those > 10mm (p=0.9101) (Table 1). Squeezing the base for several seconds prior to transection was performed in 53 lesions and did not reduce the rate of immediate bleeding. Delayed bleeding occurred in 1 patient (0.47%), a 68-year-old non-Hispanic male from whom two pedunculated adenomas 10 and 14 mm were removed by CSP and cold snaring of multiple other non-pedunculated lesions. Conclusions: Clip placement after CSP of pedunculated polyps can be limited to a small fraction of cases, thereby reducing cost and plastic waste. This prospective study confirms the safety of cold snare polypectomy for colorectal pedunculated lesions ≤ 10 mm, and suggests that CSP may be safe for selected pedunculated lesions > 10 mm.