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CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(02): E232-E238
DOI: 10.1055/a-0810-0439
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Risk of delayed bleeding before and after implementation of cold snare polypectomy in a screening colonoscopy setting

Li-Chun Chang
1   Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
2   Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
3   Health Management Center, National Taiwan University Hospital, Taipei, Taiwan.
,
Chia-Tung Shun
4   Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan.
,
Wen-Feng Hsu
1   Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
,
Chia-Hong Tu
1   Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
3   Health Management Center, National Taiwan University Hospital, Taipei, Taiwan.
,
Chieh-Chang Chen
1   Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
,
Ming-Shiang Wu
1   Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
,
Han-Mo Chiu
1   Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
3   Health Management Center, National Taiwan University Hospital, Taipei, Taiwan.
› Author Affiliations
Further Information

Publication History

submitted 12 September 2018

accepted after revision 15 November 2018

Publication Date:
30 January 2019 (online)

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Abstract

Background and study aims Cold snare polypectomy (CSP) is considered to be effective in reducing risk of delayed bleeding but randomized trials fail to support this owing to the small sample size. The current study aimed to compare risk of delayed bleeding before and after implementation of CSP in a screening colonoscopy setting.

Patients and methods This study retrospectively analyzed a prospectively maintained screening colonoscopy database in a university hospital in Taiwan. We compared the rate of delayed bleeding before and after implementation within similar periods (18 months and 15 months) and the respective number of polypectomies (1,304 and 1,255) performed to remove small and diminutive polyps. The main outcome measurement was delayed bleeding within the two periods. Multivariate analysis was performed to adjust for major confounders.

Results A total of 1,304 and 1,225 subjects received hot snare polypectomy (HSP) and CSP in two separate periods, respectively. Compared with the HSP, the CSP had a lower rate of delayed bleeding (0.1 % vs. 1.1 %, P < 0.001), severe bleeding (0 % vs. 0.7 %, P < 0.01), need for second-look colonoscopy (0 % vs. 0.8 %, P < 0.01), and emergency service visits (0.1 % vs. 1.0 %, P < 0.01). Total procedure time (12.60 ± 11.45 vs. 16.48 ± 14.27 min/person, P < 0.01) and duration of hospital stay (1.18 ± 0.50 vs. 1.53 ± 5.78 hour/person, P < 0.03) were also shorter after CSP implementation. Multivariate analysis showed that HSP was an independent risk factor for delayed bleeding after adjusting for age, gender, and number of polyps (adjusted odds ratio 14.4;95 % confidence interval = 1.88 – 110.6).

Conclusion Implementation of CSP significantly reduces risk of delayed bleeding associated with removing small and diminutive polyps in screening colonoscopy.

 

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