Skip to main content
Top
Published in:

09-05-2024 | Original Article

Effect of Cold Versus Hot Snare Polypectomy on Colon Postpolypectomy Bleeding in Patients with End-Stage Renal Disease: A Retrospective Cohort Study

Authors: Hsueh-Chien Chiang, Chien-Ming Chiang, Xi-Zhang Lin, Po-Jun Chen

Published in: Digestive Diseases and Sciences | Issue 7/2024

Login to get access

Abstract

Background

Patients with end-stage renal disease (ESRD) who undergo polypectomy may experience postpolypectomy bleeding. To reduce the risk of delayed postpolypectomy bleeding among the general population, cold snare polypectomy (CSP) is recommended for removing colon polyps smaller than 1 cm. Nevertheless, only few studies have examined the effect of CSP on patients with ESRD.

Methods

We retrospectively analyzed the data of patients with ESRD who underwent colonoscopic polypectomy for polyps larger than 5 mm at a Taiwanese university hospital from January 2014 to January 2023. The main outcome was delayed postpolypectomy bleeding within 30 days. Multivariate analysis was conducted to adjust for major confounders.

Results

A total of 557 patients with ESRD underwent colonoscopic polypectomy during the study period: 201 underwent CSP and 356 underwent hot snare polypectomy (HSP). Delayed postpolypectomy bleeding occurred in 27 patients (4.8%). The rate of delayed postpolypectomy bleeding was lower in patients with ESRD who underwent CSP than in those who underwent HSP (1.9% vs. 6.4%, P = 0.022). The percentage of patients who did not experience postpolypectomy bleeding within 30 days after CSP remained lower than that observed after HSP (P = 0.019, log-rank test). Multivariate analysis demonstrated immediate postpolypectomy bleeding and HSP to be independent risk factors for delayed postpolypectomy bleeding. A nomogram prognostic model was used to predict the potential of delayed postpolypectomy bleeding within 30 days in patients with ESRD.

Conclusions

Compared with HSP, CSP is more effective in mitigating the risk of delayed postpolypectomy bleeding in patients with ESRD.
Appendix
Available only for authorised users
Literature
2.
go back to reference Winawer SJ, Zauber AG, Ho MN et al. Prevention of colorectal cancer by colonoscopic polypectomy. The national polyp study workgroup. N Engl J Med 1993;329:1977–81.CrossRefPubMed Winawer SJ, Zauber AG, Ho MN et al. Prevention of colorectal cancer by colonoscopic polypectomy. The national polyp study workgroup. N Engl J Med 1993;329:1977–81.CrossRefPubMed
3.
go back to reference Shaukat A, Mongin SJ, Geisser MS et al. Long-term mortality after screening for colorectal cancer. N Engl J Med 2013;369:1106–1114.CrossRefPubMed Shaukat A, Mongin SJ, Geisser MS et al. Long-term mortality after screening for colorectal cancer. N Engl J Med 2013;369:1106–1114.CrossRefPubMed
4.
go back to reference Gutta A, Gromski MA. Endoscopic management of post-polypectomy bleeding. Clin Endosc 2020;53:302–310.CrossRefPubMed Gutta A, Gromski MA. Endoscopic management of post-polypectomy bleeding. Clin Endosc 2020;53:302–310.CrossRefPubMed
5.
go back to reference Kim HS, Kim TI, Kim WH et al. Risk factors for immediate postpolypectomy bleeding of the colon: a multicenter study. Am J Gastroenterol 2006;101:1333–1341.CrossRefPubMed Kim HS, Kim TI, Kim WH et al. Risk factors for immediate postpolypectomy bleeding of the colon: a multicenter study. Am J Gastroenterol 2006;101:1333–1341.CrossRefPubMed
6.
go back to reference Sorbi D, Norton I, Conio M, Balm R, Zinsmeister A, Gostout CJ. Postpolypectomy lower GI bleeding: descriptive analysis. Gastrointest Endosc 2000;51:690–696.CrossRefPubMed Sorbi D, Norton I, Conio M, Balm R, Zinsmeister A, Gostout CJ. Postpolypectomy lower GI bleeding: descriptive analysis. Gastrointest Endosc 2000;51:690–696.CrossRefPubMed
7.
go back to reference Bendall O, James J, Pawlak KM et al. Delayed bleeding after endoscopic resection of colorectal polyps: identifying high-risk patients. Clin Exp Gastroenterol 2021;14:477–492.CrossRefPubMedPubMedCentral Bendall O, James J, Pawlak KM et al. Delayed bleeding after endoscopic resection of colorectal polyps: identifying high-risk patients. Clin Exp Gastroenterol 2021;14:477–492.CrossRefPubMedPubMedCentral
8.
go back to reference Ferlitsch M, Moss A, Hassan C et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European society of gastrointestinal endoscopy (ESGE) clinical guideline. Endoscopy 2017;49:270–297.CrossRefPubMed Ferlitsch M, Moss A, Hassan C et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European society of gastrointestinal endoscopy (ESGE) clinical guideline. Endoscopy 2017;49:270–297.CrossRefPubMed
9.
go back to reference Chang LC, Chang CY, Chen CY et al. Cold versus hot snare polypectomy for small colorectal polyps: a pragmatic randomized controlled trial. Ann Intern Med 2023;176:311–319.CrossRefPubMed Chang LC, Chang CY, Chen CY et al. Cold versus hot snare polypectomy for small colorectal polyps: a pragmatic randomized controlled trial. Ann Intern Med 2023;176:311–319.CrossRefPubMed
10.
go back to reference Yang SC, Wu CK, Tai WC et al. Incidence and risk factors of colonoscopic post-polypectomy bleeding and perforation in patients with end-stage renal disease. J Gastroenterol Hepatol 2020;35:1704–1711.CrossRefPubMed Yang SC, Wu CK, Tai WC et al. Incidence and risk factors of colonoscopic post-polypectomy bleeding and perforation in patients with end-stage renal disease. J Gastroenterol Hepatol 2020;35:1704–1711.CrossRefPubMed
11.
12.
go back to reference Lai TS, Hsu CC, Lin MH, Wu VC, Chen YM. Trends in the incidence and prevalence of end-stage kidney disease requiring dialysis in Taiwan: 2010–2018. J Formos Med Assoc 2022;121:S5–S11.CrossRefPubMed Lai TS, Hsu CC, Lin MH, Wu VC, Chen YM. Trends in the incidence and prevalence of end-stage kidney disease requiring dialysis in Taiwan: 2010–2018. J Formos Med Assoc 2022;121:S5–S11.CrossRefPubMed
13.
go back to reference Kawamura T, Takeuchi Y, Asai S et al. A comparison of the resection rate for cold and hot snare polypectomy for 4–9 mm colorectal polyps: a multicentre randomised controlled trial (CRESCENT study). Gut 2018;67:1950–1957.CrossRefPubMed Kawamura T, Takeuchi Y, Asai S et al. A comparison of the resection rate for cold and hot snare polypectomy for 4–9 mm colorectal polyps: a multicentre randomised controlled trial (CRESCENT study). Gut 2018;67:1950–1957.CrossRefPubMed
14.
go back to reference Thoguluva Chandrasekar V, Spadaccini M, Aziz M et al. Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis. Gastrointest Endosc 2019;89:e3.CrossRef Thoguluva Chandrasekar V, Spadaccini M, Aziz M et al. Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis. Gastrointest Endosc 2019;89:e3.CrossRef
15.
go back to reference Kaltenbach T, Anderson JC, Burke CA et al. Endoscopic removal of colorectal lesions: recommendations by the US multi-society task force on colorectal cancer. Am J Gastroenterol 2020;115:435–464.CrossRefPubMed Kaltenbach T, Anderson JC, Burke CA et al. Endoscopic removal of colorectal lesions: recommendations by the US multi-society task force on colorectal cancer. Am J Gastroenterol 2020;115:435–464.CrossRefPubMed
16.
go back to reference Ito A, Suga T, Ota H, Tateiwa N, Matsumoto A, Tanaka E. Resection depth and layer of cold snare polypectomy versus endoscopic mucosal resection. J Gastroenterol 2018;53:1171–1178.CrossRefPubMed Ito A, Suga T, Ota H, Tateiwa N, Matsumoto A, Tanaka E. Resection depth and layer of cold snare polypectomy versus endoscopic mucosal resection. J Gastroenterol 2018;53:1171–1178.CrossRefPubMed
17.
go back to reference Takayanagi D, Nemoto D, Isohata N et al. Histological comparison of cold versus hot snare resections of the colorectal mucosa. Dis Colon Rectum 2018;61:964–970.CrossRefPubMed Takayanagi D, Nemoto D, Isohata N et al. Histological comparison of cold versus hot snare resections of the colorectal mucosa. Dis Colon Rectum 2018;61:964–970.CrossRefPubMed
19.
go back to reference Thomson HJ, Busuttil A, Eastwood MA, Smith AN, Elton RA. The submucosa of the human colon. J Ultrastruct Mol Struct Res 1986;96:22–30.CrossRefPubMed Thomson HJ, Busuttil A, Eastwood MA, Smith AN, Elton RA. The submucosa of the human colon. J Ultrastruct Mol Struct Res 1986;96:22–30.CrossRefPubMed
21.
go back to reference Suzuki S, Gotoda T, Kusano C et al. Width and depth of resection for small colorectal polyps: hot versus cold snare polypectomy. Gastrointest Endosc 2018;87:1095–1103.CrossRefPubMed Suzuki S, Gotoda T, Kusano C et al. Width and depth of resection for small colorectal polyps: hot versus cold snare polypectomy. Gastrointest Endosc 2018;87:1095–1103.CrossRefPubMed
22.
go back to reference Ortigao R, Weigt J, Afifi A, Libanio D. Cold versus hot polypectomy/endoscopic mucosal resection—a review of current evidence. United European Gastroenterol J 2021;9:938–946.CrossRefPubMedPubMedCentral Ortigao R, Weigt J, Afifi A, Libanio D. Cold versus hot polypectomy/endoscopic mucosal resection—a review of current evidence. United European Gastroenterol J 2021;9:938–946.CrossRefPubMedPubMedCentral
23.
go back to reference Rex DK, Anderson JC, Pohl H et al. Cold versus hot snare resection with or without submucosal injection of 6- to 15-mm colorectal polyps: a randomized controlled trial. Gastrointest Endosc 2022;96:330–338.CrossRefPubMed Rex DK, Anderson JC, Pohl H et al. Cold versus hot snare resection with or without submucosal injection of 6- to 15-mm colorectal polyps: a randomized controlled trial. Gastrointest Endosc 2022;96:330–338.CrossRefPubMed
24.
go back to reference Oh CK, Choi HS, Cho YS. Comparison of cold snare polypectomy and endoscopic mucosal resection for 3–10-mm colorectal polyps in end-stage renal disease patients. Saudi J Gastroenterol 2022;28:67–73.CrossRefPubMed Oh CK, Choi HS, Cho YS. Comparison of cold snare polypectomy and endoscopic mucosal resection for 3–10-mm colorectal polyps in end-stage renal disease patients. Saudi J Gastroenterol 2022;28:67–73.CrossRefPubMed
Metadata
Title
Effect of Cold Versus Hot Snare Polypectomy on Colon Postpolypectomy Bleeding in Patients with End-Stage Renal Disease: A Retrospective Cohort Study
Authors
Hsueh-Chien Chiang
Chien-Ming Chiang
Xi-Zhang Lin
Po-Jun Chen
Publication date
09-05-2024
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 7/2024
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-024-08405-w

Keynote series | Spotlight on managing health in obesity

Obesity is a major contributor to cardiorenal metabolic disease, but its impact extends throughout the body. Understand how obesity can affect other organ systems and impact treatment, and whether weight-loss measures improve outcomes.

Prof. Eva L. Feldman
Prof. Jonette Keri
Developed by: Springer Medicine
Watch now
Video

Women’s health knowledge hub

Elevate your patient care with our comprehensive, evidence-based medical education on women's health. Designed to help you provide exceptional care for your female patients at every stage of life, we provide expert insights into topics such as reproductive health, menopause, breast cancer and sex-specific health risks and precision medicine.

Read more

Keynote webinar | Spotlight on advances in lupus

  • Live
  • Webinar | 27-05-2025 | 18:00 (CEST)

Systemic lupus erythematosus is a severe autoimmune disease that can cause damage to almost every system of the body. Join this session to learn more about novel biomarkers for diagnosis and monitoring and familiarise yourself with current and emerging targeted therapies.

Join us live: Tuesday 27th May, 18:00-19:15 (CEST)

Prof. Edward Vital
Prof. Ronald F. van Vollenhoven
Developed by: Springer Medicine
Register now
Webinar