Bleeding Risk of Cold Versus Hot Snare Polypectomy for Pedunculated Colorectal Polyps Measuring 10 mm or Less: Subgroup Analysis of a Large Randomized Controlled Trial

Introduction: Concerns regarding bleeding remain in cold snare polypectomy (CSP) for small pedunculated (0-Ip) polyps. This study aims to compare the risk of CSP and hot snare polypectomy (HSP) for such lesions. Methods: Data on 0-Ip colorectal polyps ≤ 10 mm were extracted from a large, pragmatic, randomized trial. Immediate post-polypectomy bleeding (IPPB), defined as the perioperative use of a clip for bleeding, was evaluated through polyp-level analysis. Delayed post-polypectomy bleeding (DPPB), defined as bleeding occurring within two weeks postoperatively, was assessed at the patient-level among patients whose polyps were all ≤ 10 mm, including at least one 0-Ip polyp. Results: A total of 647 0-Ip polyps (CSP: 306; HSP: 341) were included for IPPB analysis and 386 patients (CSP: 192; HSP: 194) for DPPB analysis. CSP was associated with a higher incidence of IPPB (10.8% vs 3.2%, P < 0.001) but no adverse clinical events. The procedure time of all polypectomies was shorter for CSP than for HSP (123.0 ± 117.8 vs 166.0 ± 237.7 s, P = 0.003), while the procedure time of polypectomies with IPPB were similar (249.8 ± 140.2 vs 227.4 ± 125.9 s, P = 0.64). DPPB was observed in three patients (1.5%) in the HSP group, including one patient (0.5%) with severe bleeding, but not in the CSP group. Discussion: Despite CSP being associated with more IPPB events, it could be timely treated without adverse outcomes. Notably, no delayed bleeding occurred in the CSP group. Our findings support the use of CSP for 0-Ip polyps ≤ 10 mm.