Cold revolution: The change of concept and a large-scale trial in Taiwan rewrite the standard of care in colonoscopy practice
A large-scale randomized controlled trial (RCT) of more than 4,000 people found that the risk for delayed bleeding after polypectomy was significantly reduced among persons who received a cold snare polypectomy. The findings are published in Annals of Internal Medicine.
Globally, colonoscopy is one of the most commonly performed endoscopic procedures and polypectomy during colonoscopy plays a pivotal role in preventing colorectal cancer. It was reported that more than 16 million colonoscopies are performed annually in the US and 0.4 million in Taiwan. Hot snare polypectomy (HSP) has been conventionally used to remove polyps but is associated with a higher risk of delayed bleeding, post-polypectomy syndrome, or perforation. Previous research on cold snare polypectomy (CSP) demonstrated that CSP was as effective as HSP but more efficient in removing small polyps, but its effect on reducing delayed bleeding has been shown only in high-risk patients.
Researchers from Taiwan conducted a RCT of 4,270 participants who were undergoing polypectomy in six centers during 2018 to 2020. They report that only 8 out of 2,137 persons, or 0.4 percent, experienced delayed bleeding after CSP. In comparison, 31 out of 2,133 persons, or 1.5 percent, experienced delayed bleeding after HSP. They also report that only 0.2 percent of CSP group had emergency service visits compared with 0.6 percent of the HSP group. The research team note that CSP was also more efficient, with the study's results showing that the time required for polypectomy is reduced by 26.9 percent. According to professor Han-Mo Chiu of National Taiwan University Hospital, the principal investigator of this trial, the findings support the superior safety of CSP over HSP in managing colorectal polyps sized 10 mm or smaller in the general population and CSP will become the standard of care for managing sub-centimeter polyp at colonoscopy.
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