Some Like It Cold: Postpolypectomy Delayed Hemorrhage in Anticoagulated Patients

Excerpt

Current estimates suggest that colonoscopic polypectomy prevents 80% of interval colon cancers. Conventionally, polypectomy performed with electrocautery is termed ‘hot snare’ polypectomy (HSP), which carries a small but significant complication rate, including immediate and delayed postpolypectomy bleeding (DPPB), transmural thermal injury, and perforation. Cold snare polypectomy (CSP) has been recently recommended as the method of choice for removing colon polyps ≤ 9 mm [1], which comprise the majority of the polyps identified and removed during colonoscopy. Without the need for electrocautery and low risk of transecting the muscularis propria, it almost eliminates the risk of transmural thermal injury and perforation. Bleeding immediately after polypectomy, especially the capillary bleeding following the removal of small colonic polyps, generally stops spontaneously, or is easily treated with endoscopic hemostasis, such as clipping, and therefore, is of less concern for endoscopists. Therefore, DPPB has become the major complication of concern following CSP. …