title: Removal of small colorectal polyps in anticoagulated patients: a prospective randomized comparison of cold snare and conventional polypectomy.
abstract: BACKGROUND
  The bleeding risk after cold snare polypectomy in anticoagulated patients is not known.
  
  
  OBJECTIVE
  To compare the bleeding risk after cold snare polypectomy or conventional polypectomy for small colorectal polyps in anticoagulated patients.
  
  
  METHODS
  Prospective randomized controlled study.
  
  
  METHODS
  Municipal hospital in Japan.
  
  
  METHODS
  Anticoagulated patients with colorectal polyps up to 10 mm in diameter were enrolled. Patients were randomized to polypectomy with either cold snare technique (Cold group) or conventional polypectomy (Conventional group) without discontinuation of warfarin. The primary outcome measure was delayed bleeding (ie, requiring endoscopic intervention within 2 weeks after polypectomy). Secondary outcome measures were immediate bleeding and retrieval rate of colorectal polyps.
  
  
  RESULTS
  Seventy patients were randomized (159 polyps): Cold group (n = 35, 78 polyps) and Conventional group (n = 35; 81 polyps). The patients' demographic characteristics including international normalized ratio and the number, size, and shape of polyps removed were similar between the 2 techniques. Immediate bleeding during the procedure was more common with conventional polypectomy (23% [8/35]) compared with cold polypectomy (5.7% [2/35]) (P = .042). No delayed bleeding occurred in the Cold group, whereas 5 patients (14%) required endoscopic hemostasis in the Conventional group (P = .027). Complete polyp retrieval rates were identical (94% [73/78] vs 93% [75/81]). The presence of histologically demonstrated injured arteries in the submucosal layer with cold snare was significantly less than with conventional snare (22% vs 39%, P = .023).
  
  
  CONCLUSIONS
  Small sample size, single-center study.
  
  
  CONCLUSIONS
  Delayed bleeding requiring hemostasis occurred significantly less commonly after cold snare polypectomy than conventional polypectomy despite continuation of anticoagulants. Cold snare polypectomy is preferred for removal of small colorectal polyps in anticoagulated patients. (
  
  
  BACKGROUND
  NCT 01553565.).
authors.affiliation: Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Horiuchi
authors.affiliation: Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan; Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Nakayama
authors.affiliation: Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kajiyama
authors.affiliation: Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Tanaka
authors.affiliation: Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Sano
authors.affiliation: Deparment of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: David Y
authors.initials: DY
authors.lastname: Graham
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects; D001158:Arteries / Q000293:injuries; D016063:Blood Loss, Surgical; D003106:Colon / Q000098:blood supply; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects* / Q000379:methods*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D016558:Hemostasis, Endoscopic; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000628:therapy; D012007:Rectum / Q000098:blood supply; D057772:Vascular System Injuries / Q000209:etiology; D014859:Warfarin / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014859:Warfarin