527 Safety of Cold-Polypectomy for <10 mm Polyps At Colonoscopy: A Prospective, Multicenter Study

Safety of Cold-Polypectomy for <10 mm Polyps At Colonoscopy: A Prospective, Multicenter Study Alessandro Repici, Cesare Hassan, Eva Vitetta, Elisa Chiara Ferrara, Gianpiero Manes, Giuseppe Gullotti, Alessandro Princiotta, Pietro Dulbecco, Nicola Gaffuri, Elisabetta Bettoni, Nico Pagano, Giacomo Rando, Giuseppe Strangio, Alessandra Carlino, Fabio Romeo, Daniel D. Ferreira, Lorenzo Ridola, Alberto Malesci Servizio di Endoscopia Digestiva, IRCCS Istituto Clinico Humanitas, Rozzano (MI), Italy; Department of Gastroenterology, University Hospital L. Sacco, Milan, Italy; Department of Gastroenterology, University Hospital of Messina, Messina, Italy; Department of Internal Medicine, Genoa University of Genoa, Genoa, Italy; Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Bergamo, Bergamo, Italy; Department of Gastroenterology, “La Sapienza” University Hospital of Roma, Roma, Italy Background Cold-polypectomy techniques (without electrocautery) by means of biopsy forceps or snare are widely adopted to remove subcentimetric polyps. Only scanty data are, however, available on the safety of this approach. Objective To assess the safety of cold-polypectomy for subcentimetric polyps, as well as the rate of advanced neoplasia in these lesions.Design and Setting Prospective, multicentre trialPatients and Intervention All consecutive patients with at least one 10 mm polyp at colonoscopy in the 5 participating centres were prospectively included. All the 10 mm polyps detected within the study period were removed by cold-polypectomy. Main Outcome Measurements Rates of post-(cold)polypectomy immediate or delayed bleeding, as well as of other complications, were assessed at 7and 30-days by telephone calls. Rate of advanced histology was also assessed. Predictive variables of post-polypectomy bleeding or advanced neoplasia were identified by multivariate analysis.Results A total of 1,015 10 mm polyps in 823 patients (15.5% on anti-platelet agents) were removed. Of these, 822 (81%) were 5 mm and 193 (19%) 6-9 mm. A post-polypectomy immediate bleeding occurred in 18 cases, corresponding to a per-patient and per-polyp bleeding rate of 2.2% (95% CI: 1.2%, 3.2%) and 1.8% (95% CI: 1%, 2.6%), respectively. Assumption of anti-platelet agents (OR: 4; 95% CI: 1.5-10.6) and larger polyp size (OR: 2; 95% CI: 1.1-6.9) were independent predictors of bleeding. Bleeding was successfully treated by endoscopic hemostasis in all the cases, without requiring further use of medical resources. Advanced neoplasia prevalence in 5 mm polyps was as high as 8.7% .Conclusions Our study showed the high safety of a cold-polypectomy approach for subcentimetric polyps. This was due to the low rate of post-polypectomy bleeding and to the high efficacy of endoscopic hemostasis in its treatment. The high rate of advanced neoplasia in 5 mm polyps should raise some caution on the management of these lesions with non-invasive procedures.