Safety of cold snare resection techniques for removal of small colon polyps in patients with clopidogrel and aspirin: A Korean Association for the Study of Intestinal Diseases prospective, multicenter study

Background: /Aims: Polypectomy is a procedure associated with a high risk of bleeding. Guidelines recommend uninterrupted aspirin use during polypectomy, whereas cessation of clopidogrel 5-7 days before polypectomy is recommended. The cold snare resection technique, with or without submucosal injection, is considered safer than conventional polypectomy using electrocoagulation for post-polypectomy bleeding. In this study, we aimed to compare the bleeding complications associated with cold snare resection between clopidogrel and aspirin users.

Methods: This multicenter, prospective cohort study was conducted in five academic hospitals in Korea and included clopidogrel and aspirin users who underwent polypectomy. Antiplatelet agents were used without interruption, with ≤ 3 days of interruption defined as continuous use. The primary endpoint was delayed bleeding, which was defined as bleeding occurring several hours after polypectomy, whereas immediate bleeding was defined as bleeding requiring hemostasis 2 min after polypectomy. Risk factors for immediate bleeding were investigated for each polyp.

Results: Among the 263 patients (clopidogrel, n = 129; aspirin, n = 134), 509 underwent polypectomies. The rate of delayed bleeding per patient in the clopidogrel and aspirin groups was 0.8% and 0.7%, respectively, meeting noninferiority (rate difference 0.03% [95% confidence interval: -2.07% to 2.13%]). Hemostasis was achieved in 100 patients who underwent polypectomy (19.8%). Immediate bleeding risk factors included female sex, end-stage renal disease, submucosal injection before resection, and polyp size ≥ 5 mm.

Conclusions: This multicenter prospective study demonstrated the safety of cold snare resection in patients treated with uninterrupted clopidogrel and aspirin (NCT04328987).