Cold snare polypectomy outperformed conventional polypectomy for the removal of small colon polyps in patients receiving anticoagulation therapy Cold snare is a polyp removal technique using a metal snare wire to catch and remove a polyp without electrocautery.

1. Waleed Kh. Mahrous
Dr Waleed Kh. Mahrous

2. Waleed Kh. Mahrous
 Cold snare polypectomy outperformed conventional
polypectomy for the removal of small colon polyps in
patients receiving anticoagulation therapy
 Cold snare is a polyp removal technique using a metal
snare wire to catch and remove a polyp without
electrocautery.
 Cold snare polypectomy retrieved polyps of the same
size, number, and shape in significantly shorter
time than conventional polypectomy (16 minutes
versus 26 minutes, P<0.0001
Dr Waleed Kh. Mahrous
http://www.medpagetoday.com/MeetingCoverage/DDW/39335

3. Waleed Kh. Mahrous
 Cold snare polyp retrieval was also significantly
associated with less immediate bleeding (5.7%
versus 23%, P=0.04) and no delayed bleeding
(P=0.02)
 Current practice guidelines for colonoscopy
identify polypectomy as a high-risk procedure in
patients receiving anticoagulation therapy due to
increased bleeding risks, and recommend those
receiving treatment to temporarily discontinue
use of anticoagulant agents..
 "I think we need to re-evaluate our tradition of
discontinuing warfarin before the procedure
Dr Waleed Kh. Mahrous
http://www.medpagetoday.com/MeetingCoverage/DDW/39335

4. Waleed Kh. Mahrous
 Speculated that delayed bleeds would be due to
blood vessel injury in the submucosa layer
from electrocautery used in conventional
polypectomy.
 The authors evaluated risk of postprocedure bleeding
in 70 patients randomized to receive cold snare or
traditional endoscopic polypectomy to remove
colorectal polyps up to 10 mm in diameter.
Participants were receiving warfarin and were
told to not discontinue therapy prior to treatment.
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5. Waleed Kh. Mahrous
 Outcomes included immediate bleeds following the
procedure, delayed bleeding, time to complete
removal of all polyps in a patient, and
thromboembolic event incidence.
 Although cold snare had significantly better
outcomes for immediate bleeding, the odds
ratio did not reach statistical significance
 The authors reported. However, no delayed
bleeding occurred in the cold snare group whereas
14% of patients in the conventional group required
endoscopic hemostasis.
Dr Waleed Kh. Mahrous
http://www.medpagetoday.com/MeetingCoverage/DDW/39335
http://www.medpagetoday.com/MeetingCoverage/DDW/39335

6. Waleed Kh. Mahrous
 Thromboembolic events were not reported in either
group.
Dr Waleed Kh. Mahrous
http://www.medpagetoday.com/MeetingCoverage/DDW/39335