Clinical Benefit Analysis Of Pedicled Rectal Polyps With A Diameter Of ≤ 1cm By Cold Snare Polypectomy (CSP)

Objective: Cold snare polypectomy(CSP)is generally not recommended for removal of pedicled colorectal polyps.The purpose of this study was to examine and analyze the clinical benefit of CSP compared with hot snare polypectomy(HSP)in the complete removal of pedicled polyps ≤ 1 cm in diameter.Methods: A retrospective study was conducted on 357 patients with pedicled polyps with a head diameter of 6-10 mm who were removed by CSP and HSP in the department of Gastroenterology of our hospital from January 2019 to January 2022.Compared the two groups of patients with bleeding,perforation and other surgical adverse events,polyp complete removal rate,operation time,hospitalization,etc.,and analyze the risk factors that may affect postoperative bleeding.Results: A total of 357 patients underwent hot trap polypectomy(HSP)and cold trap polypectomy(CSP).There were 49 cases in THE CSP group and308 cases in the HSP group.There was no significant difference in baseline data and basic characteristics of polyps between the CSP group and the HSP group(P>0.05).CSP had no delayed bleeding compared with HSP(0.0% vs 4.2%,P =0.048);The intraoperative bleeding of CSP was more than that of HSP(12.2% vs6.5%,P= 0.150),but the number of titanium clips required for intervention was significantly reduced(0.88 ±0.33 vs 1.34±0.54)(P<0.05).There was no delayed perforation in the CSP group and the HSP group(P >0.05).The complete removal rate of CSP was higher than that of HSP(98.0% vs 96.8%,P=0.650),but the difference was not statistically significant(P=0.650).The mean length of hospital stay in the CSP group was 1.20±0.41 days,and the mean length of hospital stay in the HSP group was 1.23±0.50 days.There was no significant difference between the two groups(P=0.690).The operation time after the implementation of CSP was shortened(2.55 ± 1.24 min vs.3.94 ± 1.30 min,P<0.05),and hospitalization cost was less than HSP group,the difference was statistically significant(P<0.05);Multivariate analysis showed that hypertension(OR 5.206,95%CI 1.540～17.594,P =0.008)and intraoperative bleeding(OR 7.335,95%CI 1.656～32.484,P =0.009)were independent risk factors for delayed bleeding.Conclusions: Cold snare resection is a safe and efficient procedure that can be applied to pedicled colorectal polyps with a head ≤1cm and has several advantages over HSP: With a higher complete resection rate,the operative time is reduced without increasing the risk of bleeding.