COLD SNARE POLYPECTOMY FOR COLORECTAL POLYP IN PATIENTS TAKING ANTITHROMBOTIC AGENTS

Abstract

According to the current Japanese guidelines, cold snare polypectomy (CSP) is classified as a high-risk endoscopic procedure for bleeding and should be managed according to the risk of thromboembolism. However, according to previous reports, the risk of bleeding after CSP may be low. Therefore, antiplatelet agents and warfarin can continue to be taken before CSP, and direct oral anticoagulants (DOACs) can be discontinued for one day after CSP, rather than before.

In patients who are taking an antithrombotic agent, CSP can be performed in a standard manner regardless of the antithrombotic agent they are taking. The lesion should be bluntly removed with the surrounding normal mucosa using a snare without electrocautery. After resection, if bleeding does not tend to weaken, hemostasis using an endoclip should be performed. The bleeding that occurs immediately after resection should be washed and suctioned as much as possible, and the patient should be advised that some reddish fluid may be excreted.

CSP was originally indicated for adenomas less than 10 mm in size, but it may be indicated for lesions greater than 10 mm depending on the circumstances. The patientʼs prognosis should be carefully considered, and the indications for the CSP treatment itself and efficacy should also be carefully considered.