Digestive Disease Center, Showa Inan General Hospital, Komagane.
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Toho University Ohashi Medical Center, Tokyo.
J Clin Gastroenterol. 2018 Jul;52(6):502-507. doi: 10.1097/MCG.0000000000000802.
This study compared the incidence of delayed bleeding following 2 methods of cold snare polypectomy for colorectal polyps in patients taking antithrombotic agents.
Patients undergoing cold snare polypectomy for colorectal polyps ≤10 mm without discontinuation of antithrombotic agents were enrolled. This was a retrospective study of a prospectively collected cohort based on a historical comparison of 2 time periods. A traditional cold snare was used between January 2012 and December 2013 and a dedicated cold snare was used between January 2014 and December 2015. Patients' and polyps' characteristics, antithrombotic agents used, the snare used, the number of clips used, and adverse events were documented from a hospital online database. Delayed bleeding was defined as bleeding that required endoscopic treatment within 2 weeks after polypectomy. The submucosal layer of the resected polyps (6 to 10 mm) was histologically examined for the presence of injured arteries.
A total of 172 patients having 370 eligible polyps were enrolled; traditional cold snare group, N=100 (212 polyps) and dedicated cold snare group, N=72 (158 polyps). The patients' and polyps' characteristics were similar between the 2 groups. Hemostatic clips were used more often with the traditional than dedicated cold snares [33/100 (33%) vs. 13/72 (18%), P=0.044]. Delayed bleeding following cold snare polypectomy occurred in 1.2% (2/172); 0% (0/72) with dedicated snare versus 2% (2/100) with the traditional snare (P=0.63). The presence of histologically demonstrated injured submucosal arteries with the dedicated cold snare was significantly less than with the traditional cold snare [4.1% (4/98) vs. 16% (17/105), P=0.009].
Colorectal polyps ≤10 mm can be removed without an increase in delayed bleeding using dedicated cold snare polypectomy in patients taking antithrombotic agents.
本研究比较了两种冷圈套息肉切除术方法在服用抗血栓药物的患者中治疗结直肠息肉后延迟性出血的发生率。
纳入了正在接受冷圈套息肉切除术治疗、息肉大小≤10mm 且未停止使用抗血栓药物的患者。这是一项回顾性研究，基于两个时期的历史比较，对前瞻性收集的队列进行了研究。2012 年 1 月至 2013 年 12 月期间使用传统冷圈套，2014 年 1 月至 2015 年 12 月期间使用专用冷圈套。从医院在线数据库中记录患者和息肉的特征、使用的抗血栓药物、使用的圈套、使用的夹数量和不良事件。延迟性出血定义为息肉切除后 2 周内需要内镜治疗的出血。切除的息肉（6 至 10mm）的黏膜下层组织进行组织学检查，以确定损伤动脉的存在。
共纳入了 172 名患者的 370 个合格息肉；传统冷圈套组，N=100（212 个息肉）和专用冷圈套组，N=72（158 个息肉）。两组患者和息肉特征相似。与专用冷圈套相比，传统冷圈套更常使用止血夹[33/100（33%）比 13/72（18%），P=0.044]。冷圈套息肉切除术后发生延迟性出血的比例为 1.2%（2/172）；专用圈套组 0%（0/72），传统圈套组 2%（2/100）（P=0.63）。专用冷圈套的黏膜下层组织中存在组织学上证实的损伤动脉的比例明显低于传统冷圈套[4.1%（4/98）比 16%（17/105），P=0.009]。
在服用抗血栓药物的患者中，使用专用冷圈套息肉切除术切除≤10mm 的结直肠息肉不会增加延迟性出血的风险。
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