Posted on 02/21/2023 8:22:04 PM PST by ConservativeMind
A randomized controlled trial (RCT) of more than 4,000 people found that the risk for delayed bleeding after polypectomy was significantly reduced among persons who received a cold snare polypectomy. The findings are published in Annals of Internal Medicine.
More than 16 million colonoscopies are performed annually in the U.S., and polypectomy during colonoscopy plays a pivotal role in preventing colorectal cancer. Hot snare polypectomy (HSP) has been conventionally used to remove polyps but is associated with a higher risk of delayed bleeding, post-polypectomy syndrome, or perforation. Previous research on cold snare polypectomy (CSP) demonstrated that CSP was as effective as HSP but more efficient in removing small polyps, but its effect on reducing delayed bleeding has been shown only in high-risk patients.
Researchers from National Taiwan University Hospital conducted an RCT of 4,270 participants who were undergoing polypectomy in six centers in Taiwan. They report that only 8 out of 2,137 persons, or 0.4%, experienced delayed bleeding after CSP. In comparison, 31 out of 2,133 persons, or 1.5%, experienced delayed bleeding after HSP. They also report that only 0.2% of CSP group had emergency service visits compared with 0.6% of the HSP group. The authors show that CSP was also more efficient, with the study's results showing that the time required for polypectomy is reduced by 26.9%.
According to the authors, the findings support the superior safety of CSP over HSP in managing colorectal polyps sized 10 mm or smaller in the general population.
(Excerpt) Read more at medicalxpress.com ...
This is talking about a freezing procedure for polyp removal being better than a burning procedure.
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“Cold Snare” refers to simply cutting through the polyp with a wire snare. Forceps can be used for both hot and cold polypectomies, as well. There is no freezing. “Hot snare” uses a snare that is connected to an electrical circuit and is grounded on the patients skin with a conductive gel pad. It burns through the tissue and cauterizes. The problem is that it may start bleeding after the colonoscopy is finished.
Occasionally, if a polyp was removed with a cold snare, the MD may decide to “use heat” (ground the patient and use a hot snare or hot forcep) to cauterize an area that is bleeding after removal if it continues to bleed for any length of time after polypectomy.
In general, more of the younger gastroenterologists use almost exclusively cold polypectomy except for unusual situations. “Old timer” gastroenterologists may prefer to use hot because that is what they were taught in school. Also, I find that a higher percentage of colon surgeons tend to prefer to use heat when they perform colonoscopies.
Just one other note: The more recent recommendations from gastroenterology researchers suggests not even sending in most polyps to pathology for identification....I think that is primarily due to the fact they are looking to reduce costs. There are some GI docs who will remove tissue to send in to the lab that clearly is not needed...often the GI practice owns all or part of the lab to which the samples are sent...so they are encouraged to take biopsies and there is financial incentive. In my time working as a GI RN, I’ve removed as many as 36 “polyps” from one patient (who did not have any polyposis syndrome) and 90% of those 36 “polyps” were clearly not polyps....36 separate biopsy specimens sent to the lab and patient/patient insurance billed for 36 specimens tested. (Sent to the lab wholly-owned by the GI practice.)
That being said, there are people who have certain genetically-inherited polyposis syndromes who tend to grow literally thousands of polyps. It is a very sad thing to see because it tends to run in families and treatments are difficult for the patient to deal with. I had a regular patient who had to have his colon removed when he was 18 y.o. His father died at age 36 and another sibling was diagnosed at 16. y. o., shortly after the father died.
Why isn’t that sort of snare simply called a “normal snare?” That name seems odd.
Thank you for that clarification. I did not check into the definition for cold snare, assuming it was similar to the freezing done of skin cancers.
Why were so many things that looked like polyps not actual polyps, in your experience?
Not sure about the naming cold versus hot. As far as what the reason for removing tissue and sending for testing: It varies. There was one doc who I worked with who was exceedingly careful and thorough. Having worked with her extensively for years, I know her goal was to give the most though study for the patient. Sometimes, she would take over an hour for a colonoscopy and 30 minutes for an esophogastroduodenoscopy (upper). She sent more tissue to the lab than 5 or 6 other docs for the same number of procedures. I am certain that she wanted the best for the patient. I trust her totally. There are other docs who took many biopsies because they were encouraged by the gastroenterology group to do so...they made money on the biopsies. The docs won’t admit that is the reason but whenever they hired new doctors, the new doctors mentioned that they were encouraged to send specimens for testing. On the flip side, over time, your GI tract is going to change naturally and due to what you eat, drink, what drugs and chemicals you are exposed to...so the lining will probably have tissue that “looks” different. If a practitioner rarely takes biopsies, it could mean that they are working too fast and are overlooking something that could be a problem. That’s why the other staff assisting in the procedure are very important. We frequently told doctors that something needed to be removed completely or biopsied. And, if something clearly did not need to be biopsied, we would let the doctor know. There was one doctor who should have retired at least 10 years before he did...he would fall asleep during the colonoscopies: the scope tech would push the scope in and pull it out (highly illegal)...when we found something, we would wake him up...the RN would take the biopsy and tell the doctor what the location was, what it was we were removing and what size it was...then fill out the data in the computer. The doctor could not perform the procedures without an extraordinary amount of help...but none of his cohorts would make him retire. It was pretty sad. He wasn’t a bad person...just could not give up what he was doing.
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