Clinical Endoscopy

Original Articles

Effect of external evaluation and training on the incomplete resection rate in cold snare polypectomies for colonic lesions <10 mm: a prospective Spanish study (POLIPEVA): Marina de Benito Sanz, Jorge Feito, Luis Hernández, Javier Tejedor-Tejada, Pilar Diez-Redondo, María Henar Núñez Rodríguez, Raúl Honrubia-López, Cristina Fernández, Victoria Busto, Sofia Parejo, Marta Aicart-Ramos, Marina Solano, Silvia Patricia Ortega, Natalia Marcos, Francisco Javier García-Alonso, on behalf of the POLIPEVA study group; Clin Endosc 2026;59(4):653-662. Published online July 30, 2026; DOI: https://doi.org/10.5946/ce.2025.474

Graphical Abstract Abstract PDF Supplementary Material: Background
/Aims: Cold snare polypectomy (CSP) technique for polyps <10 mm varies widely among endoscopists. This study aimed to evaluate an online educational intervention for incomplete resections.
Methods
This multicenter trial was performed between 2021 and 2024. After a baseline assessment of incomplete resection rates for CSP of lesions <10 mm was completed, participants undertook a 1-hour online course led by an expert senior endoscopist. A second assessment was performed following course completion. Resections were evaluated using two marginal biopsies obtained after CSP, assessed by a single pathologist blinded to polyp histology. Follow-up was conducted by telephone 4 weeks after colonoscopy.
Results
A total of 29 endoscopists participated in the baseline assessment, yielding a baseline 4.8% incomplete resection rate, with a median individual rate of 4.3% (interquartile range [IQR], 2.9%–5.7%; range, 0%–15.6%). Thirteen endoscopists completed the course and participated in the second study phase, which included 1,271 polyps in phase 1 and 826 in phase 2. No significant improvement in incomplete resection rate was observed (4.8% in phase 1 vs. 4.0% in phase 2; difference, 0.8%; 95% confidence interval [CI], –1.1% to 2.6%; p=0.4). Among 3,087 polypectomies, intraprocedural bleeding occurred in 288 (9.3%) cases; most were self-limited, with only 45 (1.5%) requiring clipping. Delayed bleeding was observed in five (0.5%) patients, four of whom had mild bleeding and one severe. No perforations were observed.
Conclusions
The utility of online endoscopic technique courses appears limited. CSP demonstrates an excellent safety profile (ClinicalTrials.gov number: NCT04636619).

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Colonic Postpolypectomy Bleeding Is Related to Polyp Size and Heparin Use: Flavia Pigò, Helga Bertani, Mauro Manno, Vincenzo Giorgio Mirante, Angelo Caruso, Santi Mangiafico, Raffaele Manta, Anna Maria Rebecchi, Rita Luisa Conigliaro; Clin Endosc 2017;50(3):287-292. Published online February 9, 2017; DOI: https://doi.org/10.5946/ce.2016.126

Background
/Aims: We studied factors influencing colon postpolypectomy bleeding (PPB), with a focus on antithrombotic and anticoagulation therapy.
Methods
We conducted a retrospective case-control study of all patients who underwent polypectomy at our tertiary referral center in Italy between 2007 and 2014. Polyp characteristics (number of polyps removed per patient, size, morphology, location, resection technique, prophylactic hemostasis methods) and patient characteristics (age, sex, comorbidities, medication) were analyzed.
Results
The case and control groups included 118 and 539 patients, respectively. The two groups differed in the frequency of comorbidities (69% vs. 40%, p=0.001), polyps removed (27% vs. 18%, p=0.02), and use of heparin therapy (23% vs. 1%, p<0.001). A total of 279 polyps in the case group and 966 in the control group were nonpedunculated (69% vs. 81%, p=0.01) and measured ≥10 mm (78% vs. 32%, p=0.001). Multivariate analysis showed that polyps ≥10 mm (odds ratio [OR], 6.1; 95% confidence interval [CI], 2.3–15.5), administration of heparin (OR, 16.5; 95% CI, 6.2–44), comorbidity (OR, 2.3; 95% CI, 1.4–3.9), and presence of ≥2 risk factors (OR, 3.2; 95% CI, 1.7–6.0) were associated with PPB.
Conclusions
The incidence of PPB increases with polyp size ≥10 mm, heparin use, comorbidity, and presence of ≥2 risk factors.

Citations

Citations to this article as recorded by

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