Multiple-Bite Cold Forceps Polypectomy for Diminutive Colorectal Polyps ≤5 mm: Outcomes in Patients on Antithrombotic Therapy

BACKGROUND AND AIMS: Although some studies have explored the efficacy of cold forceps polypectomy (CFP) for diminutive colorectal polyps (DCPs) ≤3 mm, data on the efficacy and safety of multiple-bite CFP (MB-CFP) in antithrombotic-treated patients with DCPs ≤5 mm remain scarce. This study aimed to investigate the efficacy and safety of MB-CFP in this patient cohort. METHODS: This was a retrospective study conducted at a single academic hospital. A total of 1201 consecutive patients with 2344 eligible polyps were enrolled. To fully evaluate the efficacy of MB-CFP, we defined histologic polyp eradication specifically according to the present study protocol to enable quantitative comparison. RESULTS: The mean number of bites in the MB-CFP group was 3.2. Both histologic and visual polyp eradication rates were comparable between the cold snare polypectomy (CSP) and MB-CFP groups (P>0.05). MB-CFP and CSP exhibited comparable polyp recurrence rates (P>0.05), both of which were lower than that in the single-bite CFP (SB-CFP) group (P<0.05). Tissue retrieval failure was higher in the CSP group than in the MB-CFP and SB-CFP groups (P<0.001). Adverse events (AEs) were comparable among the 3 groups (P>0.05). Logistic regression analysis identified polyp resection method, colorectal polyp classification, and polyp size as independent predictors of incomplete histologic polyp eradication (OR=5.100, 95% CI=1.985-13.103; OR=34.484, 95% CI=24.500-48.536; OR=0.188, 95% CI=0.132-0.266; all P≤0.001, respectively). CONCLUSIONS: MB-CFP was effective and safe for the treatment of DCPs in patients receiving antithrombotic therapy, with favorable outcomes regarding AEs and polyp recurrence.