Li LD, Chen ZH, Zhong YS, He DL, Zhu DX, Xu JM, Jing JC. Safety of opening wounds after cold resection of colorectal cancer patients’ intestinal polyps ten mm or larger. World J Gastrointest Endosc 2026; 18(5): 120628 [DOI: 10.4253/wjge.v18.i5.120628]
Corresponding Author of This Article
Jia-Chen Jing, MD, Endoscopy Center, Shanghai Xuhui Central Hospital, No. 366 Longchuan North Road, Shanghai 200030, China. jingjiachen2025@126.com
Research Domain of This Article
Surgery
Article-Type of This Article
Clinical Trials Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
May 16, 2026 (publication date) through May 12, 2026
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Journal Information of This Article
Publication Name
World Journal of Gastrointestinal Endoscopy
ISSN
1948-5190
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Li LD, Chen ZH, Zhong YS, He DL, Zhu DX, Xu JM, Jing JC. Safety of opening wounds after cold resection of colorectal cancer patients’ intestinal polyps ten mm or larger. World J Gastrointest Endosc 2026; 18(5): 120628 [DOI: 10.4253/wjge.v18.i5.120628]
Lin-Da Li, Zhang-Han Chen, Yun-Shi Zhong, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Dong-Li He, Jia-Chen Jing, Endoscopy Center, Shanghai Xuhui Central Hospital, Shanghai 200030, China
De-Xiang Zhu, Jian-Min Xu, Department of Colorectal Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Author contributions: Zhong YS and Jing JC designed the study; Li LD and Chen ZH performed data collection, organization, and analysis; Li LD wrote the manuscript; Zhong YS and Jing JC revised and reviewed the manuscript; He DL, Zhu DX, and Xu JM contributed to data collection.
Supported by National Natural Science Foundation of China, No. 82273025 and 82403010.
Institutional review board statement: The study was reviewed and approved by the Zhongshan Hospital Institutional Review Board (No. B2022-421R).
Clinical trial registration statement: This study is registered in the Chinese Clinical Trial Registry (ChiCTR2200065019).
Informed consent statement: The clinical trial protocol was approved by the institutional ethics committee of Zhongshan Hospital, which determined that no additional informed consent beyond routine consent for endoscopic procedures was required.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Corresponding author: Jia-Chen Jing, MD, Endoscopy Center, Shanghai Xuhui Central Hospital, No. 366 Longchuan North Road, Shanghai 200030, China. jingjiachen2025@126.com
Received: March 4, 2026 Revised: April 2, 2026 Accepted: April 29, 2026 Published online: May 16, 2026 Processing time: 69 Days and 14.5 Hours
Abstract
BACKGROUND
Current guidelines have not reached consensus on hemostatic management for large polyps (10-20 mm) removed by cold snare polypectomy (CSP). In light of the low complication rate of CSP and the potential hypercoagulability in colorectal cancer (CRC) patients, prophylactic hemoclip use after CSP for polyps ≥ 10 mm appears unlikely to reduce bleeding risk in patients with suspected colorectal cancer.
AIM
To evaluate the necessity of prophylactic hemoclip use after CSP for polyps ≥ 10 mm in patients with CRC.
METHODS
This prospective cohort study with a historical control was conducted in Zhongshan Hospital. A total of 110 patients undergoing CSP without prophylactic hemoclip closure were prospectively enrolled (November 2022-October 2023), while 94 patients who received prophylactic hemoclip closure (November 2021-November 2022) served as controls. Inverse probability of treatment weighting (IPTW) was applied to balance baseline confounders. Rare bleeding events were analyzed using Firth penalized-likelihood logistic regression, and quantile regression was used to evaluate procedural time and cost.
RESULTS
Before weighting, the non-clipping group showed significantly shorter procedural time (25.31 ± 16.75 minutes vs 29.31 ± 14.97 minutes; Z = 2.49, P = 0.01) and lower cost (4604.75 ± 2564.28 CNY vs 4915.55 ± 2327.80 CNY; Z = 2.06, P = 0.04) compared to the control group. After IPTW adjustment, no statistically significant differences were found in intraoperative or postoperative bleeding rates between the groups. Quantile regression indicated no significant difference in operative time across quantiles (all P > 0.05). However, a significant association was observed at the 0.25 quantile with cost (coefficient = -382.282, P = 0.035), suggesting non-use of clips was associated with reduced cost in the lower-cost subgroup.
CONCLUSION
In this cohort, prophylactic hemoclip use does not significantly alter bleeding risk or procedural time for CSP of polyps ≥ 10 mm, but its utilization strategy may impact cost containment.
Core Tip: The routine use of prophylactic hemoclips following cold snare polypectomy for colorectal polyps ≥ 10 mm does not reduce the risk of bleeding but is associated with increased operative time and cost. This study, utilizing advanced statistical methods (inverse probability of treatment weighting, Firth regression, etc.), suggests that a non-clipping strategy yields comparable safety outcomes while potentially enhancing procedural efficiency and cost-effectiveness, challenging a common clinical practice.
