Lin ZG, Deng K. Bleeding risk and prevention after colorectal polypectomy: What differs between cold and hot resection? World J Gastrointest Endosc 2026; 18(8): 121774 [DOI: 10.4253/wjge.121774]
Corresponding Author of This Article
Kai Deng, MD, PhD, Associate Professor, Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu 610041, Sichuan Province, China. dengkai@wchscu.cn
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Gastroenterology & Hepatology
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editorial
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Lin ZG, Deng K. Bleeding risk and prevention after colorectal polypectomy: What differs between cold and hot resection? World J Gastrointest Endosc 2026; 18(8): 121774 [DOI: 10.4253/wjge.121774]
World J Gastrointest Endosc. Aug 16, 2026; 18(8): 121774 Published online Aug 16, 2026. doi: 10.4253/wjge.121774
Bleeding risk and prevention after colorectal polypectomy: What differs between cold and hot resection?
Zhi-Gang Lin, Kai Deng
Zhi-Gang Lin, Kai Deng, Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Lin ZG collected and reviewed relevant literature; Deng K drafted the original manuscript; Lin ZG and Deng K conceived and designed the manuscript, critically revised the manuscript for important intellectual content, and read and approved the final version.
AI contribution statement: The authors take full responsibility and accountability for all content of this manuscript, including any portions for which AI tools were used as assistive technologies. All AI-assisted outputs were carefully reviewed, validated, and approved by the authors. AI tools were not used to generate original scientific data, perform independent scientific analyses, or draw scientific conclusions.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Corresponding author: Kai Deng, MD, PhD, Associate Professor, Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu 610041, Sichuan Province, China. dengkai@wchscu.cn
Received: April 2, 2026 Revised: June 9, 2026 Accepted: June 29, 2026 Published online: August 16, 2026 Processing time: 131 Days and 1.6 Hours
Abstract
In this editorial, we discuss the retrospective cohort study published in World Journal of Gastroenterology by Hwang et al, which identified immediate bleeding and trainee involvement as predictors of delayed post-polypectomy bleeding. These findings are clinically important because post-polypectomy bleeding remains the most common adverse event after colorectal polypectomy, yet its mechanisms and risk profiles differ according to resection technique. Cold techniques, including cold forceps polypectomy and cold snare polypectomy, are generally associated with a low risk of delayed bleeding because they avoid thermal injury, although the risk may still increase with larger lesions, pedunculated morphology, antithrombotic therapy, and unfavorable location. Current guidance therefore favors cold snare resection for most diminutive and small colorectal polyps. In contrast, hot techniques such as endoscopic mucosal resection and endoscopic submucosal dissection exhibit a distinct bleeding pattern due to vessel damage from electrocautery and tissue necrosis after the procedure. In endoscopic mucosal resection, bleeding risk is associated with larger lesion size, proximal or right-sided colonic location, antithrombotic use, and extensive mucosal defects; in selected high-risk right-sided lesions, prophylactic clip closure may reduce delayed bleeding. In colorectal endoscopic submucosal dissection, delayed bleeding is more often seen in patients with large lesions, rectal location, antithrombotic exposure, advanced age, and greater comorbidity burden. Overall, the findings by Hwang et al reinforce that post-polypectomy bleeding should be assessed and prevented in a procedure-specific and individualized manner, integrating resection method, lesion characteristics, antithrombotic use, intraprocedural bleeding events, and operator-related factors.
Core Tip: Bleeding risk after colorectal polypectomy differs between cold and hot resection because the mechanisms of tissue injury are distinct. Cold resection generally lowers delayed bleeding by avoiding thermal injury, whereas endoscopic mucosal resection and endoscopic submucosal dissection carry bleeding risks related to electrocautery and post-procedural necrosis. Prevention should be individualized according to resection method, lesion characteristics, antithrombotic exposure, and the potential benefit of prophylactic closure.
