777 COLD SNARE POLYPECTOMY OF COLORECTAL POLYPS ≤10MM ON CLOPIDOGREL: AN AUSTRALIAN AND NEW ZEALAND RANDOMISED CONTROLLED TRIAL

Optimal peri-colonoscopic management of clopidogrel remains unclear. Cold snare polypectomy (CSP) is safe for removing polyps ≤10mm and clips can control intra-procedural bleeding. We conducted a randomised controlled trial to compare continuation versus temporary interruption of clopidogrel for routine colonoscopy using CSP for polyps ≤10mm. Between August 2016 and August 2019, consenting patients at 12 institutions were randomised to continuation of clopidogrel as a single or dual antiplatelet agent or to temporary interruption of clopidogrel 7 days prior, to 2 days after routine colonoscopy. Proceduralists were blinded to group allocation. CSP was used to remove polyps ≤10mm with through-the-scope clips applied if intraprocedural bleeding continued for >2minutes. Outcome measures included bleeding and thromboembolic complications. Two hundred seventy-six consecutive polyps ≤10mm in size were removed in 107 patients. Of these, 61.7% were male with a median age of 69 [IQR 63 to 76.75]. Fifty nine patients continued and 48 temporarily interrupted clopidogrel. There was no difference in age and gender of patients, or median number, size and location of polyps removed. One hundred thirty four polyps were removed in 49 patients who continued clopidogrel vs 142 polyps removed in 43 patients who temporarily interrupted clopidogrel (p=0.94). Intraprocedural bleeding requiring clips occurred in 11/49 patients continuing and in 2/43 patients temporarily interrupting clopidogrel (p=0.02). More post-procedural minor bleeding was seen in the temporary interruption arm (6/43 vs 1/49; p=0.03). Each arm had 1 acute coronary syndrome that was medically managed. There was no clinically significant post-procedural bleeding (Table 1). Continuation of clopidogrel for cold snare polypectomy of colorectal polyps ≤10mm in size does not increase the rate of clinically significant post-polypectomy bleeding. It is associated with an increase in intraprocedural bleeding, which can be treated with clips.