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Background and Aim: A hemostatic gel, PuraStat (3‐D Matrix, Tokyo, Japan), is used for various gastrointestinal hemostasis. In this study, we analyzed the efficacy of PuraStat for perioperative bleeding (POB) and prevention of delayed bleeding (DB) to colorectal cold snare polypectomy (CSP) with continuous anticoagulant. Methods: This was a single‐center, retrospective study. Subjects were lesions of 2–9 mm under continuous anticoagulant from 2021 to 2023 and treated with PuraStat for POB. The definition of POB was bleeding which did not stop spontaneously by 1.0–1.5 min after resection and needed hemostasis. Successful hemostasis was defined as cessation of bleeding within 1.0–1.5 min after spraying PuraStat and the rate of it and risk factors of POB were analyzed. For comparison, cases receiving previous CSP without PuraStat were extracted from all cases with CSP (2018‐2021), and POB and DB rate (DBR) were analyzed after propensity score matching. Results: One hundred twenty‐two lesions (91: direct oral anticoagulant (DOAC), 31: warfarin) with anticoagulant were analyzed and the rate of successful hemostasis with PuraStat was 92.6% (DOAC/warfarin: 93.4%/80.6%, P = 0.01). The rate of DB was 0.0%. Multivariate analysis showed that significant risk factors about unsuccessful hemostasis for POB with PuraStat were lesion size 8–9 mm (P < 0.01), warfarin (P = 0.01), and combination of antiplatelet (P = 0.01). Regarding the comparison about CSP with/without PuraStat, the clipping rate and DBR were 8.5%/94.9% (P < 0.01) and 0%/1.7% (P = 1.0). Conclusion: The effects of PuraStat for POB and DB in colorectal CSP with continuous anticoagulant were acceptable. [ABSTRACT FROM AUTHOR]

Background and Aim: High‐grade dysplasia (HGD) and T1 lesions are accidentally resected by cold snare polypectomy (CSP) and the characteristics, and follow‐up of them has not been reported. In this study, we analyzed the histopathological findings and recurrence of them. Methods: This was a multicenter retrospective‐cohort study. We collected HGD and T1 lesions of ≤ 10 mm resected by CSP among 15 520 patients receiving CSP from 2014 to 2019 at nine related institutions, and we extracted only cases receiving definite follow‐up colonoscopy after CSP of HGD and T1 lesions. We analyzed these tumor's characteristics and therapeutic results such as R0 resection and local recurrence and risk factors of recurrence. Results: We collected 103 patients (0.63%) and extracted 80 lesions in 74 patients receiving follow‐up colonoscopy for CSP scar. Mean age was 68.4 ± 12.0, and male rate was 68.9% (51/80). The mean tumor size (mm) was 6.6 ± 2.5, and the rate of polypoid morphology and rectum location was 77.5% and 25.0%. The rate of magnified observation was 53.8%. The rates of en bloc resection and R0 resection were 92.5% and 37.5%. The local recurrence rate was 6.3% (5/80, median follow‐up period: 24.0 months). The recurrence developed within 3 months after CSP for four out of five recurrent cases. Comparing five recurrent lesions to 75 non‐recurrent lesions, a positive horizontal margin was a significant risk factor (60.0% vs 10.7%, P < 0.001). Conclusions: High‐grade dysplasia and T1 resected by CSP were analyzed, and the local recurrence rate of them was substantially high. [ABSTRACT FROM AUTHOR]

Cold snare polypectomy (CSP) has the disadvantage of a lower histopathological complete resection rate (HCRR) because blunt resection using CSP‐dedicated snares (DSs) causes mucosal retraction into the sheath during capture/resection. In this study, attachments are designed to narrow the sheath tip's inner diameter from 1.8 to 1.3‒1.1 mm to prevent mucosal retraction. Eight prototype snares with different component characteristics are combined with these attachments. Additionally, product version DS with attachment (Smart Snare Cold) and existing DSs, such as Exacto Cold Snare, are prepared. For snare performance evaluation, the force required to resect (FRR) human colonic mucosa, mucosal retraction amount (MRA), and clinical data are obtained. The attachments that narrowed the inner diameter to 1.3 or 1.1 mm reduce the FRR to 74.9%−93.8% and 68.0%−84.9%, respectively, and reduce the MRA to 21.0%−35.3% and 15.1%−26.8%, respectively. Thus, the reduced inner diameter improves resection ability and prevents mucosal retraction. The clinical findings show that Smart Snare Cold has significantly higher muscularis mucosa resection rates and HCRRs than Exacto Cold Snare (P < 0.001 and P = 0.003, respectively). Thus, the novel DS with tip attachment improves the HCRR and overcomes the current CSP disadvantage by simultaneously improving resection ability and preventing mucosal retraction. [ABSTRACT FROM AUTHOR]