Bleeding risk and prevention after colorectal polypectomy: What differs between cold and hot resection?

Table 3 Main bleeding risk factors and practical considerations after hot resection

Risk domain	Main risk factors	Suggested approach
Patient-related	Antithrombotic therapy, thrombocytopenia, renal dysfunction, cirrhosis, advanced age	Consider these factors when planning electrocautery-based resection. In higher-risk patients, limit unnecessary thermal injury and consider selective closure of large right-sided H-EMR defects or selected ESD defects
Lesion-related	Large lesion size, right-sided colonic location, rectal/rectosigmoid location, pedunculated polyps with a large head or thick stalk	Use diluted epinephrine injection and/or mechanical prophylaxis for pedunculated polyps with a large head or thick stalk. Consider selective closure after H-EMR of large right-sided lesions and after selected large rectal or rectosigmoid ESD defects
Procedure-related	Thermal injury, piecemeal EMR, large mucosal defects, extensive submucosal dissection	Carefully inspect the resection defect, treat exposed vessels when present, and reserve prophylactic closure for selected high-risk defects

H-EMR: Hot endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; EMR: Endoscopic mucosal resection.