Systematic review and meta-analysis
Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis

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Background and Aims

Hot snare polypectomy and EMR are the standard of care in resecting colorectal polyps ≥10 mm. To avoid the risk of electrocautery-induced damage, there is recent evidence about using cold snare polypectomy and cold EMR for such lesions. The aim of this pooled analysis is to report outcomes of cold snare resection for polyps ≥10 mm.

Methods

PubMed/Medline, Embase, Google Scholar, and Cochrane databases were searched up to July 2018 to identify studies that performed cold snare resection for colorectal polyps ≥10 mm. Primary outcomes were adverse events (bleeding, perforation, and postpolypectomy abdominal pain), and secondary outcomes were the rates of complete resection, overall residual polyp rates, and rates for adenomas versus sessile serrated polyps (SSPs). Subgroup analysis was performed focusing on lesion size, location, and resection technique.

Results

Eight studies were included in the final analysis that included 522 colorectal polyps with a mean polyp size of 17.5 mm (range, 10-60). The overall adverse event rate was 1.1% (95% confidence interval, CI, 0.2%-2.0%; I2 = 0%). Intra- and postprocedural bleeding rates were .7% (95% CI, 0%-1.4%) and .5% (95% CI, .1%-1.2%), respectively, with abdominal pain rate being .6% (95% CI, .1%-1.3%). Polyps ≥20 mm had a higher intraprocedural bleeding rate of 1.3% (95% CI, .7%-3.3%) and abdominal pain rate of 1.2% (95% CI, .7%-3.0%) but no delayed bleedings. No perforations were reported. The complete resection rate was 99.3% (95% CI, 98.6%-100%). Overall pooled residual rates of polyps of any histology, adenomas, and SSPs were 4.1% (95% CI, .2%-8.4%), 11.1% (95% CI, 4.1%-18.1%), and 1.0% (95% CI, .4%-2.4%), respectively, during a follow-up period ranging from 154 to 258 days.

Conclusions

The results of this systematic review and pooled analysis were excellent with cold snare resection of colorectal polyps >10 mm in terms of postpolypectomy bleeding, complete resection, and residual polyp rates. Randomized controlled trials comparing cold snare resection with hot snare resections of polyps ≥10 mm are required for further investigation.

Section snippets

Methods

The methods of our analysis and inclusion criteria were based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Our systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO, www.crd.york.ac.uk/prospero/) on August 2018 (registration number: CRD42018110447). Appendix 1 (available online at www.giejournal.org) provides further information on data sources and search strategy, selection process, data

Study characteristics and quality

The literature search resulted in 54 articles (Fig. 1). After reviewing the title and abstract, 8 articles were retrieved as full text. Of these, 8 articles matched the selection criteria and were finally included in the analysis.13, 14, 15, 16, 17, 18, 19, 20 Only polyps that were resected without the aid of electrocautery were included for analysis from all studies. In total, the 8 studies included 522 polyps endoscopically removed by using the cold snare techniques, with 55.3% of patients

Discussion

This systematic review and pooled analysis of the available literature provides data on the safety and efficacy of cold snare resections and cold EMR for polyps ≥10 mm in size. Currently, data are limited and available mainly in the form of single-center studies; hence, this pooled analysis was done to provide a better understanding of this technique in the resection of colorectal polyps. According to our pooled analysis, the results (efficacy and safety) of cold snare resections are highly

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    DISCLOSURE: Dr Sharma received grant support from Fujifilm, US Endoscopy, and Medtronic, and was consultant for Boston Scientific and Olympus. All other authors disclosed no financial relationships relevant to this publication.

    If you would like to chat with an author of this article, you may contact Dr Spadaccini at [email protected].

    Drs Thoguluva Chandrasekar and Spadaccini contributed equally to this article.

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