Clin Endosc.  2024 Nov;57(6):747-758. 10.5946/ce.2024.081.

Cold snare polypectomy versus cold endoscopic mucosal resection for small colorectal polyps: a meta-analysis of randomized controlled trials

• Moond V
• Loganathan P
• Malik S
• Dahiya DS
• Mohan BP
• Ramai D
• McGinnis M
• Madhu D
• Bilal M
• Shaukat A
• Chandan S

• KMID: 2561156
• DOI: http://doi.org/10.5946/ce.2024.081

Abstract

Background/Aims
Cold snare polypectomy (CSP) is routinely performed for small colorectal polyps (≤10 mm). However, challenges include insufficient resection depth and immediate bleeding, hindering precise pathological evaluation. We aimed to compare the outcomes of cold endoscopic mucosal resection (CEMR) with that of CSP for colorectal polyps ≤10 mm, using data from randomized controlled trials (RCTs).
Methods
Multiple databases were searched in December 2023 for RCTs reporting outcomes of CSP versus CEMR for colorectal polyps ≤10 mm in size. Our primary outcomes were rates of complete and en-bloc resections, while our secondary outcomes were total resection time (seconds) and adverse events, including immediate bleeding, delayed bleeding, and perforation.
Results
The complete resection rates did not significantly differ (CSP, 91.8% vs. CEMR 94.6%), nor did the rates of en-bloc resection (CSP, 98.9% vs. CEMR, 98.3%) or incomplete resection (CSP, 6.7% vs. CEMR, 4.8%). Adverse event rates were similarly insignificant in variance. However, CEMR had a notably longer mean resection time (133.51 vs. 91.30 seconds).
Conclusions
Our meta-analysis of seven RCTs showed that while both CSP and CEMR are equally safe and effective for resecting small (≤10 mm) colorectal polyps, the latter is associated with a longer resection time.

Keyword

Cold snare polypectomy; Colorectal cancer; Endoscopic mucosal resection; Submucosal injection

Figure

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  Fig. 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses study selection flowchart. CSP, cold snare polypectomy; CEMR, cold endoscopic mucosal resection.

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  Fig. 2. Forest plot showing complete resection rates of cold snare polypectomy (CSP) vs. cold endoscopic mucosal resection (CEMR). CI, confidence interval.

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  Fig. 3. Forest plot showing en-bloc resection rates of cold snare polypectomy (CSP) vs. cold endoscopic mucosal resection (CEMR). CI, confidence interval.

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  Fig. 4. Forest plot showing incomplete resection rates of cold snare polypectomy (CSP) vs. cold endoscopic mucosal resection (CEMR). CI, confidence interval.

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