Cold Snare Polypectomy in Small (< 10 mm) Pedunculated Colorectal Polyps: A Systematic Review and Meta-analysis

Department

Internal Medicine

Document Type

Article

Publication Title

Journal of Clinical Gastroenterology

Abstract

Introduction: Endoscopic removal techniques for colorectal polyps include cold snare polypectomy (CSP) and hot snare polypectomy (HSP). Although HSP is recommended for pedunculated polyps (PPs) larger than 10 mm, data regarding use of CSP for PPs < 10 mm continues to emerge. We aimed to investigate outcomes of these techniques in small (< 10 mm) pedunculated colorectal polyps.

Methods: Multiple databases were searched till June 2022 to identify studies involving the removal of small PPs with CSP and HSP. Random effects model was used to calculate outcomes and 95% CI. Primary outcome was the pooled rate of successful en-bloc resection. Secondary outcomes were immediate and delayed bleeding with CSP and HSP as well as prophylactic and post resection clip placement.

Results: Six studies including 1025 patients (1111 polyps with a mean size 4 to 8.5 mm) were analyzed. 116 and 995 polyps were removed with HSP and CSP, respectively. The overall pooled rate of successful en-bloc resection with CSP was 99.7% (CI 99.1-99.9; I2 0%). Pooled immediate and delayed bleeding after CSP was 49.8% (CI 46.8-52.91; I2 98%) and 0% (CI 0.00-0.00; I2 0%), respectively. Delayed bleeding was higher with HSP, relative risk 0.05 (CI 0.01-0.43; I2 0%), P =0.006, whereas immediate bleeding was higher with CSP, relative risk 7.89 (CI 4.36-14.29; I2 0%), P < 0.00001. Pooled rates of prophylactic clip placement and post-procedure clip placement (to control immediate bleeding) were 55.3% and 47.2%, respectively. Finally, right colon polyp location significantly correlated with frequency of immediate bleeding.

Conclusion: Our analysis shows that CSP is safe and effective for resection of small PPs.

First Page

370

Last Page

377

DOI

10.1097/MCG.0000000000001848

Volume

58

Issue

4

Publication Date

4-1-2024

Medical Subject Headings

Humans; Colonic Polyps (surgery); Colonoscopy (methods); Colon; Postoperative Hemorrhage (etiology, prevention & control); Colorectal Neoplasms (surgery)

PubMed ID

38289665

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