Efficacy and Safety of Cold Versus Hot Snare Endoscopic Mucosal Resection in Colorectal Polyp Removal: A Systematic Review and Meta-Analysis

Authors

Chengu Niu, Rochester Regional HealthFollow
Jing Zhang, Rainier Springs Behavioral Health Hospital, Vancouver, WA.
Utsav Joshi, Rochester Regional HealthFollow
Ahmed Elkhapery, Rochester Regional HealthFollow
Hemanth Krishna Boppana, Rochester Regional HealthFollow
Patrick I. Okolo, Rochester Regional HealthFollow

Department

Internal Medicine

Additional Department

Gastroenterology

Document Type

Article

Publication Title

Journal of Clinical Gastroenterology

Abstract

Background: Cold snare endoscopic mucosal resection (C-EMR) is hypothesized to offer a safety advantage over hot snare endoscopic mucosal resection (H-EMR). The primary objective of this meta-analysis is to evaluate the effectiveness and safety of C-EMR versus H-EMR for the management of colorectal lesions.

Methods: A meta-analysis was performed to determine pooled odds ratios (ORs) for comparing outcomes between the C-EMR and H-EMR groups.

Results: The pooled OR for complete resection rates were estimated at 0.70 (95% CI: 0.36-1.36, P =0.29) and en bloc rates were 0.24 (95% CI: 0.05-1.08, P =0.06) between C-EMR group and H-EMR group. The overall complete resection rate for C-EMR was 84%, and the en bloc resection rate was 57. Notably, C-EMR was associated with a significantly lower incidence of delayed bleeding. The recurrence rate of polyps was very low (2%) when treating sessile serrated polyp (SSP) lesions, but higher (23%) for non-SSP lesions. Subgroup analysis revealed minimal recurrence of polyps after using C-EMR for lesions between 10 to 20 mm and ≥ 20 mm.

Conclusions: This meta-analysis suggests that C-EMR could be a safer and equally effective alternative to H-EMR for resecting colorectal lesions. We recommend C-EMR as the preferred method for excising large colorectal lesions.

First Page

6

Last Page

15

DOI

10.1097/MCG.0000000000002059

Volume

59

Issue

1

Publication Date

1-1-2025

Medical Subject Headings

Humans; Endoscopic Mucosal Resection (methods, adverse effects); Colonic Polyps (surgery, pathology); Treatment Outcome; Colonoscopy (methods, adverse effects); Colorectal Neoplasms (surgery, pathology)

PubMed ID

39145841

Recommended Citation

Niu, C., Zhang, J., Joshi, U., Elkhapery, A., Boppana, H. K., & Okolo, P. I. (2025). Efficacy and Safety of Cold Versus Hot Snare Endoscopic Mucosal Resection in Colorectal Polyp Removal: A Systematic Review and Meta-Analysis. Journal of Clinical Gastroenterology, 59 (1), 6-15. https://doi.org/10.1097/MCG.0000000000002059