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

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

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