No abstract

Background and study aim Cold snare endoscopic mucosal resection (CS-EMR) can reduce some of the risks associated with electrocautery use during colon polyp resection. Data regarding efficacy have yielded variable results. We conducted a systematic review and meta-analysis to estimate the pooled efficacy and safety rates of CS-EMR. Patients and methods We conducted a literature search of multiple databases for studies addressing outcomes of CS-EMR for colon polyps from inception through March 2023. The weighted pooled estimates with the 95% confidence interval (95% CI) were calculated using the random effects model. I2 statistics was used to evaluate heterogeneity. Results 4137 articles were reviewed, and 16 studies met the inclusion criteria. 2584 polyps were removed from 1930 patients and48.9% were females. 54.4% were adenomas, 45% were sessile serrated lesions (SSLs), and 0.6% were invasive carcinoma. Polyp recurrence after CS-EMR was 6.7% (95% CI: [2.4-17.4%], I2=94%). The recurrence rate for polyps ≥ 20 mm was 12.3% (95% CI: [3.4-35.7%], I2= 94.%), 17.1% (95% CI: [4.6-46.7%], I2= 93%) for adenomas, and 5.7% (95% CI: [3.2-9.9%], I2= 50%) for SSLs. The pooled intraprocedural bleeding rate was 2.6% (95% CI: [1.5-4.4%], I2=51%), the delayed bleeding rate was 1.5% (95% CI: [0.9-2.8%], I2=20%) and no perforations or post-polypectomy syndromes were reported with estimated rates of 0.6% (95% CI: [0.3-1.2%], I2=0%) and 0.6% (95% CI: [0.2-1.3%], I2=0%), respectively. Conclusion CS-EMR demonstrated an excellent safety profile for colon polyps with variable recurrence rates based on polyp size and histology. Large prospective studies are needed to validate these findings.

No abstract

Introduction: Cold snare endoscopic mucosal resection (CS-EMR) has become increasingly popular for the removal of colon polyps . 10 mm. CS-EMR can potentially avert some of the risks associated with the use of electrocautery during polyp resection without compromising clinical efficacy. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of CS-EMR in removing colon polyps. Methods: We conducted a comprehensive literature search of MEDLINE, EMBASE, Cochrane, ClinicalTrials.gov, and Scopus databases for studies published in the English language addressing outcomes of CS-EMR for colon polyps from database inceptions through April 2022. The weighted pooled estimates with the 95% confidence interval (CI) were calculated. Cochran Q test and I 2 statistics were used to evaluate heterogeneity. Results: We identified 3599 articles on the initial search, and 32 full-text studies were assessed for eligibility. Fifteen studies met inclusion criteria. There were three randomized controlled trials, six prospective, and six retrospective studies. Six studies were from the United States, two each from Australia, China, and Japan, one from the United Kingdom, and one from Greece. A total of 2382 polyps were removed from 1756 patients. 45% were females. Polyps ranged from 6-80 mm in size, and 72.4% were proximal to the splenic flexure. In addition, 50.4% of the polyps were NICE I or serrated lesions and 48.5% were NICE II, and 0.1% were NICE III. Polyp recurrence rate after CS-EMR was 9.4 % (95% CI: 3.3-15.6%, I 2 5 95.8%), piecemeal resection rate 59.4% (95% CI: 46.3-72.4%, I25 99.9%), and complete histological resection rate (defined by post polypectomy biopsies) was 93.1% (95% CI: 88.7-97.6%, I 2 590.8%). For adverse events, delayed post-polypectomy bleeding rate was 0.8% (95% CI: 0.3-1.3%, I 2 5 21.4%), perforation and the post-polypectomy syndrome rate was 0.3% (95% CI: 0-0.5%, I 2 5 0%) (Figure). Given significant heterogeneity in recurrence rate, subgroup analyses were performed. Recurrence rate in serrated lesions (n5484) was 3.8% (95% CI: 0.2-7.4%, I 2 5 76.7%), in polyps , 20 mm (n5 137) 0.8% (95% CI: -0.7-2.3%, I 2 5 0%), and in polyps $ 20 mm (n5617) 15.7% (95% CI: 2.6-28.7%, I 2 5 95.2%). Conclusion: CS-EMR has an excellent safety profile and acceptable recurrence rate for resection of colon polyps, especially for polyps , 20 mm and serrated lesions. However, large prospective studies to validate safety and efficacy are needed.[0161] Figure 1. Forest plots of A) recurrence rate, B) complete histological resection, C) delayed post polypectomy bleeding, and D) perforation of cold snare endoscopic mucosal resection in colon polyps

No abstract