Cold snare polypectomy vs. hot snare polypectomy vs. argon plasma coagulation for small (5–9mm) left-sided colorectal polyps: a prospective randomized trial

Abstract

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Different endoscopic treatments for small colorectal polyps: A systematic review, pair-wise, and network meta-analysis

“…For IB rate, eleven articles compared five different treatments (2,670 polyps) ( 27 , 32 – 38 , 40 , 43 , 44 ). Besides two articles reported no IB in the UCSP group (0/279 polyps), ( 41 , 42 ) and one three-arm study reported no IB in the APC group (0/39 polyps) ( 33 ). No statistically significant differences were found between the five different treatments ( Figure 4B ; Supplementary Table 3 ).…”

“…A flow chart of the trial selection process is shown in Figure 1 . Fourteen articles compared HSP with CSP, ( 15 , 16 , 21 , 25 – 35 ) three articles compared HSP to EMR, ( 31 , 36 , 37 ) three articles compared CSP to CS-EMR, ( 31 , 38 , 39 ) two articles compared CSP to EMR, ( 31 , 40 ) two articles compared CSP to UCSP, ( 41 , 42 ) one article compared CS-EMR to EMR, ( 43 ) one article compared UEMR to EMR, ( 44 ) and one article compared APC to HSP and CSP ( 33 ). All studies were published after 2010, and nine studies were multicenter studies.…”

“…Sensitivity analysis for the primary outcome showed similar outcome. After excluding 4 articles using R0 resection rate ( 33 , 35 , 38 , 42 ). In NMA of 13 articles, HSP had higher complete resection rate than CSP (OR: 2.7, 95% CI: 1.1–13, I 2 = 33.1%) confirming the outcomes of the primary analyses ( Supplementary Figure 4 ).…”

“…And after excluding articles using R0 resection rate, sensitivity analysis showed similar outcome to our primary analysis. Meanwhile, as the most accurate evaluation method, recent RCTs also found higher rates of polyp recurrence in the CSP group in follow-up colonoscopy, although with no statistically significant difference ( 28 , 33 , 35 ). More high-quality evidence on findings at surveillance colonoscopy is needed.…”

Argon plasma in the polyps treatment is a promising technique that requires evidence

“…Although it is not the first time of using APC ablation in polyps treatment, the best evidence came from a recently published prospective randomized trial which compared the recurrence rates between cold snare polypectomy, hot snare polypectomy, and argon plasma coagulation for small (5–9 mm) left-sided colorectal polyps and concluded that there was no difference in polyp recurrence rate among the three endoscopic techniques. They used the following setting for (APC) ablation (50–60 W, flow: 2 L/min) which differs from the case report APC setting, this indicates that there is no evidence-based consensus on APC settings [ 9 ]. The previous trial limitations were: included only small polyps< 10 mm, in addition to a short following-up period as the recurrence will require more than 6 months or even year to be detected.…”