Effectiveness and safety of cold <i>versus</i> hot snare polypectomy: A meta‐analysis

Qu, Junyan; Jian, Haixu; Li, Lixiang; Zhang, Yan; Feng, Bing-cheng; Li, Zhen; Zuo, Xu

doi:10.1111/jgh.14464

Cited by 53 publications

(85 citation statements)

References 30 publications

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“…Furthermore, the incomplete resection rate of CFP was significantly higher than that of CSP. These results are comparable with those of a previous systematic review and meta-analysis [7][8][9][10][11]. However, we performed a subgroup analysis stratified by polyp size, which was not performed in previous reports.…”

Section: Discussionsupporting

confidence: 89%

“…Recently, trials comparing the effects and risks of CSP and hot snare polypectomy (HSP) or endoscopic mucosal resection (EMR) for colorectal polyps ! 10 mm have been reported, and systematic reviews with meta-analyses that integrated those trials have been published [7][8][9]. However, the polyp size was not evaluated in these studies, and no metaanalysis analyzed the influence of the polyp size.…”

Section: Introductionmentioning

confidence: 99%

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Indications for Cold Polypectomy Stratified by the Colorectal Polyp Size: A Systematic Review and Meta-Analysis

Kawamura

Takeuchi

Yokota

et al. 2020

J Anus Rectum Colon

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Objectives: Cold polypectomy (CP) is widely used because of its safety profile. This systematic review and meta-analysis aimed to clarify the indications for CP based on polyp size. Methods: We searched PubMed and the Cochrane Library for randomized controlled trials that compared cold snare polypectomy (CSP) and other procedures for polyps ! 10 mm. Large-scale prospective observational studies were also searched to assess delayed bleeding rates. The studies were integrated to assess the risk ratio for incomplete resection rates according to polyp size. The Cochrane risk of bias tool was used to evaluate the study bias. The certainty of cumulative evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system. Results: We found 280 articles and reviewed their eligibility. We selected and extracted 12 randomized controlled trials and 3 prospective observational studies. The risk ratio of incomplete resection of polyps ! 10 mm using CSP compared with hot snare polypectomy (HSP) was 1.36 (95% confidence interval [CI], 0.92-2.01). The risk ratio for incomplete removal using CSP compared with cold forceps polypectomy (CFP) was 0.50 (95% CI, 0.31-0.82). For polyps ! 3 mm, the risk ratio of CSP compared with CFP was 1.40 (95% CI, 0.39-4.95). Certainty of cumulative evidence was considered low. No delayed bleeding after CP was reported after the treatment of 3446 polyps. Conclusions: CSP and HSP may result in the same complete resection rates for polyps ! 10 mm. For polyps ! 3 mm, CFP and CSP may have the same resection rates (PROSPERO registration number: CRD 42019122132).

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Indications for Cold Polypectomy Stratified by the Colorectal Polyp Size: A Systematic Review and Meta-Analysis

Kawamura

Takeuchi

Yokota

et al. 2020

J Anus Rectum Colon

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“…Indeed, with cold snare resection there is no coagulated eschar formation, thus significantly reducing the delayed bleeding from sloughing. For lesions <10 mm, a shorter procedural time has already been demonstrated, 27,28 and the gain could theoretically be greater for larger lesions.…”

Section: Discussionmentioning

confidence: 93%

Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis

Chandrasekar

Spadaccini

Aziz

et al. 2019

Gastrointestinal Endoscopy

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“…Most polyps encountered during colonoscopy are either diminutive (<5 mm) or small (6-9 mm) nonpedunculated polyps. The current ESGE guidelines 32 recommend CSP as the preferred technique for the removal of subcentimeter (<10 mm) polyps, with a recent meta-analysis 33 supporting this recommendation. A recent multicenter randomized controlled trial 34 showed that CSP is not inferior (comparable resection rate) to HSP for small nonpedunculated polyps with a superior safety profile (lower delayed PPB rate).…”

Section: Prevention Of Post-polypectomy Bleedingmentioning

confidence: 98%

Endoscopic Management of Post-Polypectomy Bleeding

Gutta

Gromski

2020

Clin Endosc

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Post-polypectomy bleeding (PPB) is one of the most common complications of endoscopic polypectomy. There are multiple risk factors related to patient and polyp characteristics that should be considered. In most cases, immediate PPB can be effectively managed endoscopically when recognized and managed promptly. Delayed PPB can manifest in a myriad of ways. In severe delayed PPB, resuscitation for hemodynamic stabilization should be prioritized, followed by endoscopic evaluation and therapy once the patient is stabilized. Future areas of research in PPB include the risks of direct oral anticoagulants and of specific electrosurgical settings for hot-snare polypectomy vs. cold-snare polypectomy, benefits of closure of post-polypectomy mucosal defects using through-the-scope clips, and prospective comparative evaluation of newer hemostasis agents such as hemostatic spray powder and over-the-scope clips.Clin Endosc 2020;53:302-310

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Effectiveness and safety of cold versus hot snare polypectomy: A meta‐analysis

Abstract: Cold snare polypectomy is a safe, efficient, and effective polypectomy technique for diminutive or small colorectal polyps.

Cited by 53 publications

References 30 publications

Indications for Cold Polypectomy Stratified by the Colorectal Polyp Size: A Systematic Review and Meta-Analysis

Indications for Cold Polypectomy Stratified by the Colorectal Polyp Size: A Systematic Review and Meta-Analysis

Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis

Endoscopic Management of Post-Polypectomy Bleeding

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