Effectiveness and safety of the different endoscopic resection methods for 10- to 20-mm nonpedunculated colorectal polyps

Yuan, Xin; Gao, Huizhi; Liu, Cenqin; Cui, Hongyao; Zhang, Zhixin; Xie, Jiarong; Lu, Hongpeng; Xu, Lei

doi:10.4103/sjg.sjg_180_21

Cited by 12 publications

(7 citation statements)

References 55 publications

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“…These findings have been shown in several studies and meta-analyses comparing different polypectomy techniques, such as HSP, EMR, CSP, and CS-EMR. [27,28] However, more data is needed to evaluate the safety of CS-EMR in patients at higher risk for bleeding; such as patients on antiplatelet or anticoagulation therapy.…”

Section: Discussionmentioning

confidence: 99%

Cold snare endoscopic mucosal resection for colon polyps: a systematic review and meta-analysis

et al. 2023

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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.

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Section: Discussionmentioning

confidence: 99%

Cold snare endoscopic mucosal resection for colon polyps: a systematic review and meta-analysis

et al. 2023

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“…A meta-analysis of 36 studies showed that the pooled R0 resection and en bloc resection rates were 90% and 82%, respectively, for U-EMR, while the pooled rate of R0 resection was 98% for CS-EMR. 70 The adverse events post-U-EMR or CS-EMR were similar and lower than those of HS-EMR. 70 Studies comparing the U-EMR to HS-EMR showed the advantage of U-EMR over HS-EMR.…”

Section: Standard Injection-assisted Emrmentioning

confidence: 84%

“…70 The adverse events post-U-EMR or CS-EMR were similar and lower than those of HS-EMR. 70 Studies comparing the U-EMR to HS-EMR showed the advantage of U-EMR over HS-EMR. 60 63 65-67 The rate of complete histological and macroscopic resection was higher in U-EMR compared with HS-EMR, although only two study reached statistical significance.…”

Section: Standard Injection-assisted Emrmentioning

confidence: 84%

“…53 In contrast to these results, a meta-analysis showed no difference between the delayed bleeding after cold and hot-snare EMR. 70 An RCT of 918 large polyps ≥20 mm in size found that closing the resection defect with clips after EMR reduced the risk of delayed bleeding from 7.1% to 3.5% for the right-colon polyps (p=0.015). 108 Hence, the ASGE Technology Committee recommends using soft coagulation with the tip of a snare to control intraprocedural bleeding.…”

Section: Incomplete Resections and Recurrencementioning

confidence: 99%

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Endoscopic resection of large non-pedunculated colorectal polyps: current standards of treatment

Taghiakbari,

Kim,

Djinbachian

et al. 2024

egastro

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Colorectal cancer is a significant public health concern, and large non-pedunculated colorectal polyps pose a substantial risk for malignancy and incomplete resection, which may lead to interval cancer. The choice of resection technique is influenced by various factors, including polyp size, morphology, location, submucosal invasion depth and endoscopist expertise. For non-cancerous superficial large non-pedunculated polyps, conventional hot or cold snare polypectomy, endoscopic mucosal resection and endoscopic submucosal dissection are common techniques for non-surgical therapeutic endoscopic resection of these polyps. This manuscript provides a comprehensive review of literature on current endoscopic resection techniques for large non-pedunculated colorectal polyps, emphasising indications, advantages, limitations and outcomes.

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“…This procedure entails the injection of submucosal fluid to create a wider separation between the mucosa and submucosa, followed by a one-time or piecemeal snared polypectomy. In cases where accurate identification of the intestinal wall is challenging and poses a risk of bleeding during the excision process, a block excision may be utilized [ 10 ]. However, it is currently unknown which method of excision of serrated polyps greater than 10 millimeters in size is the most effective.…”

Section: Introductionmentioning

confidence: 99%

Cold EMR vs. Hot EMR for the removal of sessile serrated polyps larger than 10 mm: a systematic review and meta-analysis

Ding,

Yang,

Wang

et al. 2024

BMC Surg

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Background Endoscopic mucosal resection (EMR) appears to be a promising technique for the removal of sessile serrated polyps (SSPs) ≥ 10 mm. To assess the effectiveness and safety of EMR for removing SSPs ≥ 10 mm, we conducted this systematic review and meta-analysis. Methods We conducted a thorough search of Embase, PubMed, Cochrane, and Web of Science databases for relevant studies reporting on EMR of SSPs ≥ 10 mm, up until December 2023. Our primary endpoints of interest were rates of technical success, residual SSPs, and adverse events (AE). Results Our search identified 426 articles, of which 14 studies with 2262 SSPs were included for analysis. The rates of technical success, AEs, and residual SSPs were 100%, 2.0%, and 3.1%, respectively. Subgroup analysis showed that the technical success rates were the same for polyps 10–19 and 20 mm, and en-bloc and piecemeal resection. Residual SSPs rates were similar in en-bloc and piecemeal resection, but much lower in cold EMR (1.0% vs. 4.2%, P = 0.034). AEs rates were reduced in cold EMR compared to hot EMR (0% vs. 2.9%, P = 0.168), in polyps 10–19 mm compared to 20 mm (0% vs. 4.1%, P = 0.255), and in piecemeal resection compared to en-bloc (0% vs. 0.7%, P = 0.169). Conclusions EMR is an effective and safe technique for removing SSPs ≥ 10 mm. The therapeutic effect of cold EMR is superior to that of hot EMR, with a lower incidence of adverse effects. PROSPERO registration number CRD42023388959.

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Effectiveness and safety of the different endoscopic resection methods for 10- to 20-mm nonpedunculated colorectal polyps

Cited by 12 publications

References 55 publications

Cold snare endoscopic mucosal resection for colon polyps: a systematic review and meta-analysis

Cold snare endoscopic mucosal resection for colon polyps: a systematic review and meta-analysis

Endoscopic resection of large non-pedunculated colorectal polyps: current standards of treatment

Cold EMR vs. Hot EMR for the removal of sessile serrated polyps larger than 10 mm: a systematic review and meta-analysis

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