Efficacy and Safety of Endoscopic Resection of Sessile Serrated Polyps 10 mm or Larger: A Systematic Review and Meta-Analysis

Chandrasekar, Viveksandeep Thoguluva; Aziz, Muhammad; Patel, Harsh K.; Sidhu, Naaz; Duvvuri, Abhiram; Dasari, Chandrashekhar; Kennedy, Kevin F.; Ashwath, Ashwini; Spadaccini, Marco; Desai, Madhav; Jegadeesan, Ramprasad; Sathyamurthy, Anjana; Vennalaganti, Prashanth; Kohli, Divyanshoo R.; Hassan, Cesare; Pellisé, María; Repici, Alessandro; Sharma, Prateek; Bourke, Michael J.

doi:10.1016/j.cgh.2019.11.041

Cited by 29 publications

(31 citation statements)

References 30 publications

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“…A systematic review and meta‐analysis also found that that cold EMR was associated with significantly lower rates of PPB (0% vs. 2.3%, p = 0.03). 44 …”

Section: Current Management For Colorectal Lesionsmentioning

confidence: 99%

Cold versus hot polypectomy/endoscopic mucosal resection–A review of current evidence

et al. 2021

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Background: Colonoscopy with polypectomy substantially reduces the risk of colorectal cancer (CRC) but interval cancers still account for 9% of all CRCs, some of which are due to incomplete resection. Aim:The aim of this review is to compare the outcomes of cold and hot endoscopic resection and provide technical tips and tricks for optimizing cold snare polypectomy.Results: Cold snare polypectomy (CSP) is the standard technique for small (≤10 mm) colorectal polyps. For large colonic polyps (>10 mm), hot resection techniques with use of electrocautery (polypectomy or endoscopic mucosal resection) were recommended until recently. However, the use of electrocoagulation brings serious adverse effects in up to 9% of the patients, such as delayed bleeding, post-polypectomy syndrome and perforation. In recent years, efforts have been made to improve the polypectomy with cold snare in order to avoid these adverse effects of electrocoagulation without compromising the efficacy of the resection. Several authors have recently shown that the complication rates of CSP of polyps >10 mm is close to zero and recurrence rates varies between 5-18%. Lower recurrence rates are found in serrated lesions (<8%).

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“…A systematic review and meta‐analysis also found that that cold EMR was associated with significantly lower rates of PPB (0% vs. 2.3%, p = 0.03). 44 …”

Section: Current Management For Colorectal Lesionsmentioning

confidence: 99%

Cold versus hot polypectomy/endoscopic mucosal resection–A review of current evidence

et al. 2021

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“…Van Hattem et al also examined cold vs. C-EMR for the treatment of large (≥20 mm) SSPs [ 41 ], with similar recurrence rates, but cold EMR surpassed the conventional method with respect to safety, since it totally eradicated adverse events (delayed bleeding and perforation). Data from individual studies have been verified in a meta-analysis that evaluated the resection outcomes of SSPs sized 10 mm or larger [ 47 ]. Cold EMR was associated with a significantly lower residual polyp rate (0.9% vs. 5%; P=0.01) and less delayed bleeding (0% vs. 2.3%; P=0.03) compared to C-EMR.…”

Section: Cold Emrmentioning

confidence: 99%

Modified endoscopic mucosal resection techniques for treating precancerous colorectal lesions

Tziatzios¹,

Gkolfakis

Papadopoulos

et al. 2021

aog

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Endoscopic mucosal resection (EMR) is a technique allowing efficacious and minimally invasive resection of precancerous lesions across the entire gastrointestinal tract. However, conventional EMR, involving injection of fluid into the submucosal space, is imperfect, given the high rate of recurrence of post-endoscopic resection adenoma, especially after piecemeal resection. In light of these observations, modifications of the technique have been proposed to overcome the weakness of conventional EMR. Some of them were designed to maximize the chance of en bloc resection—cap-assisted EMR, underwater EMR, tip-in EMR, precutting, assisted by ligation device—while others were designed to minimize the complications (cold EMR). In this review, we present their modes of action and summarize the evidence regarding their efficacy and safety.

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“…Advanced endoscopic techniques have been accepted as proper therapeutic interventions in T1 CRC patients following cautious selection and assessment ( 4 , 6 , 7 ). Local excision in T1 CRC patients could decrease the morbidity and further enhance the quality of life.…”

Section: Introductionmentioning

confidence: 99%

Influence of Old Age on Risk of Lymph Node Metastasis and Survival in Patients With T1 Colorectal Cancer: A Population-Based Analysis

Zheng

et al. 2021

Front. Oncol.

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BackgroundWe aimed at determining the influence of old age on lymph node metastasis (LNM) and prognosis in T1 colorectal cancer (CRC).MethodsWe collected data from eligible patients in Surveillance, Epidemiology, and End Results database between 2004 and 2015. Independent predictors of LNM were identified by logistic regression analysis. Cox regression analysis, propensity score-matched analysis, and competing risks analysis were used to analyze the associations between old age and lymph node (LN) status and to validate the prognostic value of old age on cancer-specific survival (CSS).ResultsIn total, 10,092 patients were identified. Among them, 6,423 patients (63.6%) had greater than or equal to 12 examined lymph nodes (LNE ≥12), and 5,777 patients (57.7%) were 65 years or older. The observed rate of LNM was 4.6% (15 out of 325) in T1 CRC elderly patients, with tumor size <3 cm, well differentiated, with negative carcinoembryonic antigen (CEA) level, and adenocarcinoma. Logistic regression models demonstrated that tumor size ≥3 cm (odds ratio, OR = 1.316, P = 0.038), poorly differentiated (OR = 3.716, P < 0.001), older age (OR = 0.633 for ages 65–79 years, OR = 0.477 for age over 80 years, both P <0.001), and negative CEA level (OR = 0.71, P = 0.007) were independent prognostic factors. Cox regression analysis demonstrated that CSS was not significantly different between elderly patients undergoing radical resection with LNE ≥12 and those with LNE <12 (hazard ratio = 0.865, P = 0.153), which was firmly validated after a propensity score-matched analysis by a competing risks model.ConclusionsThe predictive value of tumor size, grading, primary site, histology, CEA level, and age for LNM should be considered in medical decision making about local resection. We found that tumor size was <3 cm, well differentiated, negative CEA level, and adenocarcinoma in elderly patients with T1 colorectal cancer which was suitable for local excision.

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Efficacy and Safety of Endoscopic Resection of Sessile Serrated Polyps 10 mm or Larger: A Systematic Review and Meta-Analysis

Cited by 29 publications

References 30 publications

Cold versus hot polypectomy/endoscopic mucosal resection–A review of current evidence

Cold versus hot polypectomy/endoscopic mucosal resection–A review of current evidence

Modified endoscopic mucosal resection techniques for treating precancerous colorectal lesions

Influence of Old Age on Risk of Lymph Node Metastasis and Survival in Patients With T1 Colorectal Cancer: A Population-Based Analysis

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