Resection rates and safety profile of cold vs. hot snare polypectomy in polyps sized 5–10 mm and 11–20 mm

Gessl, Irina; Waldmann, Elisabeth; Penz, Daniela; Majcher, B; Dokladanska, A; Hinterberger, A; Szymanska, A; Trauner, Michael; Ferlitsch, Monika

doi:10.1016/j.dld.2019.01.007

Cited by 20 publications

(29 citation statements)

References 32 publications

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“…A total of 21 studies employed EMR, including eight studies with analysable data (381 lesions) on the R0 resection rate and 16 studies with analysable data (814 lesions) on the en bloc resection rate. [ 8 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 ] The pooled proportions for R0 resection rate and en bloc resection rate were 87% (95% CI 0.75–0.93, I 2 = 83%) and 88% (95% CI 0.79–0.93, I 2 = 89%), respectively.…”

Section: Resultsmentioning

confidence: 99%

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

Yuan

Gao

Liu

et al. 2021

Saudi Journal of Gastroenterology

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Background: We performed a systematic review and pooled analysis to assess the effectiveness and safety of different endoscopic resection methods for 10- to 20-mm nonpedunculated colorectal polyps. Methods: Articles in PubMed, EMBASE, and the Cochrane Library related to the common endoscopic treatment of 10- to 20-mm nonpedunculated polyps published as of April 2020 were searched. Primary outcomes were the R0 resection rate and en bloc resection rate. Secondary outcomes were safety and the recurrence rate. Meta-regression and subgroup analysis were also performed. Results: A total of 36 studies involving 3212 polyps were included in the final analysis. Overall, the effectiveness of resection methods with a submucosal uplifting effect, including endoscopic mucosal resection (EMR), cold EMR and underwater EMR (UEMR), was better than that of methods without a nonsubmucosal uplifting effect [R0 resection rate, 90% (95% confidence interval (CI) 0.81–0.94, I 2 = 84%) vs 82% (95% CI 0.78–0.85, I 2 = 0%); en bloc resection rate 85% (95% CI 0.79–0.91, I 2 = 83%) vs 74% (95% CI 0.47–0.94, I 2 = 94%)]. Regarding safety, the pooled data showed that hot resection [hot snare polypectomy, UEMR and EMR] had a higher risk of intraprocedural bleeding than cold resection [3% (95% CI 0.01–0.05, I 2 = 68%) vs 0% (95% CI 0–0.01, I 2 = 0%)], while the incidences of delayed bleeding, perforation and post-polypectomy syndrome were all low. Conclusions: Methods with submucosal uplifting effects are more effective than those without for resecting 10- to 20-mm nonpedunculated colorectal polyps, and cold EMR is associated with a lower risk of intraprocedural bleeding than other methods. Additional research is needed to verify the advantages of these methods, especially cold EMR.

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Section: Resultsmentioning

confidence: 99%

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

Yuan

Gao

Liu

et al. 2021

Saudi Journal of Gastroenterology

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“…W E EXTRACTED 15 studies that reported on CSP for large (≥1 cm) colorectal polyps. These included four prospective single arm studies, [39][40][41][42] 10 retrospective studies, [43][44][45][46][47][48][49][50][51][52] and one prospective RCT 20 (Table 3).…”

Section: Cold Procedures For Large (≥1 Cm) Colorectal Polypsmentioning

confidence: 99%

“…39,41 Of the 10 retrospective studies, two reported on SSLs only, 43,44 and the other studies included any kinds of polyp. [45][46][47][48][49][50][51][52] Regarding the lesion size, two studies included lesions of up to 15 mm in size, 50,52 and three studies included lesions of up to 20 mm in size. [43][44][45][46] One study from Australia investigated the outcomes of piecemeal CSP for lesions >20 mm.…”

Section: Cold Procedures For Large (≥1 Cm) Colorectal Polypsmentioning

confidence: 99%

Safety and efficacy of cold versus hot snare polypectomy including colorectal polyps ≥1 cm in size

Takeuchi

Shichijo

Kawakami

et al. 2021

Digestive Endoscopy

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Cold snare polypectomy (CSP; polypectomy without electrocautery) has spread rapidly worldwide during the past decade in what has been called "Cold Revolution". We performed a PubMed literature search for studies investigating CSP outcomes for colorectal polyps. Five randomized controlled trials (RCTs) assessed the complete resection rates (CRRs). The CRRs were similar regardless of the presence or absence of electrocautery, and the efficacy of submucosal injection for better CRRs is still controversial. Eight RCTs assessed the adverse events. The incidence of intraprocedural bleeding with cold procedures was comparable to or higher than that of hot procedures. The incidences of delayed bleeding were comparable to or lower with cold procedures, especially in patients taking anticoagulants. Fifteen studies have been reported on CSP for large (≥1 cm) colorectal polyps (10 retrospective studies, four prospective single-arm studies, and one prospective RCT). These studies reported that the safe cold procedures (a low intra-and post-procedural bleeding rate without perforation) could be implemented for lesions ≥1 cm. However, considering the incision depth of CSP and the local recurrence rate based on the current evidence, only large sessile serrated lesions (SSLs) can be candidates for cold procedures, and large adenomas should not be candidates for this procedure. Based on the current evidence, CSP seems to be the appropriate standard procedure for sub-centimeter colorectal low-grade adenomas due to its safety and simplicity. Thus, large SSLs can be candidates for cold procedures; however, careful inspection and further prospective studies are warranted to confirm the procedure's clinical relevance.

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“…In a recent study, the resection rates and safety profile of cold vs. hot snare polypectomy in polyps sized 5-10 mm and 11-20 mm were assessed [14]. Giving further evidence that the cold snare is not inferior to the hot snare for adenomas sized 5-10 mm and should be preferred, regarding the better safety and cost-effectiveness.…”

Section: Snare Polypectomymentioning

confidence: 99%

Endoscopic management of early colorectal cancer

Farhat¹,

Yared²,

Elmais³

et al. 2020

Gastroenterol Hepatol Endosc

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The endoscopic treatment of cancerous and precancerous lesions in the gastrointestinal (GI) tract has experienced major breakthroughs in the past years. Colonoscopy plays a major role in the prevention and detection of colorectal cancer patients and is used for diagnosis and treatment of early colorectal cancer and its precursors. Improvements in colonoscopy preparation, new techniques of adenoma detection, and recent progress in endoscopic imaging methods are providing higher-quality results and thus reducing the incidence and mortality of the disease. During the past decade, endoscopic resection techniques have evolved, and cancers confined to the mucosal and superficial submucosal layers can now be resected via flexible endoscopes. Therefore, it is important to understand the indications and limitations of endoscopic resection, to determine whether the cancer can be curatively resected, and assess the risk of lymph node metastasis, which precludes endoscopic treatment.The successful removal of an early colorectal cancer requires advanced techniques and expertise. Currently, many options are available such as snare polypectomy, that is the most frequently used, and endoscopic mucosal resection (EMR), that is an efficient method with low complication rate for the treatment of most benign and advanced lesions in the GI tract, but carries a risk of incomplete resection and recurrence of early cancer. However, with the introduction of precutting EMR or hybrid ESD, endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFTR), the scope of lesions eligible for curative endoscopic treatment has been widened significantly. These resection techniques have the potential to spare surgical treatment to a selected population of patients. We will review these different endoscopic techniques.

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Resection rates and safety profile of cold vs. hot snare polypectomy in polyps sized 5–10 mm and 11–20 mm

Cited by 20 publications

References 32 publications

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

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

Safety and efficacy of cold versus hot snare polypectomy including colorectal polyps ≥1 cm in size

Endoscopic management of early colorectal cancer

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Resection rates and safety profile of cold vs. hot snare polypectomy in polyps sized 5–10 mm and 11–20 mm

Cited by 20 publications

References 32 publications

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

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

Safety and efficacy of cold versus hot snare polypectomy including colorectal polyps ≥1 cm in size

Endoscopic management of early colorectal cancer

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Product

Resources

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Resection rates and safety profile of cold vs. hot snare polypectomy in polyps sized 5–10 mm and 11–20 mm