Safety and efficacy of cold snare polypectomy for small colorectal polyps

Abstract

Trial design: Elimination of small colorectal polyps with cold snare polypectomy (CSP) is reported to be as safe as hot snare polypectomy (HSP). The effectiveness of CSP has not been clearly defined, and the incidence of long-term recurrence has not been determined. We conducted a randomized control study and one-year follow-up study to assess their safety and efficacy. Methods: Patients with small colorectal polyps were randomized to receive CSP or HSP. Polypectomy was performed to determine the pathological curability, and patients completed a questionnaire about the tolerability of the procedure. Follow-up colonoscopy was performed to determine the local recurrence of adenoma. The major outcome was the non-inferiority of CSP to HSP in the rate of delayed bleeding and minor outcomes, including the incidence of immediate bleeding and perforation, procedural time, and the resection rate. Results: A total of 119 participants were recruited in this randomized study and underwent polypectomy. Among the 458 polyps, 332 eligible polyps were analyzed. The rate of adverse events was 0.6% (1/175) for CSP and 0% (0/157) for HSP, which showed the non-inferiority of CSP. While the complete resection rate of CSP was very high (100%), the R0 rate was not satisfactory (horizontal margin, 65.5%; vertical margin, 89.1%). Two local recurrences (2.5%) were observed in the follow-up of 80 adenomas treated with CSP. No recurrence was found in 79 lesions in the HSP group, which was not significant ( P = .06). Conclusions: Colorectal polyps were safely resected using CSP, similar to HSP. Most would agree to say that CSP is considered safer than HSP. The main question is then related to efficacy. Our results of the present study demonstrate that recurrence after CSP should be carefully managed for curative treatment.

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

“…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.…”

“…A flow 10.3389/fmed.2023.1154411 chart of the trial selection process is shown in Figure 1. Fourteen articles compared HSP with CSP, (15,16,21,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(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.…”

“…Fourteen articles were included in the meta-analysis comparing CSP with HSP for small polyps, (15,16,21,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Seventeen articles were included in the network metaanalysis for 4-10 mm non-pedunculated polyps (27)(28)(29)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44). The characteristics of the included studies are summarized in Table 1.…”

“…For all pair-wise meta-analyses, HSP had a higher complete resection rate than CSP (OR: 3. Network meta-analysis and sensitivity analysis for small (4-10 mm) non-pedunculated polyps and SUCRA value of treatments For complete resection rate, 17 studies, including multi-arm studies, compared seven different treatments (4,361 polyps) (27)(28)(29)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44). Combining direct and indirect evidence, HSP and EMR had higher complete resection rates than CSP in the NMA (OR: 2.7, 95% CI: 1.3-9.2, I 2 = 27.7%, with moderate quality), (OR: 2.6, 95% CI: 1.0-8.8, I 2 = 55%, with low quality), (Figure 4A; Supplementary Table 2).…”

Snare devices with thinner loop wire may provide higher performance for cold snare polypectomy in an experimental model

“…Endoscopic treatments, including endoscopic submucosal dissection, have been accepted as reliable and less invasive treatment even for large intestinal lesions 1 2 3 . Among them, cold snare polypectomy without high-frequency generators recently has been accepted as an easy and simple way to resect precancerous lesions < 10 mm in diameter, especially in periodic colonoscopy after a patient’s colon is disease-free 4 5 6 7 8 . It enables resection of polyps with less damage to residual tissue surrounding the resected lesion.…”