Underwater versus conventional cold snare polypectomy of colorectal polyps 4–9 mm in diameter: a prospective randomized controlled trial

Myung, Yu Sik; Kwon, Hyuki; Han, Jieun; Lim, Jongreul; Choi, Sujin; Baeg, Myong Ki; Han, Sok Won

doi:10.1007/s00464-022-09013-3

Cited by 6 publications

(15 citation statements)

References 27 publications

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“…A flow chart of the trial selection process is shown in Figure 1 . Fourteen articles compared HSP with CSP, ( 15 , 16 , 21 , 25 – 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.…”

Section: Resultsmentioning

confidence: 99%

“…Water immersion improves the visibility and operability of the endoscope. By sucking the specimen and water at the same time, it is possible to retrieve the resected specimen more easily and quickly (42). UCSP shows great potential for resecting 4-10 mm 10.3389/fmed.2023.1154411 non-pedunculated polyps; however, the number of studies of UCSP is limited, and new RCT has designed (52).…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…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).…”

Section: Meta-analysis and Subgroup Analysis Compared Hsp And Csp For...mentioning

confidence: 99%

“…For IB rate, eleven articles compared five different treatments (2,670 polyps) (27, 32-38, 40, 43, 44). Besides two articles reported no IB in the UCSP group (0/279 polyps), (41,42) and one threearm study reported no IB in the APC group (0/39 polyps) (33). No statistically significant differences were found between the five different treatments (Figure 4B; Supplementary Table 3).…”

Section: Meta-analysis and Subgroup Analysis Compared Hsp And Csp For...mentioning

confidence: 99%

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

Zhu

et al. 2023

Front. Med.

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Background and study aimsIn recent years, cold snare polypectomy (CSP) has been increasingly used for small polyps (<10 mm) instead of hot snare polypectomy (HSP). However, evidence-based research regarding the effectiveness and safety of CSP and HSP are still lacking. Additionally, for 4–10 -mm non-pedunculated polyps, the polyp removal method is still controversial. Therefore, it is clinically significant to conduct pair-wise and network meta-analyses to assess such resection methods.MethodsWe searched PubMed, Embase, and the Cochrane library for randomized controlled trials (RCTs). Only studies that involved the resection of polyps <10 mm were included. Outcomes included the complete resection rate, polyp retrieval rate, procedure-related complications, and procedure times.ResultsOverall, 23 RCTs (5,352 patients) were identified. In meta-analysis compared CSP versus HSP for polyps <10 mm, CSP showed lower complete resection rate than HSP although with no statistically significant difference [odds ratio (OR): 0.77, 95% confidence interval (CI): 0.56–1.06]. CSP showed a lower risk of major post-polypectomy complications compared to HSP (OR: 0.28, 95% CI: 0.11–0.73). In the network meta-analysis for 4–10 mm non-pedunculated polyps, HSP, and endoscopic mucosal resection (EMR) showed a higher complete resection rate than CSP (OR: 2.7, 95% CI: 1.3–9.2 vs. OR: 2.6, 95% CI: 1.0–10) but a significantly longer time than CSP (WMD: 16.55 s, 95% CI [7.48 s, 25.25 s], p < 0.001), (WMD: 48.00 s, 95% CI [16.54 s, 79.46 s], p = 0.003). Underwater CSP ranked third for complete resection with no complications.ConclusionFor <10 mm polyps, CSP is safer than HSP, especially for patients taking antithrombotic drugs. For 4–10 mm non-pedunculated polyps, HSP, and EMR have higher complete resection rates than CSP.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022315575.

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