Randomized controlled trial investigating use of submucosal injection of EverLift™ in rates of complete resection of non-pedunculated 4–9 mm polyps

Wei, Mike; Louie, Christine Y.; Chen, Yu; Pan, Jennifer Y.; Quan, Susan Y.; Wong, Robert K. S.; Brown, Ryanne A.; Clark, Melissa; Jensen, Kristin C.; Lau, Hubert D.; Friedland, Shai

doi:10.1007/s00384-022-04136-4

Cited by 7 publications

(17 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%

“…For major PPB and PPB, 14 articles compared seven treatments (3,316 patients) ( 27 , 29 , 30 , 32 – 37 , 39 , 40 , 42 – 44 ). Only three patients presented major PPB requiring medical intervention.…”

Section: Resultsmentioning

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%

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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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“…However, such solutions are usually applied for polyps larger than 10 mm, and their roles for polyps smaller than 10 mm remain uncertain. A recent study by Wei and colleagues further assessed the role of a vicious solution, Everlift, in CSP for polyps sized 4–9 mm, but their results detected no improvement in reducing the positive margin when submucosal injection of Everlift was performed (10). According to our experience, we speculated that snare slipping over the elevated polyp during SI-CSP for polyps sized 3–9 mm may be one of the main causes for the unfavorable result.…”

Section: Discussionmentioning

confidence: 99%

Impact of Submucosal Saline Injection During Cold Snare Polypectomy for Colorectal Polyps Sized 3–9 mm: A Multicenter Randomized Controlled Trial

Mou

Qin

et al. 2023

Am J Gastroenterol

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INTRODUCTION: The role of submucosal injection during cold snare polypectomy (CSP) remains uncertain. In this study, we investigated the impact of submucosal saline injection during CSP for colorectal polyps sized 3-9 mm. METHODS:This was a multicenter randomized controlled trial conducted in 6 Chinese centers between July and September 2020 (ChiCTR2000034423). Patients with nonpedunculated colorectal polyps sized 3-9 mm were randomized in a 1:1 ratio to either CSP with submucosal injection (SI-CSP) or conventional CSP (C-CSP). The primary outcome was the incomplete resection rate (IRR). Secondary outcomes included procedure time, intraprocedural bleeding, delayed bleeding, and perforation.

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Cold Snare Polypectomy With or Without Submucosal Injection for Endoscopic Resection of Colorectal Polyps: A Meta-Analysis of Randomized Controlled Trials

Lv,

Liu,

Wang

et al. 2024

Dig Dis Sci

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Randomized controlled trial investigating use of submucosal injection of EverLift™ in rates of complete resection of non-pedunculated 4–9 mm polyps

Cited by 7 publications

References 27 publications

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

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

Impact of Submucosal Saline Injection During Cold Snare Polypectomy for Colorectal Polyps Sized 3–9 mm: A Multicenter Randomized Controlled Trial

Cold Snare Polypectomy With or Without Submucosal Injection for Endoscopic Resection of Colorectal Polyps: A Meta-Analysis of Randomized Controlled Trials

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