S161 Cold Snare Endoscopic Mucosal Resection for Colon Polyps: A Systematic Review and Meta-Analysis

Abstract

Introduction: Cold snare endoscopic mucosal resection (CS-EMR) has become increasingly popular for the removal of colon polyps . 10 mm. CS-EMR can potentially avert some of the risks associated with the use of electrocautery during polyp resection without compromising clinical efficacy. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of CS-EMR in removing colon polyps. Methods: We conducted a comprehensive literature search of MEDLINE, EMBASE, Cochrane, ClinicalTrials.gov, and Scopus databases for studies published in the English language addressing outcomes of CS-EMR for colon polyps from database inceptions through April 2022. The weighted pooled estimates with the 95% confidence interval (CI) were calculated. Cochran Q test and I 2 statistics were used to evaluate heterogeneity. Results: We identified 3599 articles on the initial search, and 32 full-text studies were assessed for eligibility. Fifteen studies met inclusion criteria. There were three randomized controlled trials, six prospective, and six retrospective studies. Six studies were from the United States, two each from Australia, China, and Japan, one from the United Kingdom, and one from Greece. A total of 2382 polyps were removed from 1756 patients. 45% were females. Polyps ranged from 6-80 mm in size, and 72.4% were proximal to the splenic flexure. In addition, 50.4% of the polyps were NICE I or serrated lesions and 48.5% were NICE II, and 0.1% were NICE III. Polyp recurrence rate after CS-EMR was 9.4 % (95% CI: 3.3-15.6%, I 2 5 95.8%), piecemeal resection rate 59.4% (95% CI: 46.3-72.4%, I25 99.9%), and complete histological resection rate (defined by post polypectomy biopsies) was 93.1% (95% CI: 88.7-97.6%, I 2 590.8%). For adverse events, delayed post-polypectomy bleeding rate was 0.8% (95% CI: 0.3-1.3%, I 2 5 21.4%), perforation and the post-polypectomy syndrome rate was 0.3% (95% CI: 0-0.5%, I 2 5 0%) (Figure). Given significant heterogeneity in recurrence rate, subgroup analyses were performed. Recurrence rate in serrated lesions (n5484) was 3.8% (95% CI: 0.2-7.4%, I 2 5 76.7%), in polyps , 20 mm (n5 137) 0.8% (95% CI: -0.7-2.3%, I 2 5 0%), and in polyps $ 20 mm (n5617) 15.7% (95% CI: 2.6-28.7%, I 2 5 95.2%). Conclusion: CS-EMR has an excellent safety profile and acceptable recurrence rate for resection of colon polyps, especially for polyps , 20 mm and serrated lesions. However, large prospective studies to validate safety and efficacy are needed.[0161] Figure 1. Forest plots of A) recurrence rate, B) complete histological resection, C) delayed post polypectomy bleeding, and D) perforation of cold snare endoscopic mucosal resection in colon polyps

Cold snare endoscopic mucosal resection for colonic polyps: addressing methodological critiques and enhancing future discussions

“…However, alternative methods, such as logit or double arcsine transformation, could have been explored 2 . Reassuringly, the overall results seem to align with the conclusions of the individual studies included in our analysis 1 . As we clarified in the paper, we clearly stated that there were no reported perforations or post-polypectomy syndromes in the included studies.…”

“…We appreciate the interest from Lv et al in our study “Cold snare endoscopic mucosal resection for colon polyps: a systematic review and meta-analysis” 1 . In this response, we seek to address their comments, clarify our methodological choices, and affirm the conclusions of our study.…”

Geometry of cold snare polypectomy and risk of incomplete resection

“…However, our modelled IRRs are consistent with recurrence rates reported in a recent systematic review. [21] Abdallah et al reported a recurrence rate of 12.3% (3.4%-35.7%) for polyps ≥20mm resected by piecemeal-cold snare polypectomy (P-CSP), derived from 4 studies. [13,[22][23][24] Unfortunately, recurrence rates for adenomas and sessile serrated lesions (SSLs) were not reported separately.…”