Download PDF
Endoscopy 2023; 55(12): 1083-1094
DOI: 10.1055/a-2129-5752
Systematic review

Cold snare endoscopic mucosal resection for colon polyps: a systematic review and meta-analysis

Mohamed Abdallah
1   Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, United States
,
Khalid Ahmed
2   Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, United States
,
Daniyal Abbas
3   Department of Internal Medicine, East Carolina University, Greenville, North Carolina, United States
,
Mouhand F. H. Mohamed 
4   Brown University, Warren Alpert Medical School, Providence, Rhode Island, United States
,
Gaurav Suryawanshi
1   Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, United States
,
Nicholas McDonald
1   Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, United States
,
Natalie Wilson
1   Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, United States
,
Shifa Umar
5   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Aasma Shaukat
6   Division of Gastroenterology, Department of Medicine and Population Health, NYU Grossman School of Medicine, New York, New York, United States
,
Mohammad Bilal
1   Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints


See also:

Methodological issues in the evaluation of cold snare endoscopic mucosal resection for colon polypsEndoscopy 2024; 56(01): 79-79
DOI: 10.1055/a-2162-8583

Abstract

Background Cold snare endoscopic mucosal resection (CS-EMR) can reduce the risks associated with electrocautery during colon polyp resection. Data on efficacy are variable. This systematic review and meta-analysis aimed to estimate the pooled efficacy and safety rates of CS-EMR.

Methods We conducted a comprehensive literature search of multiple databases, from inception to March 2023, for studies addressing outcomes of CS-EMR for colon polyps. The weighted pooled estimates with 95 %CIs were calculated using the random effects model. I2 statistics were used to evaluate heterogeneity.

Results 4137 articles were reviewed, and 16 studies, including 2592 polyps in 1922 patients (51.4 % female), were included. Overall, 54.4 % of polyps were adenomas, 45 % were sessile serrated lesions (SSLs), and 0.6 % were invasive carcinomas. Polyp recurrence after CS-EMR was 6.7 % (95 %CI 2.4 %–17.4 %, I2  = 94 %). The recurrence rate was 12.3 % (95 %CI 3.4 %–35.7 %, I2  = 94 %) for polyps ≥ 20 mm, 17.1 % (95 %CI 4.6 %–46.7 %, I2  = 93 %) for adenomas, and 5.7 % (95 %CI 3.2 %–9.9 %, I2  = 50 %) for SSLs. The pooled intraprocedural bleeding rate was 2.6 % (95 %CI 1.5 %–4.5 %, I2  = 51 %), the delayed bleeding rate was 1.5 % (95 %CI 0.8 %–2.7 %, I2  = 18 %), and no perforations or post-polypectomy syndromes were reported, with estimated rates of 0.6 % (95 %CI 0.3 %–1.3 %, I2  = 0 %) and 0.6 % (95 %CI 0.3 %–1.4 %, I2  = 0 %), respectively.

Conclusion CS-EMR demonstrated an excellent safety profile for colon polyps, with variable recurrence rates based on polyp size and histology. Large prospective studies are needed to validate these findings.

Supplementary material



Publication History

Received: 01 February 2023

Accepted after revision: 14 July 2023

Accepted Manuscript online:
14 July 2023

Article published online:
22 September 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Kwok K, Tran T, Lew D. Polypectomy for large polyps with endoscopic mucosal resection. Gastrointest Endosc Clin N Am 2022; 32: 259-276
    CrossrefPubMedGoogle Scholar
  • 2 Papastergiou V, Paraskeva KD, Fragaki M. et al. Cold versus hot endoscopic mucosal resection for nonpedunculated colorectal polyps sized 6–10 mm: a randomized trial. Endoscopy 2018; 50: 403-411
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Kaltenbach T, Anderson JC, Burke CA. et al. Endoscopic removal of colorectal lesions – recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2020; 158: 1095-1129
    CrossrefPubMedGoogle Scholar
  • 4 Shaukat A, Kaltenbach T, Dominitz JA. et al. Endoscopic recognition and management strategies for malignant colorectal polyps: recommendations of the US Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2020; 92: 997-1015.e1
    CrossrefPubMedGoogle Scholar
  • 5 Yamashina T, Fukuhara M, Maruo T. et al. Cold snare polypectomy reduced delayed postpolypectomy bleeding compared with conventional hot polypectomy: a propensity score-matching analysis. Endosc Int Open 2017; 5: E587-e94
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 van Hattem WA, Shahidi N, Vosko S. et al. Piecemeal cold snare polypectomy versus conventional endoscopic mucosal resection for large sessile serrated lesions: a retrospective comparison across two successive periods. Gut 2021; 70: 1691-1697
    CrossrefPubMedGoogle Scholar
  • 7 Yabuuchi Y, Imai K, Hotta K. et al. Efficacy and safety of cold-snare endoscopic mucosal resection for colorectal adenomas 10 to 14 mm in size: a prospective observational study. Gastrointest Endosc 2020; 92: 1239-1246
    CrossrefPubMedGoogle Scholar
  • 8 Rex DK, Anderson JC, Pohl H. et al. Cold versus hot snare resection with or without submucosal injection of 6- to 15-mm colorectal polyps: a randomized controlled trial. Gastrointest Endosc 2022; 96: 330-338
    CrossrefPubMedGoogle Scholar
  • 9 McWhinney CD, Vemulapalli KC, El Rahyel A. et al. Adverse events and residual lesion rate after cold endoscopic mucosal resection of serrated lesions ≥10 mm. Gastrointest Endosc 2021; 93: 654-659
    CrossrefPubMedGoogle Scholar
  • 10 Suresh S, Zhang J, Ahmed A. et al. Risk factors associated with adenoma recurrence following cold snare endoscopic mucosal resection of polyps ≥ 20  mm: a retrospective chart review. Endosc Int Open 2021; 9: E867-e73
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Tutticci NJ, Hewett DG. Cold EMR of large sessile serrated polyps at colonoscopy (with video). Gastrointest Endosc 2018; 87: 837-842
    CrossrefPubMedGoogle Scholar
  • 12 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009; 62: 1006-1012
    CrossrefPubMedGoogle Scholar
  • 13 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71
    CrossrefPubMedGoogle Scholar
  • 14 The Paris endoscopic classification of superficial neoplastic lesions. esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58 (Suppl. 06) S3-43
    PubMedGoogle Scholar
  • 15 Stang A. Critical evaluation of the Newcastle–Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603-605
    CrossrefPubMedGoogle Scholar
  • 16 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
    CrossrefPubMedGoogle Scholar
  • 17 Lau J, Ioannidis JP, Terrin N. et al. The case of the misleading funnel plot. BMJ 2006; 333: 597-600
    CrossrefPubMedGoogle Scholar
  • 18 Choksi N, Elmunzer BJ, Stidham RW. et al. Cold snare piecemeal resection of colonic and duodenal polyps ≥1 cm. Endosc Int Open 2015; 3: E508-513
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Guo Y, Li HM, Zhu WQ. Cold or hot snare with endoscopic mucosal resection for 6–9 mm colorectal polyps: a propensity score matching analysis. J Laparoendosc Adv Surg Tech A 2022; 32: 158-164
    CrossrefPubMedGoogle Scholar
  • 20 Li D, Wang W, Xie J. et al. Efficacy and safety of three different endoscopic methods in treatment of 6–20 mm colorectal polyps. Scand J Gastroenterol 2020; 55: 362-370
    CrossrefPubMedGoogle Scholar
  • 21 Mangira D, Cameron K, Simons K. et al. Cold snare piecemeal EMR of large sessile colonic polyps ≥20 mm (with video). Gastrointest Endosc 2020; 91: 1343-1352
    CrossrefPubMedGoogle Scholar
  • 22 Piraka C, Saeed A, Waljee AK. et al. Cold snare polypectomy for non-pedunculated colon polyps greater than 1 cm. Endosc Int Open 2017; 5: E184-e9
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Rameshshanker R, Tsiamoulos Z, Latchford A. et al. Resection of large sessile serrated polyps by cold piecemeal endoscopic mucosal resection: Serrated COld Piecemeal Endoscopic mucosal resection (SCOPE). Endoscopy 2018; 50: E165-e7
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Shimodate Y, Itakura J, Takayama H. et al. Impact of submucosal saline solution injection for cold snare polypectomy of small colorectal polyps: a randomized controlled study. Gastrointest Endosc 2020; 92: 715-722.e1
    CrossrefPubMedGoogle Scholar
  • 25 Song JH, Friedland S. Is submucosal injection helpful in cold snare polypectomy for small colorectal polyps?. Clin Endosc 2021; 54: 397-403
    CrossrefPubMedGoogle Scholar
  • 26 Kim MJ, Na SY, Kim JS. et al. Cold snare polypectomy versus cold endoscopic mucosal resection for small colorectal polyps: a multicenter randomized controlled trial. Surg Endosc 2023; 37: 3789-3795
    CrossrefPubMedGoogle Scholar
  • 27 Yuan X, Gao H, Liu C. et al. Effectiveness and safety of the different endoscopic resection methods for 10- to 20-mm nonpedunculated colorectal polyps: a systematic review and pooled analysis. Saudi J Gastroenterol 2021; 27: 331-341
    CrossrefPubMedGoogle Scholar
  • 28 Thoguluva Chandrasekar V, Spadaccini M, Aziz M. et al. Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis. Gastrointest Endosc 2019; 89: 929-936.e3
    CrossrefPubMedGoogle Scholar
  • 29 Mehta D, Loutfy AH, Kushnir VM. et al. Cold versus hot endoscopic mucosal resection for large sessile colon polyps: a cost-effectiveness analysis. Endoscopy 2022; 54: 367-375
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 McDonald N, Chandan S, Bilal M. Colonoscopic polypectomy in patients on anticoagulation: time to embrace the cold revolution?. Gut 2022; 71: 653
    CrossrefPubMedGoogle Scholar