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

Mohamed Abdallah; Khalid Ahmed; Daniyal Abbas; Mouhand F. H. Mohamed; Gaurav Suryawanshi; Nicholas McDonald; Natalie Wilson; Shifa Umar; Aasma Shaukat; Mohammad Bilal

doi:10.1055/a-2129-5752

Endoscopy, Table of Contents

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

¹Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, United States

,

Khalid Ahmed

²Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, United States

,

Daniyal Abbas

³Department of Internal Medicine, East Carolina University, Greenville, North Carolina, United States

,

Mouhand F. H. Mohamed

⁴Brown University, Warren Alpert Medical School, Providence, Rhode Island, United States

,

Gaurav Suryawanshi

¹Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, United States

,

Nicholas McDonald

¹Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, United States

,

Natalie Wilson

¹Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, United States

,

Shifa Umar

⁵Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States

,

Aasma Shaukat

⁶Division of Gastroenterology, Department of Medicine and Population Health, NYU Grossman School of Medicine, New York, New York, United States

,

Mohammad Bilal

¹Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, United States

› Author Affiliations

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.

Full Text

References

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
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
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
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
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
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
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
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
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
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
11 Tutticci NJ, Hewett DG. Cold EMR of large sessile serrated polyps at colonoscopy (with video). Gastrointest Endosc 2018; 87: 837-842
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
13 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71
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
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
16 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
17 Lau J, Ioannidis JP, Terrin N. et al. The case of the misleading funnel plot. BMJ 2006; 333: 597-600
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
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
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
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
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
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
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
25 Song JH, Friedland S. Is submucosal injection helpful in cold snare polypectomy for small colorectal polyps?. Clin Endosc 2021; 54: 397-403
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
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
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
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
30 McDonald N, Chandan S, Bilal M. Colonoscopic polypectomy in patients on anticoagulation: time to embrace the cold revolution?. Gut 2022; 71: 653

Supplementary Material

Supplementary material