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

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.

Publication History

Received: 01 February 2023

Accepted after revision: 14 July 2023

Accepted Manuscript online:
14 July 2023

Article published online:
22 September 2023

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