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Endoscopy
DOI: 10.1055/a-2561-5093
Systematic review

Cold snare polypectomy versus hot endoscopic mucosal resection for large non-pedunculated colorectal polyps: a systematic review and meta-analysis of randomized controlled trials

Andrea Sorge 
1   Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy (Ringgold ID: RIN9304)
2   Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
,
Michele Montori
3   Gastroenterology & Hepatology, University Hospital Ghent, Gent, Belgium (Ringgold ID: RIN60200)
4   Clinic of Gastroenterology, Hepatology and Emergency Digestive Endoscopy, Università Politecnica delle Marche, Ancona, Italy (Ringgold ID: RIN9294)
,
Maria Eva Argenziano
4   Clinic of Gastroenterology, Hepatology and Emergency Digestive Endoscopy, Università Politecnica delle Marche, Ancona, Italy (Ringgold ID: RIN9294)
2   Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
5   Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium (Ringgold ID: RIN26656)
,
Pieter Jan Poortmans
6   Department of Gastroenterology and Hepatology, University Hospital Ghent, Gent, Belgium (Ringgold ID: RIN60200)
5   Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium (Ringgold ID: RIN26656)
7   Department of Gastroenterology and Hepatology, Brussels University Hospital, Anderlecht, Belgium (Ringgold ID: RIN680893)
,
Daniele Balducci 
4   Clinic of Gastroenterology, Hepatology and Emergency Digestive Endoscopy, Università Politecnica delle Marche, Ancona, Italy (Ringgold ID: RIN9294)
,
Gian Eugenio Tontini
8   Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (Ringgold ID: RIN9339)
9   Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy (Ringgold ID: RIN9304)
,
Sander Smeets 
10   Department of Gastroenterology and Hepatology Ghent, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
,
Tamas Tornai
2   Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
,
Massimo Del Fabbro
11   Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy (Ringgold ID: RIN9304)
12   UOC Maxillofacial Surgery and Dentistry, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (Ringgold ID: RIN9339)
,
Sandro Sferrazza
13   Digestive Endoscopy Unit, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy (Ringgold ID: RIN367405)
,
Lobke Desomer
14   Gastroenterology + Hepatology, AZ Delta vzw, Roeselare, Belgium (Ringgold ID: RIN192827)
,
Gabriele Gallo Afflitto
15   Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy (Ringgold ID: RIN9318)
16   Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN4960)
,
David James Tate
2   Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
5   Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium (Ringgold ID: RIN26656)
› InstitutsangabenGefördert durch: This study was partially funded by the Italian Ministry of Health, current research IRCCS.
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Background: This meta-analysis of randomized controlled trials (RCTs) aimed to compare the risk of recurrence and adverse events between cold snare polypectomy (CSP) and hot-endoscopic mucosal resection (H-EMR) for large non-pedunculated colorectal polyps (LNPCPs). Methods: A systematic search of Medline, Embase and Cochrane Library databases was performed through August 2024 for studies comparing recurrence, bleeding and perforation rates between CSP and H-EMR for LNPCPs ≥15mm (PROSPERO ID: CRD42024568272). RCTs were included in the quantitative analysis. A random-effects meta-analysis, with heterogeneity measured with I2, was conducted to generate pooled risk ratios (RR) with 95% confidence intervals. Results: Four RCTs comprising 1516 LNPCPs (766 CSP and 750 H-EMR) in 1442 patients were included in the quantitative analysis. CSP demonstrated a higher recurrence risk at first surveillance colonoscopy than H-EMR in the pooled analysis (22.6% vs. 10.8%; RR=1.98; 95% CI: 1.22–3.21; p=0.02; moderate-certainty evidence), corresponding to a number needed to harm of 9. Regarding adverse events, CSP demonstrated a 67% reduced risk of delayed bleeding (1.2% vs. 3.9%; RR=0.33; 95% CI: 0.12-0.89; p=0.03; high-certainty evidence), corresponding to a number needed to treat of 37. Although CSP appeared to reduce the risk of intraprocedural bleeding (10.0% vs. 19.8%; RR=0.30, 95% CI: 0-52256.34, p=0.42), the wide confidence interval from the random-effects model included 1. There were no intraprocedural or delayed perforations in the CSP group. Conclusion: CSP has nearly double the recurrence risk of H-EMR for LNPCPs. However, its superior safety profile may make it a preferable option for patients where procedural safety is prioritized over radicality, such as those with extensive comorbidities.



Publikationsverlauf

Eingereicht: 24. Dezember 2024

Angenommen nach Revision: 18. März 2025

Accepted Manuscript online:
18. März 2025

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