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

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.

First, the authors have commented on our use of the Newcastle–Ottawa Scale for the assessment of the included studies. We applied the Newcastle–Ottawa Scale uniformly across our study selection, aligning with our aim to pool rates and not to compare groups via odds ratios, thus treating the cold snare endoscopic mucosal resection (CS-EMR) arm of the included randomized controlled trials essentially as cohorts. This method is appropriate for our study because we are evaluating only one group and not comparing groups.

Next, the authors have commented on data transformation. We conformed to the original random effects model concept, presuming normal distribution [2] [3], which is a familiar approach in prevalence meta-analyses in gastroenterology [4]. 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. The included estimate was the software’s conservative estimate of real-world possibilities beyond our study. We believe this enhances the generalizability and reliability of our study.

Based on the above considerations, we maintain that our study provides clinicians with valuable information for decision making and provides important information regarding the safety and efficacy of CS-EMR for colon polyp resection. Future randomized controlled trials will be instrumental in further assessing the efficacy and safety of CS-EMR compared with conventional and underwater EMR.

Publication History

Article published online:
21 December 2023

• References

• 1 Abdallah M, Ahmed K, Abbas D. et al. Cold snare endoscopic mucosal resection for colon polyps: a systematic review and meta-analysis. Endoscopy 2023;
• 2 Barendregt JJ, Doi SA, Lee YY. et al. Meta-analysis of prevalence. J Epidemiol Community Health 2013; 67: 974-978
• 3 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188
• 4 Papaefthymiou A, Ramai D, Maida M. et al. Performance and safety of motorized spiral enteroscopy: a systematic review and meta-analysis. Gastrointest Endosc 2023; 97: 849-858.e5