Methodological issues in the evaluation of cold snare endoscopic mucosal resection for colon polyps

We read with great interest the study by Abdallah et al. [1]. The authors report the efficacy and safety of cold snare endoscopic mucosal resection in an evidence-based manner. However, we highlight certain methodological concerns.

First, the literature incorporated in this meta-analysis included randomized controlled trials, cohort studies, and other research types. However, the quality assessment of each study was conducted solely using the Newcastle–Ottawa scale for cohort studies. Considering the design characteristics of various research types, it is more suitable to utilize the appropriate literature evaluation tools for different types of studies.

Second, it is important to highlight that the present study is a meta-analysis focusing on rates. Nevertheless, it is important to note that the studies included in this analysis exhibited either extremely high or extremely low rates of primary outcome measures. Consequently, the process of combining the data from these studies necessitates careful consideration of data normality and the potential need for data transformation [2].

Third, it is worth mentioning that in the results section, none of the included studies reported any instances of two complications, namely perforation and postpolypectomy syndrome. In the present context, the pooled rate of 0.6 % pertaining to the occurrence of both complications may be deemed as deceptive. The observed data may potentially be attributed to the underlying algorithm of the statistical software, rather than reflecting the actual clinical context.

In brief, the present study’s reliability will be impacted by the methodological concerns outlined.

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