Different endoscopic treatments for small colorectal polyps: A systematic review, pair-wise, and network meta-analysis

Xuanhan Li; He Zhu; Fudong Li; Ri Li; Hong Xu

doi:10.3389/fmed.2023.1154411

Different endoscopic treatments for small colorectal polyps: A systematic review, pair-wise, and network meta-analysis

Front Med (Lausanne). 2023 Apr 6:10:1154411. doi: 10.3389/fmed.2023.1154411. eCollection 2023.

Authors

Xuanhan Li¹, He Zhu¹, Fudong Li¹, Ri Li², Hong Xu¹

Affiliations

¹ Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin, China.
² Department of Library, The First Hospital of Jilin University, Changchun, Jilin, China.

Abstract

Background and study aims: In recent years, cold snare polypectomy (CSP) has been increasingly used for small polyps (<10 mm) instead of hot snare polypectomy (HSP). However, evidence-based research regarding the effectiveness and safety of CSP and HSP are still lacking. Additionally, for 4-10 -mm non-pedunculated polyps, the polyp removal method is still controversial. Therefore, it is clinically significant to conduct pair-wise and network meta-analyses to assess such resection methods.

Methods: We searched PubMed, Embase, and the Cochrane library for randomized controlled trials (RCTs). Only studies that involved the resection of polyps <10 mm were included. Outcomes included the complete resection rate, polyp retrieval rate, procedure-related complications, and procedure times.

Results: Overall, 23 RCTs (5,352 patients) were identified. In meta-analysis compared CSP versus HSP for polyps <10 mm, CSP showed lower complete resection rate than HSP although with no statistically significant difference [odds ratio (OR): 0.77, 95% confidence interval (CI): 0.56-1.06]. CSP showed a lower risk of major post-polypectomy complications compared to HSP (OR: 0.28, 95% CI: 0.11-0.73). In the network meta-analysis for 4-10 mm non-pedunculated polyps, HSP, and endoscopic mucosal resection (EMR) showed a higher complete resection rate than CSP (OR: 2.7, 95% CI: 1.3-9.2 vs. OR: 2.6, 95% CI: 1.0-10) but a significantly longer time than CSP (WMD: 16.55 s, 95% CI [7.48 s, 25.25 s], p < 0.001), (WMD: 48.00 s, 95% CI [16.54 s, 79.46 s], p = 0.003). Underwater CSP ranked third for complete resection with no complications.

Conclusion: For <10 mm polyps, CSP is safer than HSP, especially for patients taking antithrombotic drugs. For 4-10 mm non-pedunculated polyps, HSP, and EMR have higher complete resection rates than CSP.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022315575.

Keywords: cold snare polypectomy; colonic polyps; hot snare polypectomy; meta-analysis; therapeutics; treatment outcome.

Publication types

Systematic Review

Grants and funding

This work was supported by the Jilin Provincial Finance Department (No. 3D513G543428).