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The efficacy and safety of cold snare versus hot snare polypectomy for endoscopic removal of small colorectal polyps: a systematic review and meta-analysis of randomized controlled trials

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Abstract

Purpose

The optimal technique for removing small colorectal polyps ranging from 5 to 10 mm in size remains uncertain. In order to compare the efficacy and adverse events between cold snare polypectomy (CSP) and hot snare polypectomy (HSP) for removing small polyps, we conducted a systematic review and meta-analysis of available randomized controlled trials.

Methods

We conducted a comprehensive search of MEDLINE, EMBASE, and the Cochrane Library databases from 1998 to May 2023 to identify randomized controlled trials that evaluated the efficacy and safety of cold snare polypectomy (CSP) and hot snare polypectomy (HSP) for resecting small colorectal polyps. The primary outcome measure was the incomplete resection rate (IRR).

Results

Seven studies that met our study criteria, with a total of 3178 included polyps, were included in our analysis. The incomplete resection rate (IRR) was found to be significantly higher in the CSP group compared to the HSP group (risk ratio [RR] 1.57 [1.17–2.11], P = 0.003). Although the CSP group had a higher local recurrence rate than the HSP group, the difference was not statistically significant (RR: 3.98 [0.66–23.84], P = 0.13). The polyp retrieval rates were not significantly different between the two groups (RR: 1.00 [0.99–1], P = 0.22). Perforation was not reported or mentioned in any of the seven studies. The overall immediate bleeding rate was significantly higher in the CSP group than the HSP group (RR: 2.26 [1.63–3.14], P < 0.001), but immediate postpolypectomy bleeding requiring additional intervention was similar between the groups (RR: 1.08 [0.54–2.17], P = 0.82). The delayed bleeding rate (RR: 0.83 [0.45–1.55], P = 0.56) and specific polypectomy time (RR: −0.46 [−1.05–0.12], P = 0.12) were also similar between the groups.

Conclusions

The meta-analysis shows a significantly higher IRR for CSP compared with HSP when removing small polyps.

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Funding

This study was partially supported by Natural Science Foundation of Hunan Province, China (No. 2022JJ40685).

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Authors and Affiliations

  1. Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Hunan Province, Changsha, 410011, People’s Republic of China

    Jian Gong & Li Gu

  2. Department of Urology, The Second Xiangya Hospital, Central South University, Hunan Province, Changsha, 410011, People’s Republic of China

    Wentao Liu

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Contributions

Conception and design of the study was by Li Gu. Analysis and interpretation of the data was by Wentao Liu, Li Gu. Drafting of the article was by Wentao Liu, Jian Gong. Critical revision of the article for important intellectual content was by Li Gu and Wentao Liu. Final approval of the article was by Li Gu.

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Correspondence to Li Gu.

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Supplementary file1 (DOCX 32 KB)

384_2023_4429_MOESM2_ESM.tif

Supplemental Fig. 1: Begg’s funnel plot of IRR (TIF 434 KB)

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Liu, W., Gong, J. & Gu, L. The efficacy and safety of cold snare versus hot snare polypectomy for endoscopic removal of small colorectal polyps: a systematic review and meta-analysis of randomized controlled trials. Int J Colorectal Dis 38, 136 (2023). https://doi.org/10.1007/s00384-023-04429-2

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