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

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

Andrea Sorge  ‡
1   Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy (Ringgold ID: RIN9304)
2   Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
,
Michele Montori‡
2   Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
3   Clinic of Gastroenterology, Hepatology and Emergency Digestive Endoscopy, Università Politecnica delle Marche, Ancona, Italy (Ringgold ID: RIN9294)
,
Maria Eva Argenziano 
2   Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
3   Clinic of Gastroenterology, Hepatology and Emergency Digestive Endoscopy, Università Politecnica delle Marche, Ancona, Italy (Ringgold ID: RIN9294)
4   Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium (Ringgold ID: RIN26656)
,
Pieter Jan Poortmans 
2   Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
4   Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium (Ringgold ID: RIN26656)
5   Department of Gastroenterology and Hepatology, Brussels University Hospital, Brussels, Belgium (Ringgold ID: RIN680893)
,
Daniele Balducci 
3   Clinic of Gastroenterology, Hepatology and Emergency Digestive Endoscopy, Università Politecnica delle Marche, Ancona, Italy (Ringgold ID: RIN9294)
,
Gian Eugenio Tontini
6   Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (Ringgold ID: RIN9339)
1   Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy (Ringgold ID: RIN9304)
,
Sander Smeets 
2   Department of Gastroenterology and Hepatology, 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
7   Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy (Ringgold ID: RIN9304)
8   UOC Maxillofacial Surgery and Dentistry, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (Ringgold ID: RIN9339)
,
Sandro Sferrazza
9   Digestive Endoscopy Unit, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy (Ringgold ID: RIN367405)
,
Lobke Desomer
2   Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
10   Department of Gastroenterology and Hepatology, AZ Delta, Roeselare, Belgium (Ringgold ID: RIN192827)
,
Gabriele Gallo Afflitto
11   Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy (Ringgold ID: RIN9318)
12   Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN4960)
,
David J. Tate
2   Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)
4   Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium (Ringgold ID: RIN26656)
› Author AffiliationsSupported by: This study was partially funded by the Italian Ministry of Health, current research IRCCS.
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Abstract

Background

This meta-analysis of randomized controlled trials (RCTs) aimed to compare the risk of recurrence and adverse events (AEs) between cold snare polypectomy (CSP) and hot endoscopic mucosal resection (H-EMR) for large nonpedunculated colorectal polyps (LNPCPs).

Methods

A systematic search of Medline, Embase, and Cochrane Library databases until August 2024 was performed for studies comparing recurrence, bleeding, and perforation rates between CSP and H-EMR for LNPCPs ≥15 mm. A random-effects meta-analysis, with heterogeneity measured with I2, was conducted to generate pooled risk ratios (RRs) with 95%CIs.

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 AEs, 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 0–52 256, 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 co-morbidities.

Supplementary Material



Publication History

Received: 24 December 2024

Accepted after revision: 18 March 2025

Accepted Manuscript online:
18 March 2025

Article published online:
29 April 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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