CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(01): E9-E13
DOI: 10.1055/a-1293-6965
Original article

Is jumbo biopsy forceps comparable to cold snare for diminutive colorectal polyps? – a meta-analysis

Sachin Srinivasan
1   Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, MO
Peter D. Siersema
2   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
Madhav Desai
1   Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, MO
› Author Affiliations


Background and study aims Diminutive colorectal polyps are increasingly being detected and it is not clear whether jumbo biopsy forceps (JBF) has comparable efficacy to that of cold snare polypectomy (CSP) for management of these lesions.

Methods An electronic literature search was performed for studies comparing resection rates of JBF and CSP for diminutive polyps (≤ 5 mm). The primary outcome was incomplete resection rate (IRR). Secondary outcomes included failure of tissue retrieval and complication rates (post-polypectomy bleeding, perforation etc.). Leave-one-out analysis was performed to examine the disproportionate role of any of the studies. Meta-analysis outcomes and heterogeneity (I2) were computed using Comprehensive meta-analysis software.

Results A total of 4 studies (3 randomized controlled trials and 1 retrospective study) with 407 patients and 569 total polyps (mean size of 3.62 mm) was included for analysis. IRR of JBF was slightly higher than that of CSP (10.2 % vs 7.2 %) but this was not statistically significantly different (Pooled OR 1.76; 95 % CI 0.94–3.28; I2 = 0). Leave-one-out analysis showed no significant difference in the pooled OR comparison either. Two of the 4 studies reported 0 % failure of tissue retrieval for JBF and 1 % and 4.3 % for CSP. There were no complications for either group from the 2 studies that reported this outcome. The quality of the included studies was moderate to high.

Conclusions This systematic review with only limited data shows that JBF and CSP are not statistically different in completely removing diminutive polyps, although careful endoscopic assessment is needed to ensure complete removal of all polyp tissue.

Supplementary material

Publication History

Received: 04 May 2020

Accepted: 29 September 2020

Article published online:
01 January 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Leung K, Pinsky P, Laiyemo O. et al. Ongoing colorectal cancer risk despite surveillance colonoscopy:the polyp prevention trial continued follow-up study. Gastrointest Endosc 2010; 71: 111-117
  • 2 Lee CK, Shim J-J, Jang JY. Cold snare polypectomy vs. Cold forceps polypectomy using double-biopsy technique for removal of diminutive colorectal polyps: a prospective randomized study. Am J Gastroenterol 2013; 108: 1593-1600
  • 3 Pohl H, Srivastava A, Bensen SP. et al. Incomplete polyp resection during colonoscopy-results of thecomplete adenoma resection (CARE) study. Gastroenterology 2013; 144: 74-80.e1
  • 4 Tranquillini CV, Bernardo WM, Brunaldi VO. et al. Best polypectomy technique for small and diminutive colorectal polyps: A systematic review and meta-analysis. Arq Gastroenterol 2018; 55: 358-368
  • 5 Raad D, Tripathi P, Cooper G. et al. Role of the cold biopsy technique in diminutive and small colonic polyp removal: a systematic review and meta-analysis. Gastrointest Endosc 2016; 83: 508-515
  • 6 Desai S, Gupta S, Copur-Dahi N. et al. A prospective randomized study comparing jumbo biopsy forceps to cold snare for the resection of diminutive colorectal polyps. Surg Endosc 2020; 34: 1206-1213
  • 7 Huh CW, Kim JS, Choi HH. et al. Jumbo biopsy forceps versus cold snares for removing diminutive colorectal polyps: a prospective randomized controlled trial. Gastrointest Endosc 2019; 90: 105-111
  • 8 Gonzalez I, Riley DE, Ho SB. et al. M1523: Quality Colonoscopy: midterm results of a qualitative comparison of cold snare versus cold biopsy forceps for the resection of colonic polyps. Gastrointest Endosc 2010; 71: AB244
  • 9 Moher D, Liberati A, Tetzlaff J. et al. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLOS Med 2009; 6: e1000097
  • 10 Higgins JPT, Altman DG, Gøtzsche PC. et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928
  • 11 Wells G, Shea B, O’Connell D. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Sci Open; 2015 Available at:
  • 12 Liu S, Ho SB, Krinsky ML. Quality of polyp resection during colonoscopy: are we achieving polyp clearance?. Dig Dis Sci 2012; 57: 1786-1791
  • 13 Ponugoti PL, Cummings OW, Rex DK. Risk of cancer in small and diminutive colorectal polyps. Dig Liver Dis 2017; 49: 34-37
  • 14 Komeda Y, Kashida H, Sakurai T. et al. Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy. World J Gastroenterol 2017; 23: 328-335
  • 15 Draganov PV, Chang MN, Alkhasawneh A. et al. Randomized, controlled trial of standard, large-capacity versus jumbo biopsy forceps for polypectomy of small, sessile, colorectal polyps. Gastrointest Endosc 2012; 75: 118-126