Cold snare resection for non-ampullary sporadic duodenal adenomas: systematic review and meta-analysis

Abstract

Background and study aims The role of cold snare polypectomy (CSP) in curative resection of non-ampullary sporadic duodenal adenomas (NASDA) is debated. We conducted a systematic review and meta-analysis to investigate the efficacy and safety of CSP for NASDA.

Patients and methods In this systematic review and meta-analysis, we identified published series of patients with CSP for NASDA by searching PubMed and Google Scholar, which resulted in six papers (205 lesions). The main outcome was the rate of local remission after repeated CSP, the secondary outcomes were rates of local remission at first control and rates for delayed bleeding and immediate perforations. We computed the weighted summary proportions under the fixed and random effects model.

Results The pooled proportion of local remission after repeated CSP was 88% (95% confidence interval [CI] 57%-100%). The pooled proportion of local remission at first control was 81% (95% CI 55%-98%), the pooled proportion of delayed bleeding was 1% (95% CI 0%-4%) and the pooled proportion of immediate perforation was 0% (95% CI 0%-2%).

Conclusions Our meta-analysis suggests that CSP should be considered as the first-line therapy for NASDA.

Keywords

Neoplasia - Endoscopy Small Bowel - Small intestinal bleeding - Endoscopy Upper GI Tract

Publication History

Received: 26 April 2023

Accepted after revision: 27 September 2023

Accepted Manuscript online:
04 October 2023

Article published online:
09 November 2023

• References

• 1 Gaspar JP, Stelow EB, Wang AY. Approach to the endoscopic resection of duodenal lesions. World J Gastroenterol 2016; 22: 600-617 DOI: 10.3748/wjg.v22.i2.600. (PMID: 26811610)
• 2 Spigelman AD, Williams CB, Talbot IC. et al. Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet 1989; 2: 783-785
• 3 Sellner F. Investigations on the significance of the adenoma-carcinoma sequence in the small bowel. Cancer 1990; 66: 702-715 DOI: 10.1002/1097-0142. (PMID: 2167140)
• 4 Vanbiervliet G, Moss A, Arvanitakis M. et al. Endoscopic management of superficial nonampullary duodenal tumors: European Society of Gastrointestinal Endoscopy (ESGE). Endoscopy 2021; 53: 522-534
• 5 Abbass R, Rigaux J, Al-Kawas FH. Nonampullary duodenal polyps: characteristics and endoscopic management. Gastrointest Endosc 2010; 71: 754-759 DOI: 10.1016/j.gie.2009.11.043. (PMID: 20363416)
• 6 Hatzaras I, Palesty JA, Abir F. et al. Small-bowel tumors: epidemiologic and clinical characteristics of 1260 cases from the Connecticut Tumor Registry. Arch Surg 2007; 142: 229-235
• 7 Pimentel-Nunes P, Libânio D, Bastiaansen BAJ. et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022. Endoscopy 2022; 54: 591-622 DOI: 10.1055/a-1811-7025. (PMID: 35523224)
• 8 Haddaway NR, Collins AM, Coughlin D. et al. The role of Google Scholar in evidence reviews and its applicability to grey literature searching. PLoS One 2015; 10: e0138237 DOI: 10.1371/journal.pone.0138237. (PMID: 26379270)
• 9 R Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing. Vienna, Austria. https://www.R-project.org/ 2023
• 10 Choksi N, Elmunzer BJ, Stidham RW. et al. Cold snare piecemeal resection of colonic and duodenal polyps ≥1 cm. Endosc Int Open 2015; 3: E508-E513 DOI: 10.1055/s-0034-1392214. (PMID: 26528509)
• 11 Dang DT, Suresh S, Vance RB. et al. Outcomes of cold snare piecemeal EMR for nonampullary small-bowel adenomas larger than 1 cm: a retrospective study. Gastrointest Endosc 2022; 95: 1176-1182
• 12 Wang H, Sidhu M, Gupta S. et al. Cold snare endoscopic mucosal resection for the removal of large duodenal adenomas. Gastrointest Endosc 2023; 97: 1100-1108
• 13 Okimoto K, Maruoka D, Matsumura T. et al. Long-term outcomes of cold snare polypectomy for superficial non-ampullary duodenal epithelial tumors. J Gastroenterol Hepatol 2022; 37: 75-80 DOI: 10.1111/jgh.15666. (PMID: 34409657)
• 14 Takizawa K, Kakushima N, Tanaka M. et al. Cold snare polypectomy for superficial non-ampullary duodenal epithelial tumor: a prospective clinical trial (pilot study). Surg Endosc 2022; 36: 5217-5223 DOI: 10.1007/s00464-021-08899-9. (PMID: 34859300)
• 15 Trivedi M, Klapheke R, Youssef F. et al. Comparison of cold snare and hot snare polypectomy for the resection of sporadic nonampullary duodenal adenomas. Gastrointest Endosc 2022; 96: 657-664 DOI: 10.1016/j.gie.2022.05.007. (PMID: 35618029)
• 16 Maruoka D, Matsumura T, Kasamatsu S. et al. Cold polypectomy for duodenal adenomas: a prospective clinical trial. Endoscopy 2017; 49: 776-783 DOI: 10.1055/s-0043-107028. (PMID: 28493238)
• 17 Meulen LWT, Bogie RMM, Winkens B. et al. Thermal ablation of mucosal defect margins to prevent local recurrence of large colorectal polyps: a systematic review and meta-analysis. Endosc Int Open 2022; 10: E1127-E1135 DOI: 10.1055/a-1869-2446. (PMID: 36247075)
• 18 Qu J, Jian H, Li L. et al. Effectiveness and safety of cold versus hot snare polypectomy: A meta-analysis. J Gastroenterol Hepatol 2019; 34: 49-58 DOI: 10.1111/jgh.14464. (PMID: 30176072)
• 19 Thoguluva Chandrasekar V, Spadaccini M, Aziz M. et al. Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis. Gastrointest Endosc 2019; 89: 929-936
• 20 Tomizawa Y, Ginsberg GG. Clinical outcome of EMR of sporadic, nonampullary, duodenal adenomas: a 10-year retrospective. Gastrointest Endosc 2018; 87: 1270-1278 DOI: 10.1016/j.gie.2017.12.026. (PMID: 29317270)
• 21 Probst A, Freund S, Neuhaus L. et al. Complication risk despite preventive endoscopic measures in patients undergoing endoscopic mucosal resection of large duodenal adenomas. Endoscopy 2020; 52: 847-855 DOI: 10.1055/a-1144-2767. (PMID: 32289854)
• 22 Klein A, Nayyar D, Bahin FF. et al. Endoscopic mucosal resection of large and giant lateral spreading lesions of the duodenum: success, adverse events, and long-term outcomes. Gastrointest Endosc 2016; 84: 688-696 DOI: 10.1016/j.gie.2016.02.049. (PMID: 26975231)
• 23 Tribonias G, Komeda Y, Voudoukis E. et al. Cold snare polypectomy with pull technique of flat colonic polyps up to 12 m: a porcine model. Ann Gastroenterol 2015; 8: 141-143
• 24 Ferlitsch M, Moss A, Hassan C. et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49: 270-297 DOI: 10.1055/s-0043-102569. (PMID: 28212588)
• 25 van Hattem WA, Shahidi N, Vosko S. et al. Piecemeal cold snare polypectomy versus conventional endoscopic mucosal resection for large sessile serrated lesions: a retrospective comparison across two successive periods. Gut 2021; 70: 1691-1697 DOI: 10.1136/gutjnl-2020-321753. (PMID: 33172927)
• 26 STERIS Healthcare. Exacto cold snare. https://www.steris.com/healthcare/products/endoscopy-devices/polypectomy-and-tissue-acquisition-devices/exacto-cold-snare#ProductOverview
• 27 Olympus. Cold and hot snares. https://et-catalog.olympus.eu/products.html?level_1_id=11951
• 28 Boston Scientific. Captivator cold single-use snare. https://www.bostonscientific.com/en-US/products/snares/captivator-cold-single-use-snare.html
• 29 Takeuchi Y, Hamada K, Nakahira H. et al. Efficacy and safety of intensive downstaging polypectomy (IDP) for multiple duodenal adenomas in patients with familial adenomatous polyposis: a prospective cohort study. Endoscopy 2023; 55: 515-523
• 30 Faber T, Ravaud P, Riveros C. et al. Meta-analyses including non-randomized studies of therapeutic interventions: a methodological review. BMC Med Res Methodol 2016; 16: 35 DOI: 10.1186/s12874-016-0136-0. (PMID: 27004721)