Abstract
Background Cold resection of colorectal lesions is widely performed because of its safety and
effectiveness; however, it remains uncertain whether adding submucosal injection could
improve the efficacy and safety. We aimed to compare cold endoscopic mucosal resection
(C-EMR) versus cold snare polypectomy (CSP) for colorectal lesions.
Methods We performed a systematic review of randomized controlled trials (RCTs) identified
from PubMed, Cochrane Library, and Embase. The primary outcome was complete resection.
Secondary outcomes were procedure time, en bloc resection, and adverse events (AEs).
Prespecified subgroup analyses based on the size and morphology of the polyps were
performed. The random-effects model was used to calculate the pooled risk ratio (RR)
and mean difference, with corresponding 95%CIs, for dichotomous and continuous variables,
respectively. Heterogeneity was assessed using the Cochran Q test and I
2 statistics.
Results 7 RCTs were included, comprising 1556 patients, with 2287 polyps analyzed. C-EMR
and CSP had similar risk ratios for complete resection (RR 1.02, 95%CI 0.98–1.07),
en bloc resection (RR 1.08, 95%CI 0.82–1.41), and AEs (RR 0.74, 95%CI 0.41–1.32).
C-EMR had a longer procedure time (mean difference 42.1 seconds, 95%CI 14.5–69.7 seconds).
In stratified subgroup analyses, the risk was not statistically different between
C-EMR and CSP for complete resection in polyps<10 mm or ≥10 mm, or for complete resection,
en bloc resection, and AEs in the two groups among nonpedunculated polyps.
Conclusions The findings of this meta-analysis suggest that C-EMR has similar efficacy and safety
to CSP, but significantly increases the procedure time.
PROSPERO: CRD42023439605.
