Methodological considerations for recurrence analysis

10.1055/a-2561-5093

We read with great interest the study by Sorge et al. comparing cold snare polypectomy (CSP) and hot endoscopic mucosal resection (H-EMR) for the management of large nonpedunculated colorectal polyps [1]. This meta-analysis offered valuable insights into the differences between the two techniques regarding recurrence rates and safety, providing important evidence to inform clinical practice and guide future research; however, some findings warrant further evaluation to avoid potential bias.

The authors reported no significant difference in adenoma recurrence between CSP and H-EMR; however, our analysis of the same data reveals a recurrence rate of 25.9% (95%CI 20.8%–30.9%) in the CSP group, which differs from the rate reported in the article of 21.4% (95%CI 17.2%–26.1%). Using R Studio (version 2024.9.0.375; PBC, Boston, Massachusetts, USA), we conducted further analysis of the statistical effects, as shown in [Fig. 1]. With substantial heterogeneity of 62%, using the DerSimonian–Laird variance estimation method, a significant difference was observed between the two groups using a random-effects model, with a risk ratio (RR) of 2.28 (95%CI 1.12–4.61; P = 0.02). When using the Paule–Mandel estimation method and a random-effects model, the RR was 2.83 (95%CI 0.82–9.79; P = 0.10), with a heterogeneity of 58%. The variance estimation method has a significant impact on the results and can influence the interpretation [2] [3]. To avoid potential bias, the authors should provide an explanation and further clarify their choice of variance estimation metric.

Fig. 1 Forest plots comparing the adenoma recurrence rates using: a the DerSimonian–Laird method; b the Paule–Mandel method.

Future meta-analyses should include more studies comparing recurrence rates across different lesion types and resection methods to provide more robust and comprehensive evidence.

Publication History

Article published online:
28 October 2025

• References

• 1 Sorge A, Montori M, Argenziano ME. et al. Cold snare polypectomy versus hot endoscopic mucosal resection for large nonpedunculated colorectal polyps: a systematic review and meta-analysis of randomized controlled trials. Endoscopy 2025;
• 2 Mathes T, Kuss O. A comparison of methods for meta-analysis of a small number of studies with binary outcomes. Res Synth Methods 2018; 9: 366-381
• 3 Langan D, Higgins JPT, Jackson D. et al. A comparison of heterogeneity variance estimators in simulated random-effects meta-analyses. Res Synth Methods 2019; 10: 83-98