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Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis

  • Author Footnotes
    ∗ Drs Thoguluva Chandrasekar and Spadaccini contributed equally to this article.
    Viveksandeep Thoguluva Chandrasekar
    Footnotes
    ∗ Drs Thoguluva Chandrasekar and Spadaccini contributed equally to this article.
    Affiliations
    Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, USA

    Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri, USA
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  • Author Footnotes
    ∗ Drs Thoguluva Chandrasekar and Spadaccini contributed equally to this article.
    Marco Spadaccini
    Correspondence
    Reprint requests: Marco Spadaccini, MD, Digestive Endoscopy Unit, Via Manzoni 56, 20089 Rozzano (Milano), Italy.
    Footnotes
    ∗ Drs Thoguluva Chandrasekar and Spadaccini contributed equally to this article.
    Affiliations
    Department of Gastroenterology, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center and Humanitas University, Rozzano (MI), Italy
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  • Muhammad Aziz
    Affiliations
    Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, USA

    Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri, USA
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  • Roberta Maselli
    Affiliations
    Department of Gastroenterology, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center and Humanitas University, Rozzano (MI), Italy
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  • Seemeen Hassan
    Affiliations
    Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City Kansas City, Missouri, USA
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  • Lorenzo Fuccio
    Affiliations
    Department of Gastroenterology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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  • Abhiram Duvvuri
    Affiliations
    Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, USA

    Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri, USA
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  • Leonardo Frazzoni
    Affiliations
    Department of Gastroenterology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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  • Madhav Desai
    Affiliations
    Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, USA

    Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri, USA
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  • Alessandro Fugazza
    Affiliations
    Department of Gastroenterology, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center and Humanitas University, Rozzano (MI), Italy
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  • Ramprasad Jegadeesan
    Affiliations
    Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, USA

    Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri, USA
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  • Matteo Colombo
    Affiliations
    Department of Gastroenterology, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center and Humanitas University, Rozzano (MI), Italy
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  • Chandra Skekhar Dasari
    Affiliations
    Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri, USA
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  • Cesare Hassan
    Affiliations
    Department of Gastroenterology, Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
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  • Prateek Sharma
    Affiliations
    Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, USA

    Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri, USA
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  • Alessandro Repici
    Affiliations
    Department of Gastroenterology, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center and Humanitas University, Rozzano (MI), Italy
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  • Author Footnotes
    ∗ Drs Thoguluva Chandrasekar and Spadaccini contributed equally to this article.
Published:January 09, 2019DOI:https://doi.org/10.1016/j.gie.2018.12.022

      Background and Aims

      Hot snare polypectomy and EMR are the standard of care in resecting colorectal polyps ≥10 mm. To avoid the risk of electrocautery-induced damage, there is recent evidence about using cold snare polypectomy and cold EMR for such lesions. The aim of this pooled analysis is to report outcomes of cold snare resection for polyps ≥10 mm.

      Methods

      PubMed/Medline, Embase, Google Scholar, and Cochrane databases were searched up to July 2018 to identify studies that performed cold snare resection for colorectal polyps ≥10 mm. Primary outcomes were adverse events (bleeding, perforation, and postpolypectomy abdominal pain), and secondary outcomes were the rates of complete resection, overall residual polyp rates, and rates for adenomas versus sessile serrated polyps (SSPs). Subgroup analysis was performed focusing on lesion size, location, and resection technique.

      Results

      Eight studies were included in the final analysis that included 522 colorectal polyps with a mean polyp size of 17.5 mm (range, 10-60). The overall adverse event rate was 1.1% (95% confidence interval, CI, 0.2%-2.0%; I2 = 0%). Intra- and postprocedural bleeding rates were .7% (95% CI, 0%-1.4%) and .5% (95% CI, .1%-1.2%), respectively, with abdominal pain rate being .6% (95% CI, .1%-1.3%). Polyps ≥20 mm had a higher intraprocedural bleeding rate of 1.3% (95% CI, .7%-3.3%) and abdominal pain rate of 1.2% (95% CI, .7%-3.0%) but no delayed bleedings. No perforations were reported. The complete resection rate was 99.3% (95% CI, 98.6%-100%). Overall pooled residual rates of polyps of any histology, adenomas, and SSPs were 4.1% (95% CI, .2%-8.4%), 11.1% (95% CI, 4.1%-18.1%), and 1.0% (95% CI, .4%-2.4%), respectively, during a follow-up period ranging from 154 to 258 days.

      Conclusions

      The results of this systematic review and pooled analysis were excellent with cold snare resection of colorectal polyps >10 mm in terms of postpolypectomy bleeding, complete resection, and residual polyp rates. Randomized controlled trials comparing cold snare resection with hot snare resections of polyps ≥10 mm are required for further investigation.

      Graphical abstract

      Abbreviations:

      CSP (cold snare polypectomy), HSP (hot snare polypectomy), SSP (sessile serrated polyp)
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