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Abstract
Background and aims
The practices for resection of diminutive colon polyps vary among endoscopists and
US Multi-Society Task force (USMSTF) guidelines recommend use of cold snare polypectomy
(CSP) for this purpose. In this meta-analysis, we have compared CSP and cold forceps
polypectomy (CFP) for resection of diminutive polyps.
Methods
We reviewed several databases to identify randomized controlled trials (RCTs) that
compared CSP and CFP for resection of diminutive polyps. Our outcomes of interest
were complete resection of all diminutive polyps, complete resection of polyps ≤ 3mm
in size, failure of tissue retrieval and polypectomy time. For categorical variables,
we calculated pooled odds ratios (OR) with 95% confidence intervals (CI); for continuous
variables, we calculated mean difference (MD) with 95% CI. Data were analyzed using
random effects model and heterogeneity was assessed using the I2 statistic
Results
We included 9 studies with 1037 patients. Rate of complete resection of all diminutive
polyps was significantly higher in the CSP group, OR (95% CI) 1.68 (1.09, 2.58). Subgroup
analysis including jumbo or large capacity forceps, found no significant difference
in complete resection between groups, OR (95% CI) 1.43 (0.80, 2.56). We found no significant
difference in the rates of complete resection of ≤ 3mm polyps between groups, OR (95%
CI) 0.83 (0.30, 2.31). Rate of failure of tissue retrieval was significantly higher
in CSP group, OR (95% CI): 10.13 (2.29, 44.74). We found no significant difference
in polypectomy time between groups.
Conclusions
CFP using large capacity or jumbo biopsy forceps is non-inferior to CSP for complete
resection of diminutive polyps.
Keywords
Acronyms:
USMSTF (US Multi-Society Task force), CSP (Cold snare polypectomy), CFP (Cold forceps polypectomy), RCTs (Randomized controlled trials), OR (Odds ratio), CI (Confidence interval), MD (Mean difference), PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis), CMA (Comprehensive Meta-Analysis), ESGE (European Society of Gastrointestinal Endoscopy)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
March 2,
2023
Received in revised form:
February 7,
2023
Received:
October 30,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Author contributions:
FK and DGA were responsible for conception and design; FK, MAK and W L-S performed analysis and interpretation of the data; SS, AA, UF, AA, MA, JC, AK, AS, DL and TK participated in drafting of the article; DGA, W L-S, DL and AK performed critical revision of the article for important intellectual content, all authors approved the final version of the manuscript.
Authors have no relevant conflicts of interest
This project was not funded from any source
Identification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy
