Abstract
Cold Snare Versus Hot Snare Endoscopic Mucosal Resection of Large Non-pedunculated Colorectal Polyps: A Meta-analysis
Federico A. Peralta IV, MD; Nikko Theodore V. Raymundo, MD; Enrik John T. Aguila, MD
St. Luke’s Medical Center – Global City
Significance: Endoscopic mucosal resection (EMR) is a crucial technique in the removal of precancerous and early-stage cancer lesions within the gastrointestinal tract. Hot snare EMR (H-EMR) and cold snare EMR (C-EMR) techniques are widely debated regarding their efficacy and safety in the resection of large non-pedunculated colorectal polyps (>20mm). This meta-analysis aims to compare the outcomes of H-EMR and C-EMR, focusing on technical success, risk of perforation and bleeding, and rate of polyp recurrence.
Methodology: Relevant studies were identified through systematic searches of PubMed, MEDLINE, Cochrane, and Google Scholar databases. Out of 173, four eligible studies (2 randomized controlled trials and 2 retrospective studies) were included in the analysis. A quality assessment was performed using the Cochrane Risk of Bias tool for the randomized controlled trials and the Newcastle-Ottawa scale for the retrospective studies.
Results: There is no statistically significant difference in the technical success rate of C-EMR compared to H-EMR for removing large nonpedunculated colonic polyps (OR 2.11, 95% CI [0.14-31]; I²=67%). Additionally, there is no significant difference in the risk of perforation between the two methods (OR 0.23, 95% CI [0.04-1.30]; I²=0%). H-EMR has a higher risk of postpolypectomy bleeding compared to C-EMR (OR 0.2, 95% CI [0.07-0.56]; I²=0%). In contrast, C-EMR has been shown to have a higher rate of polyp recurrence compared to H-EMR (OR 2.56, 95% CI [1.40-4.70]; I²=43%). Additional subgroup analysis of the included randomized controlled trials for rate of polyp recurrence showed consistent findings (OR 2.70, 95% CI [1.62-4.49]; I2=80%).
Conclusion: C-EMR is non-inferior to H-EMR in the resection of large nonpedunculated colonic polyp, with both methods showing similarly low perforation rates. C-EMR has a higher rate of polyp recurrence compared to H-EMR. Meanwhile, H-EMR has a higher risk of postpolypectomy bleeding compared to H-EMR. Cost-effective analyses to compare C-EMR and H-EMR are recommended.
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
| Monthly Critical Appraisal of Topics Conferences to be gaciliated by Research Coordinators per Institution | Monthly Critical Appraisal of Topics Conferences per Institution |
| CAT Plenary/Liver Con Dates: September 23, 2023 December 16, 2023 March 2024 (During the JAC) Resumption of face-to-face Quarterly Critical Appraisal of Topics facilitated by the JRRE |
2 Clinical scenarios and articles are to be sent to institutions each on August 2023, November 2023, and February 2024; |
| Hybrid Research Workshop 4 week asynchronous via Moodle, followed by a 1 day on-site Onsite Workshop Research Protocol Presentation for Level I GI Fellows-In-Training - Research Protocol Presentation: August 12, 2023 - Research Forums of the Tripartite Societies |
Week 1: July 15-21, 2023 Week 2: July 22-28, 2023 Week 3: July 29-August 4, 2023 Week 4: August 5-11, 2023 |
| Research Manuscript Workshop for level II GI Fellows-In-Training | January 6, 2024 |