Viveksandeep Thoguluva Chandrasekar1, Marco Spadaccini2, Muhammad Aziz1, Roberta Maselli2, Seemeen Hassan3, Lorenzo Fuccio4, Abhiram Duvvuri1, Leonardo Frazzoni4, Madhav Desai1, Alessandro Fugazza2, Ramprasad Jegadeesan1, Matteo Colombo2, Chandra Skekhar Dasari5, Cesare Hassan6, Prateek Sharma1, Alessandro Repici2. 1. 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. 2. Department of Gastroenterology, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center and Humanitas University, Rozzano (MI), Italy. 3. Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City Kansas City, Missouri, USA. 4. Department of Gastroenterology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. 5. Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri, USA. 6. Department of Gastroenterology, Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
Abstract
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.
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.
Authors: Nauzer Forbes; Robert J Hilsden; Brendan Cord Lethebe; Courtney M Maxwell; Mubasiru Lamidi; Gilaad G Kaplan; Matthew T James; Roshan Razik; Lawrence C Hookey; William A Ghali; Michael J Bourke; Steven J Heitman Journal: Am J Gastroenterol Date: 2020-05 Impact factor: 12.045
Authors: Suraj Suresh; Jinyu Zhang; Abdelwahab Ahmed; Mouhanna Abu Ghanimeh; Ahmed Elbanna; Randeep Kaur; Mahmoud Isseh; Andrew Watson; Duyen T Dang; Krishnavel V Chathadi; Robert Pompa; Sumit Singla; Cyrus Piraka; Tobias Zuchelli Journal: Endosc Int Open Date: 2021-05-27
Authors: Vinay Chandrasekhara; Nikhil A Kumta; Barham K Abu Dayyeh; Manoop S Bhutani; Pichamol Jirapinyo; Kumar Krishnan; John T Maple; Joshua Melson; Rahul Pannala; Mansour A Parsi; Amrita Sethi; Guru Trikudanathan; Arvind J Trindade; David R Lichtenstein Journal: VideoGIE Date: 2021-04-02