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Cold snare polypectomy compared to cold forceps polypectomy for endoscopic resection of guideline defined diminutive polyps: A systematic review and meta-analysis of randomized trials

  • Systematic review
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Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

International guidelines recommend cold snare polypectomy (CSP) for polyps  < 10 mm in size. However, recent randomized clinical trials (RCTs) showed conflicting results for the use of cold forceps polypectomy (CFP) vs. CSP for the resection of diminutive colorectal polyps (DCPs) (≤ 5 mm), especially for polyps  ≤ 3 mm. Herein we compared CFP with CSP for patients with DCPs in this meta-analysis of RCTs.

Methods

We systematically searched the Cochrane Library, PubMed and EMBASE databases from inception to November 24, 2022, (Registration number INPLASY2022110135). The primary endpoint was DCP complete resection rate. The secondary endpoints were mean polypectomy time, polyp retrieval rate and complications.

Results

Seven RCTs involving 1023 DCPs were included. The complete resection rate (91.6% vs. 94.7%) for CFP was not significantly lower for polyps ≤ 5 mm (relative risk [RR] = 1.03; 95% confidence interval [CI]: 0.98–1.07). Sub-group analysis showed that the complete resection rate (88.7% vs. 92.4%) for CFP was not significantly lower for DCPs > 3 mm (RR = 1.04; 95% CI: 0.97–1.12). Another sub-group analysis showed that the complete resection rate (97.0% vs. 96.3%) was similar for polyps ≤ 3 mm for CFP vs. CSP (RR = 1.00; 95% CI: 0.98–1.03). The mean polypectomy time was not different between CFP and CSP (95% CI: -11.86–10.18). The polyp retrieval rate (100% vs. 96.9%) was not significantly higher for CFP (RR = 1.02; 95% CI: 0.98–1.07). There were no reported complications in the included studies. The overall study quality was moderate except for the removal of polyps ≤ 5 mm (low-quality evidence).

Conclusion

CFP was comparable to CSP for the resection of polyps ≤ 3 mm; however, caution should be taken for DCPs > 3 mm because of the low complete resection rate (< 90%).

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Data availability

The data that support the findings of this study is available from the corresponding author upon reasonable request.

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Author information

Authors and Affiliations

  1. Department of Gastroenterology, Zhenning Buyi and Miao Autonomous County People’s Hospital, Zhenning, 561200, Guizhou Province, China

    Yong-Cai Lv & Yan-Hua Yao

  2. Department of Geriatric Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, Guizhou Province, China

    Jing-Jing Lei

  3. Department of Gastroenterology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, No. 1558 Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China

    Tao Tang

Authors
  1. Yong-Cai Lv
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  2. Yan-Hua Yao
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  4. Tao Tang
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Contributions

LY-C designed the study; LY-C, YY-H, LJ-J and TT participated in the acquisition, analysis and interpretation of the data; LY-C wrote the manuscript; TT revised the article.

Corresponding author

Correspondence to Tao Tang.

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YCL, YHL, JJL and TT declare that they have no conflict of interest.

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Ethical approval was not required for this study.

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Lv, YC., Yao, YH., Lei, JJ. et al. Cold snare polypectomy compared to cold forceps polypectomy for endoscopic resection of guideline defined diminutive polyps: A systematic review and meta-analysis of randomized trials. Indian J Gastroenterol 42, 757–765 (2023). https://doi.org/10.1007/s12664-023-01441-w

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  • DOI: https://doi.org/10.1007/s12664-023-01441-w

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