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Comparative efficacy of cold polypectomy techniques for diminutive colorectal polyps: a systematic review and network meta-analysis

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Abstract

Background

Although cold polypectomy techniques are preferred over polypectomy with electrocautery in the management of diminutive polyps, comprehensive comparisons among various cold polypectomy techniques have not yet been fully performed.

Methods

We searched for all relevant randomized controlled trials published up until October 2016 examining the efficacy of cold polypectomy techniques for diminutive polyps. Cold polypectomy techniques were classified as cold forceps polypectomy (CFP), jumbo forceps polypectomy (JFP), traditional cold snare polypectomy (CSP), and dedicated CSP, according to the type of device. A network meta-analysis was performed to calculate the direct and indirect estimates of efficacy among the cold polypectomy techniques.

Results

Seven studies with 703 patients and 968 polyps were included in the meta-analysis. Regarding comparative efficacy for complete histological eradication, there was no inconsistency in the network (Cochran’s Q test, df = 4, P = 0.22; I 2 = 30%). In terms of complete histological eradication, both dedicated and traditional CSP were superior to CFP (odds ratio [OR] [95% confidence interval [CI]] 4.31 [1.92–9.66] and 2.45 [1.30–4.63], respectively); dedicated CSP was superior to traditional CSP (OR [95% CI] 1.76 [1.07–2.89]); and there was no difference between JFP versus CFP (OR [95% CI] 1.36 [0.40–4.61]). Regarding tissue retrieval rate, there was no difference between dedicated versus traditional CSP (OR [95% CI] 1.03 [0.44–2.38]). The procedure time for CSP was comparable to that of CFP.

Conclusions

Dedicated CSP was shown to be superior to other cold polypectomy techniques in terms of complete histological eradication. Cold polypectomy using a dedicated snare can be recommended for the removal of diminutive colorectal polyps.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

    Yoon Suk Jung & Dong Il Park

  2. Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, 153 Gyeongchun-ro, Guri, 11923, Korea

    Chan Hyuk Park, Chang Soo Eun & Dong Soo Han

  3. Biostatistical Consulting and Research Lab, Medical Research Coordinating Center, Hanyang University, Seoul, Korea

    Eunwoo Nam

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  1. Yoon Suk Jung
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Correspondence to Chan Hyuk Park.

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Yoon Suk Jung, Chan Hyuk Park, Eunwoo Nam, Chang Soo Eun, Dong Il Park, and Dong Soo Han have no conflicts of interest or financial ties to disclose.

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464_2017_5786_MOESM1_ESM.tif

Risk of bias summary: the review authors' judgments regarding each risk of bias item for each included study (TIFF 305 kb)

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Jung, Y.S., Park, C.H., Nam, E. et al. Comparative efficacy of cold polypectomy techniques for diminutive colorectal polyps: a systematic review and network meta-analysis. Surg Endosc 32, 1149–1159 (2018). https://doi.org/10.1007/s00464-017-5786-4

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