BEST POLYPECTOMY TECHNIQUE FOR SMALL AND DIMINUTIVE COLORECTAL POLYPS: A SYSTEMATIC REVIEW AND META-ANALYSIS.

BACKGROUND Polypectomy of colorectal polyps is the mainstay of colorectal cancer prevention. Identification of the best polypectomy technique is imperative. OBJECTIVE This review aims at comparing efficacy of nine different resection methods for small colorectal polyps (<10 mm). METHODS We searched and selected only randomized controlled trials. Primary outcome was complete resection rates of small polyps by histological eradication. Secondary outcomes were: adverse events, retrieval tissue failures rates and duration of procedure. RESULTS Eighteen trials including 3215 patients and 5223 polyps were analysed. Overall, cold polypectomy had a significantly shorter time of procedure than hot polypectomy (RD -5.92, 95%CI -9.90 to -1.94, P<0.05), with no statistical difference on complete histological eradication (RD 0.08, 95%CI -0.03 to 0.19, P>0.05). Regarding cold polypectomy techniques, cold snare was found superior to cold forceps on complete and en-bloc resection rates and less time consuming. When comparing endoscopic mucosal resection (EMR) with hot-snare and cold-snare, the latter showed no-inferiority on histological eradication, adverse events or retrieval tissue failure rates. CONCLUSION Cold polypectomy is the best technique for resection of small colorectal polyps. Among cold methods, dedicated cold snare was found superior on histological eradication. Cold snare endoscopic mucosal resection might be considered an option for polyps from 5 to 9 mm.

[1]  D. Altman,et al.  Assessing Risk of Bias in Included Studies , 2008 .

[2]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[3]  J. Shim,et al.  Cold Snare Polypectomy Vs. Cold Forceps Polypectomy Using Double-Biopsy Technique for Removal of Diminutive Colorectal Polyps: A Prospective Randomized Study , 2013, The American Journal of Gastroenterology.

[4]  D. Moher,et al.  Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement , 2009, BMJ : British Medical Journal.

[5]  A. Horiuchi,et al.  Prospective Randomized Comparison of Cold Snare Polypectomy and Conventional Polypectomy for Small Colorectal Polyps , 2011, Digestion.

[6]  H. Kashida,et al.  A comparison of the resection rate for cold and hot snare polypectomy for 4–9 mm colorectal polyps: a multicentre randomised controlled trial (CRESCENT study) , 2017, Gut.

[7]  T. Matsuda,et al.  Cold polypectomy techniques for diminutive polyps in the colorectum , 2014, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.

[8]  K. Kinzler,et al.  Genetic instabilities in human cancers , 1998, Nature.

[9]  Y. Jung,et al.  Comparative efficacy of cold polypectomy techniques for diminutive colorectal polyps: a systematic review and network meta-analysis , 2018, Surgical Endoscopy.

[10]  J. Church.  Clinical significance of small colorectal polyps , 2004, Diseases of the colon and rectum.

[11]  Douglas K Rex,et al.  Estimation of Impact of American College of Radiology Recommendations on CT Colonography Reporting for Resection of High-Risk Adenoma Findings , 2009, The American Journal of Gastroenterology.

[12]  Myung-Gyu Choi,et al.  Cold snare polypectomy versus cold forceps polypectomy for diminutive and small colorectal polyps: a randomized controlled trial. , 2015, Gastrointestinal endoscopy.

[13]  Hiroki Sato,et al.  Efficacy and adverse events of cold vs hot polypectomy: A meta-analysis. , 2016, World journal of gastroenterology.

[14]  G. Paspatis,et al.  Cold versus hot endoscopic mucosal resection for nonpedunculated colorectal polyps sized 6–10 mm: a randomized trial , 2017, Endoscopy.

[15]  S. Riley,et al.  Cold snare polypectomy: Does snare type influence outcomes? , 2015, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.

[16]  D. Graham,et al.  Removal of small colorectal polyps in anticoagulated patients: a prospective randomized comparison of cold snare and conventional polypectomy. , 2014, Gastrointestinal endoscopy.

[17]  S. Riley,et al.  A randomized comparison of cold snare polypectomy versus a suction pseudopolyp technique , 2015, Endoscopy.

[18]  M. Wallace,et al.  Diminutive colorectal polyp resection comparing hot and cold snare and cold biopsy forceps polypectomy. Results of a pilot randomized, single-center study (with videos)1 , 2014, Endoscopy international open.

[19]  F. Aslan,et al.  What Is the Most Accurate Method for the Treatment of Diminutive Colonic Polyps? , 2015, Medicine.

[20]  Paul Fockens,et al.  Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline , 2017, Endoscopy.

[21]  G. Cooper,et al.  Role of the cold biopsy technique in diminutive and small colonic polyp removal: a systematic review and meta-analysis. , 2016, Gastrointestinal endoscopy.

[22]  D. Rex,et al.  A survey of colonoscopic polypectomy practices among clinical gastroenterologists. , 2004, Gastrointestinal endoscopy.

[23]  Hot snare polypectomy with or without saline solution/epinephrine lift for the complete resection of small colorectal polyps. , 2018, Gastrointestinal endoscopy.

[24]  F. Aslan,et al.  Cold snare polypectomy versus hot snare polypectomy in endoscopic treatment of small polyps. , 2014, The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology.

[25]  B. Vogelstein,et al.  A genetic model for colorectal tumorigenesis , 1990, Cell.

[26]  J. Ioannidis,et al.  The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration , 2009, BMJ : British Medical Journal.

[27]  D. Graham,et al.  Prospective, randomized comparison of 2 methods of cold snare polypectomy for small colorectal polyps. , 2015, Gastrointestinal endoscopy.

[28]  G. Paspatis,et al.  A prospective randomized comparison of cold vs hot snare polypectomy in the occurrence of postpolypectomy bleeding in small colonic polyps , 2011, Colorectal Disease.

[29]  Mihir S. Wagh,et al.  Randomized, controlled trial of standard, large-capacity versus jumbo biopsy forceps for polypectomy of small, sessile, colorectal polyps. , 2012, Gastrointestinal endoscopy.

[30]  M. Kudo,et al.  Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy , 2017, World journal of gastroenterology.

[31]  A. Zauber,et al.  Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. , 2012, The New England journal of medicine.

[32]  Qi-sheng Zhang,et al.  Polypectomy for complete endoscopic resection of small colorectal polyps. , 2017, Gastrointestinal endoscopy.

[33]  S. Hong,et al.  A prospective randomized comparative study of cold forceps polypectomy by using narrow-band imaging endoscopy versus cold snare polypectomy in patients with diminutive colorectal polyps. , 2016, Gastrointestinal endoscopy.