Cold snare endoscopic mucosal resection for colon polyps: a systematic review and meta-analysis

Abstract

Background Cold snare endoscopic mucosal resection (CS-EMR) can reduce the risks associated with electrocautery during colon polyp resection. Data on efficacy are variable. This systematic review and meta-analysis aimed to estimate the pooled efficacy and safety rates of CS-EMR. Methods We conducted a comprehensive literature search of multiple databases, from inception to March 2023, for studies addressing outcomes of CS-EMR for colon polyps. The weighted pooled estimates with 95 %CIs were calculated using the random effects model. I2 statistics were used to evaluate heterogeneity. Results 4137 articles were reviewed, and 16 studies, including 2592 polyps in 1922 patients (51.4 % female), were included. Overall, 54.4 % of polyps were adenomas, 45 % were sessile serrated lesions (SSLs), and 0.6 % were invasive carcinomas. Polyp recurrence after CS-EMR was 6.7 % (95 % CI 2.4 %–17.4 %, I2 = 94 %). The recurrence rate was 12.3 % (95 %CI 3.4 %–35.7 %, I2 = 94 %) for polyps ≥ 20 mm, 17.1 % (95%CI 4.6%–46.7%, I2=93%) for adenomas, and 5.7% (95%CI 3.2%–9.9%, I2=50%) for SSLs. The pooled intraprocedural bleeding rate was 2.6% (95%CI 1.5%–4.5%, I2=51 %), the delayed bleeding rate was 1.5% (95%CI 0.8%–2.7%, I2=18%), and no perforations or post-polypectomy syndromes were reported, with estimated rates of 0.6% (95% CI 0.3%–1.3%, I2=0%) and 0.6% (95%CI 0.3%–1.4%, I2=0 %), respectively. Conclusion CS-EMR demonstrated an excellent safety profile for colon polyps, with variable recurrence rates based on polyp size and histology. Large prospective studies are needed to validate these findings.