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.

中文翻译：

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冷圈内窥镜切除大于10 mm的无蒂结直肠息肉：系统评价和汇总分析

背景和目标

热网膜息肉切除术和EMR是切除≥10 mm的大肠息肉的标准治疗方法。为了避免电灼引起的损害，最近有证据表明对这些病变使用冷圈套息肉切除术和冷EMR。这项汇总分析的目的是报告对于≥10 mm的息肉进行冷圈套切除的结果。

方法

截至2018年7月，已搜索PubMed / Medline，Embase，Google Scholar和Cochrane数据库，以鉴定对结直肠息肉≥10 mm进行冷圈套切除的研究。主要结局为不良事件（出血，穿孔和息肉切除术后腹部疼痛），次要结局为完全切除率，总残余息肉率以及腺瘤与无柄锯齿状息肉（SSP）的发生率。进行亚组分析，重点是病变的大小，位置和切除技术。

结果

最终分析中包括八项研究，其中包括522例结肠息肉，息肉平均大小为17.5 mm（范围10-60）。总体不良事件发生率为1.1％（95％置信区间，CI，0.2％-2.0％；I ² = 0％）。术中和术后出血率分别为0.7％（95％CI，0％-1.4％）和0.5％（95％CI，.1％-1.2％），腹痛率为0.6％（95） ％CI，.1％-1.3％）。≥20 mm的息肉的术中出血率较高，为1.3％（95％CI，0.7％-3.3％），腹痛率为1.2％（95％CI，0.7％-3.0％），但无延迟出血。没有穿孔的报道。完全切除率为99.3％（95％CI，98.6％-100％）。任何组织学，腺瘤和SSP息肉的总合并残留率分别为4.1％（95％CI，.2％-8.4％），11.1％（95％CI，4.1％-18.1％）和1.0％（95％）在154到258天的随访期内，CI分别为.4％-2.4％）。

结论

对于息肉切除术后出血，完全切除和残留息肉发生率方面，结直肠息肉的冷网状切除术> 10 mm，该系统评价和汇总分析的结果非常出色。需要进一步比较冷息肉切除术和热息肉切除术对≥10 mm息肉进行比较的随机对照试验。