Cold snare versus cold forceps polypectomy for endoscopic resection of diminutive polyps: meta-analysis of randomized controlled trials.

Faisal Kamal, Muhammad Ali Khan, Wade Lee-Smith, Sachit Sharma, Ashu Acharya, Umer Farooq, Amit Agarwal, Muhammad Aziz, Justin Chuang, Anand Kumar, Alexander Schlachterman, David Loren, Thomas Kowalski, Douglas Adler

Journal: Gastrointestinal endoscopy 2023;98(1):7-18.e4

PMID: 36907527

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND AND AIMS

The practices for resection of diminutive colon polyps vary among endoscopists, and U.S. Multi-Society Task force guidelines recommend use of cold snare polypectomy (CSP) for this purpose. In this meta-analysis, we compared CSP and cold forceps polypectomy (CFP) for resection of diminutive polyps.

METHODS

Several databases were reviewed to identify randomized controlled trials that compared CSP and CFP for resection of diminutive polyps. The study outcomes of interest were complete resection of all diminutive polyps, complete resection of polyps ≤3 mm in size, failure of tissue retrieval, and polypectomy time. For categorical variables, pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated; for continuous variables, mean differences (MDs) with 95% CIs were calculated. Data were analyzed by using a random-effects model, and heterogeneity was assessed by using the I statistic.

RESULTS

We included 9 studies with 1037 patients. Rate of complete resection of all diminutive polyps was significantly higher in the CSP group (OR, 1.68; 95% CI, 1.09-2.58). Subgroup analysis, including jumbo or large-capacity forceps, found no significant difference in complete resection between groups (OR, 1.43; 95% CI, .80-2.56). We found no significant between-groups in the rates of complete resection of polyps ≤3 mm in size (OR, .83; 95% CI, .30-2.31). Rate of failure of tissue retrieval was significantly higher in the CSP group (OR, 10.13; 95% CI, 2.29-44.74). No significant between-group difference was noted in polypectomy time.

CONCLUSIONS

CFP using large-capacity or jumbo biopsy forceps is noninferior to CSP for complete resection of diminutive polyps.

Address: Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.; Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.; Mulford Health Sciences Library.; Department of Medicine; Division of Gastroenterology.; Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.; Department of Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, Illinois, USA.; Division of Gastroenterology, University of Toledo, Toledo, Ohio, USA.; Department of Medicine.; Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Denver, Colorado, USA. Electronic address: [email protected].

DOI: 10.1016/j.gie.2023.03.008