Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Outcomes of thin versus thick-wire snares for cold snare polypectomy: a systematic review and meta-analysis

  • Received : 2022.04.27
  • Accepted : 2022.06.27
  • Published : 2022.11.30
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Abstract

Background/Aims: Cold snare polypectomy (CSP) is commonly used for the resection of colorectal polyps ≤10 mm. Data regarding the influence of snare type on CSP effectiveness are conflicting. Hence, this meta-analysis aimed to compare the outcomes and safety of thin- and thick-wire snares for CSP. Methods: A comprehensive search of the literature published between 2000 and 2021 was performed of various databases for comparative studies evaluating the outcomes of thin- versus thick-wire snares for CSP. Results: Five studies with data on 1,425 polyps were included in the analysis. The thick-wire snare was comparable to the thin-wire snare with respect to complete histological resection (risk ratio [RR], 1.03; 95% confidence interval [CI], 0.97-1.09), overall bleeding (RR, 0.98; 95% CI, 0.40-2.40), polyp retrieval (RR, 1.01; 95% CI, 0.97-1.04), and involvement of submucosa in the resection specimen (RR, 1.28; 95% CI, 0.72-2.28). There was no publication bias and a small study effect, and the relative effects remained the same in the sensitivity analysis. Conclusions: CSP using a thin-wire snare has no additional benefit over thick-wire snares in small colorectal polyps. Factors other than snare design may play a role in improving CSP outcomes.

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References

  1. Zauber AG, Winawer SJ, O'Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012;366:687-696.  https://doi.org/10.1056/NEJMoa1100370
  2. Lowenfels AB, Williams JL, Holub JL, et al. Determinants of polyp size in patients undergoing screening colonoscopy. BMC Gastroenterol 2011;11:101. 
  3. Lieberman DA, Holub JL, Moravec MD, et al. Prevalence of colon polyps detected by colonoscopy screening in asymptomatic black and white patients. JAMA 2008;300:1417-1422.  https://doi.org/10.1001/jama.300.12.1417
  4. Burgess NG, Metz AJ, Williams SJ, et al. Risk factors for intraprocedural and clinically significant delayed bleeding after wide-field endoscopic mucosal resection of large colonic lesions. Clin Gastroenterol Hepatol 2014;12:651-661.  https://doi.org/10.1016/j.cgh.2013.09.049
  5. Kaltenbach T, Anderson JC, Burke CA, et al. Endoscopic removal of colorectal lesions-recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2020;91:486-519.  https://doi.org/10.1016/j.gie.2020.01.029
  6. Ferlitsch M, Moss A, Hassan C, et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017;49:270-297.  https://doi.org/10.1055/s-0043-102569
  7. Takamaru H, Saito Y, Hammoud GM, et al. Comparison of postpolypectomy bleeding events between cold snare polypectomy and hot snare polypectomy for small colorectal lesions: a large-scale propensity score-matched analysis. Gastrointest Endosc 2022;95:982-989.  https://doi.org/10.1016/j.gie.2021.12.017
  8. Brenner H, Chang-Claude J, Jansen L, et al. Colorectal cancers occurring after colonoscopy with polyp detection: sites of polyps and sites of cancers. Int J Cancer 2013;133:1672-1679.  https://doi.org/10.1002/ijc.28166
  9. Humphris JL, Tippett J, Kwok A, et al. Cold snare polypectomy for diminutive polyps: an assessment of the risk of incomplete removal of small adenomas. Gastrointest Endosc 2009;69:AB207. 
  10. Gonzalez I, Riley DE, Ho SB, et al. Quality colonoscopy: midterm results of a qualitative comparison of cold snare versus cold biopsy forceps for the resection of colonic polyps. Gastrointest Endosc 2010;71:AB244. 
  11. de Benito Sanz M, Hernandez L, Garcia Martinez MI, et al. Efficacy and safety of cold versus hot snare polypectomy for small (5-9 mm) colorectal polyps: a multicenter randomized controlled trial. Endoscopy 2022;54:35-44.  https://doi.org/10.1055/a-1327-8357
  12. Ouzzani M, Hammady H, Fedorowicz Z, et al. Rayyan-a web and mobile app for systematic reviews. Syst Rev 2016;5:210. 
  13. Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928. 
  14. Sterne JA, Hernan MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016;355:i4919. 
  15. Puhan MA, Schunemann HJ, Murad MH, et al. A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis. BMJ 2014;349:g5630. 
  16. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. 
  17. Din S, Ball AJ, Riley SA, et al. Cold snare polypectomy: does snare type influence outcomes? Dig Endosc 2015;27:603-608.  https://doi.org/10.1111/den.12431
  18. Horiuchi A, Hosoi K, Kajiyama M, et al. Prospective, randomized comparison of 2 methods of cold snare polypectomy for small colorectal polyps. Gastrointest Endosc 2015;82:686-692.  https://doi.org/10.1016/j.gie.2015.02.012
  19. Dwyer JP, Tan JY, Urquhart P, et al. A prospective comparison of cold snare polypectomy using traditional or dedicated cold snares for the resection of small sessile colorectal polyps. Endosc Int Open 2017;5:E1062-E1068.  https://doi.org/10.1055/s-0043-113564
  20. Jung Y, Chun AR, Han SJ, et al. Comparison of the clinical efficacy of the cold snare polypectomy using a thin wire mini-snare and thick wire mini-snare for small sized colorectal polyps. Gastrointest Endosc 2018;87:AB366. 
  21. Sidhu M, Forbes N, Tate DJ, et al. A randomized controlled trial of cold snare polypectomy technique: technique matters more than snare wire diameter. Am J Gastroenterol 2022;117:100. 
  22. Pohl H, Srivastava A, Bensen SP, et al. Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology 2013;144:74-80.  https://doi.org/10.1053/j.gastro.2012.09.043
  23. Lee SP, Sung IK, Kim JH, et al. Risk factors for incomplete polyp resection during colonoscopic polypectomy. Gut Liver 2015;9:66-72.  https://doi.org/10.5009/gnl13330
  24. Pedersen IB, Bretthauer M, Kalager M, et al. Incomplete endoscopic resection of colorectal polyps: a prospective quality assurance study. Endoscopy 2021;53:383-391.  https://doi.org/10.1055/a-1243-0379
  25. Saito S, Tajiri H, Ikegami M. Serrated polyps of the colon and rectum: endoscopic features including image enhanced endoscopy. World J Gastrointest Endosc 2015;7:860-871.  https://doi.org/10.4253/wjge.v7.i9.860
  26. Pohl H, Anderson JC, Aguilera-Fish A, et al. Recurrence of colorectal neoplastic polyps after incomplete resection. Ann Intern Med 2021;174:1377-1384.  https://doi.org/10.7326/M20-6689
  27. ASGE Technology Committee, Abu Dayyeh BK, Thosani N, et al. ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 2015;81:502.
  28. Bendall O, James J, Pawlak KM, et al. Delayed bleeding after endoscopic resection of colorectal polyps: identifying high-risk patients. Clin Exp Gastroenterol 2021;14:477-492.  https://doi.org/10.2147/CEG.S282699
  29. Jung YS, Park CH, Nam E, et al. Comparative efficacy of cold polypectomy techniques for diminutive colorectal polyps: a systematic review and network meta-analysis. Surg Endosc 2018;32:1149-1159. https://doi.org/10.1007/s00464-017-5786-4