Shinozaki Medical Clinic, Utsunomiya, Japan.
Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
Dig Endosc. 2018 Sep;30(5):592-599. doi: 10.1111/den.13173. Epub 2018 May 14.
Safety and effectiveness of cold snare polypectomy (CSP) compared with hot snare polypectomy (HSP) has been reported. The aim of the present study is to carry out a meta-analysis of the efficacy and safety of HSP and CSP.
Randomized controlled trials were reviewed to compare HSP with CSP for resecting small colorectal polyps. Outcomes reviewed include complete resection rate, polyp retrieval, delayed bleeding, perforation and procedure time. Outcomes were documented by pooled risk ratios (RR) with 95% confidence intervals (CI) using the Mantel-Haenszel random effect model.
Eight studies were reviewed in this meta-analysis, including 1665 patients with 3195 polyps. Complete resection rate using HSP was similar to CSP (RR: 1.02, 95% CI: 0.98-1.07, P = 0.31). Polyp retrieval after HSP was similar to CSP (RR: 1.00, 95% CI: 1.00-1.01, P = 0.60). Delayed bleeding rate after HSP was higher than after CSP, although not significantly (patient basis: RR: 7.53, 95% CI: 0.94-60.24, P = 0.06; polyp basis: RR: 7.35, 95% CI: 0.91-59.33, P = 0.06). Perforation was not reported in all eight studies. Total colonoscopy time for HSP was significantly longer than CSP (mean difference 7.13 min, 95% CI: 5.32-8.94, P < 0.001). Specific polypectomy time for HSP was significantly longer than CSP (mean difference 30.92 s, 95% CI: 9.15-52.68, P = 0.005).
This meta-analysis shows significantly shorter procedure time using CSP compared with HSP. CSP tends toward less delayed bleeding compared with HSP. We recommend CSP as the standard treatment for resecting small benign colorectal polyps.
已报道冷圈套息肉切除术（CSP）与热圈套息肉切除术（HSP）的安全性和有效性。本研究旨在对 HSP 和 CSP 的疗效和安全性进行荟萃分析。
对比较 HSP 和 CSP 切除小的结直肠息肉的随机对照试验进行综述。综述的结果包括完全切除率、息肉取出、延迟性出血、穿孔和手术时间。使用 Mantel-Haenszel 随机效应模型，通过汇总风险比（RR）和 95%置信区间（CI）记录结果。
本荟萃分析共纳入 8 项研究，共 1665 例患者，3195 个息肉。HSP 组的完全切除率与 CSP 相似（RR：1.02，95%CI：0.98-1.07，P = 0.31）。HSP 组息肉取出与 CSP 相似（RR：1.00，95%CI：1.00-1.01，P = 0.60）。HSP 组延迟性出血率高于 CSP 组，但差异无统计学意义（患者基础：RR：7.53，95%CI：0.94-60.24，P = 0.06；息肉基础：RR：7.35，95%CI：0.91-59.33，P = 0.06）。所有 8 项研究均未报告穿孔。HSP 组全结肠镜检查时间明显长于 CSP 组（平均差异 7.13 分钟，95%CI：5.32-8.94，P < 0.001）。HSP 组特定息肉切除术时间明显长于 CSP 组（平均差异 30.92 秒，95%CI：9.15-52.68，P = 0.005）。
与 HSP 相比，CSP 具有明显更短的手术时间。CSP 与 HSP 相比，延迟性出血发生率较低。我们建议 CSP 作为切除小的良性结直肠息肉的标准治疗方法。
