Srinivasan Sachin, Siersema Peter D, Desai Madhav
Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, MO.
Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Endosc Int Open. 2021 Jan;9(1):E9-E13. doi: 10.1055/a-1293-6965. Epub 2021 Jan 1.
Diminutive colorectal polyps are increasingly being detected and it is not clear whether jumbo biopsy forceps (JBF) has comparable efficacy to that of cold snare polypectomy (CSP) for management of these lesions. An electronic literature search was performed for studies comparing resection rates of JBF and CSP for diminutive polyps (≤ 5 mm). The primary outcome was incomplete resection rate (IRR). Secondary outcomes included failure of tissue retrieval and complication rates (post-polypectomy bleeding, perforation etc.). Leave-one-out analysis was performed to examine the disproportionate role of any of the studies. Meta-analysis outcomes and heterogeneity (I ) were computed using Comprehensive meta-analysis software. A total of 4 studies (3 randomized controlled trials and 1 retrospective study) with 407 patients and 569 total polyps (mean size of 3.62 mm) was included for analysis. IRR of JBF was slightly higher than that of CSP (10.2 % vs 7.2 %) but this was not statistically significantly different (Pooled OR 1.76; 95 % CI 0.94-3.28; ). Leave-one-out analysis showed no significant difference in the pooled OR comparison either. Two of the 4 studies reported 0 % failure of tissue retrieval for JBF and 1 % and 4.3 % for CSP. There were no complications for either group from the 2 studies that reported this outcome. The quality of the included studies was moderate to high. This systematic review with only limited data shows that JBF and CSP are not statistically different in completely removing diminutive polyps, although careful endoscopic assessment is needed to ensure complete removal of all polyp tissue.
越来越多的小的结直肠息肉被检测出来，目前尚不清楚对于这些病变的处理，大型活检钳（JBF）与冷圈套息肉切除术（CSP）的疗效是否相当。我们进行了一项电子文献检索，以查找比较JBF和CSP对小息肉（≤5mm）切除率的研究。主要结局是不完全切除率（IRR）。次要结局包括组织获取失败率和并发症发生率（息肉切除术后出血、穿孔等）。进行留一法分析以检验任何一项研究的不成比例作用。使用综合荟萃分析软件计算荟萃分析结果和异质性（I²）。总共纳入4项研究（3项随机对照试验和1项回顾性研究），共407例患者和569枚息肉（平均大小为3.62mm）进行分析。JBF的IRR略高于CSP（10.2%对7.2%），但差异无统计学意义（合并OR 1.76；95%CI 0.94 - 3.28；）。留一法分析显示合并OR比较也无显著差异。4项研究中有2项报告JBF的组织获取失败率为0%，CSP的分别为1%和4.3%。报告此结局的2项研究中两组均无并发症。纳入研究的质量为中等至高。这项仅有有限数据的系统评价表明，尽管需要仔细的内镜评估以确保完全切除所有息肉组织，但在完全切除小息肉方面，JBF和CSP在统计学上没有差异。
