Li Xuanhan, Zhu He, Li Fudong, Li Ri, Xu Hong
Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin, China.
Department of Library, The First Hospital of Jilin University, Changchun, Jilin, China.
Front Med (Lausanne). 2023 Apr 6;10:1154411. doi: 10.3389/fmed.2023.1154411. eCollection 2023.
In recent years, cold snare polypectomy (CSP) has been increasingly used for small polyps (<10 mm) instead of hot snare polypectomy (HSP). However, evidence-based research regarding the effectiveness and safety of CSP and HSP are still lacking. Additionally, for 4-10 -mm non-pedunculated polyps, the polyp removal method is still controversial. Therefore, it is clinically significant to conduct pair-wise and network meta-analyses to assess such resection methods.
We searched PubMed, Embase, and the Cochrane library for randomized controlled trials (RCTs). Only studies that involved the resection of polyps <10 mm were included. Outcomes included the complete resection rate, polyp retrieval rate, procedure-related complications, and procedure times.
Overall, 23 RCTs (5,352 patients) were identified. In meta-analysis compared CSP versus HSP for polyps <10 mm, CSP showed lower complete resection rate than HSP although with no statistically significant difference [odds ratio (OR): 0.77, 95% confidence interval (CI): 0.56-1.06]. CSP showed a lower risk of major post-polypectomy complications compared to HSP (OR: 0.28, 95% CI: 0.11-0.73). In the network meta-analysis for 4-10 mm non-pedunculated polyps, HSP, and endoscopic mucosal resection (EMR) showed a higher complete resection rate than CSP (OR: 2.7, 95% CI: 1.3-9.2 vs. OR: 2.6, 95% CI: 1.0-10) but a significantly longer time than CSP (WMD: 16.55 s, 95% CI [7.48 s, 25.25 s], < 0.001), (WMD: 48.00 s, 95% CI [16.54 s, 79.46 s], = 0.003). Underwater CSP ranked third for complete resection with no complications.
For <10 mm polyps, CSP is safer than HSP, especially for patients taking antithrombotic drugs. For 4-10 mm non-pedunculated polyps, HSP, and EMR have higher complete resection rates than CSP.
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022315575.
近年来，冷圈套息肉切除术（CSP）越来越多地用于切除小息肉（<10 mm），而非热圈套息肉切除术（HSP）。然而，关于CSP和HSP有效性和安全性的循证研究仍然缺乏。此外，对于4 - 10 mm的无蒂息肉，息肉切除方法仍存在争议。因此，进行成对和网状荟萃分析以评估此类切除方法具有临床意义。
我们在PubMed、Embase和Cochrane图书馆中检索随机对照试验（RCT）。仅纳入涉及切除<10 mm息肉的研究。结局指标包括完全切除率、息肉回收成功率、手术相关并发症和手术时间。
总体而言，共识别出23项RCT（5352例患者）。在对<10 mm息肉的CSP与HSP的荟萃分析中，CSP的完全切除率低于HSP，尽管差异无统计学意义[比值比（OR）：0.77，95%置信区间（CI）：0.56 - 1.06]。与HSP相比，CSP术后发生主要并发症的风险更低（OR：0.28，95% CI：0.11 - 0.73）。在对4 - 10 mm无蒂息肉的网状荟萃分析中，HSP和内镜黏膜切除术（EMR）的完全切除率高于CSP（OR：2.7，95% CI：1.3 - 9.2；对比OR：2.6，95% CI：1.0 - 10），但手术时间显著长于CSP（加权均数差：16.55秒，95% CI [7.48秒，25.25秒]，P < 0.001），（加权均数差：48.00秒，95% CI [16.54秒，79.46秒]，P = 0.003）。水下CSP在完全切除且无并发症方面排名第三。
对于<10 mm的息肉，CSP比HSP更安全，尤其对于正在服用抗血栓药物的患者。对于4 - 10 mm的无蒂息肉，HSP和EMR的完全切除率高于CSP。
