Niu Chengu, Bapaye Jay, Zhang Jing, Liu Hongli, Zhu Kaiwen, Farooq Umer, Zahid Salman, Chathuranga Dileepa, Okolo Patrick I
Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, USA.
Harbin Medical University, Harbin, China.
J Gastroenterol Hepatol. 2023 Sep;38(9):1458-1467. doi: 10.1111/jgh.16312. Epub 2023 Aug 4.
Cold snare polypectomy (CSP) has become increasingly utilized to resect colorectal polyps, given its efficacy and safety. This study aims to compare CSP and hot snare polypectomy (HSP) for resecting small (< 10 mm) and large (10-20 mm) colorectal lesions.
Relevant publications were obtained from Cochrane Library, Embase, Google Scholar, PubMed, and Web of Science databases. The publication search was limited by English-language and human studies. Pooled mean difference and odds ratios (ORs) were calculated for outcomes of interest.
Twenty-three studies were included in this meta-analysis. Pooled OR of delayed post-polypectomy bleeding (DPPB) in the CSP group versus the HSP group was 0.29 (P = 0.0001, I = 29%). Subgroup analysis according to lesion size showed a significant reduction in the DPPB rate in lesion sizes 10-20 mm (pooled OR 0.08, P = 0.003, I = 0%) and < 10 mm (pooled OR 0.35, P = 0.001, I = 27%). Pooled OR of major bleeding in the CSP group was 0.23 (P = 0.0004, I = 0%). Subgroup analysis by lesion size revealed a significant decrease in the rate of major bleeding in the CSP group for both lesion sizes 10-20 mm (pooled OR 0.11, P = 0.04) and < 10 mm (pooled OR 0.26, P = 0.003). Complete resection, en bloc resection, and recurrence rate were comparable in the two groups.
Cold snare polypectomy was associated with a lower rate of DPPB and lower risk of major bleeding compared with HSP in both small and large polyps. CSP should be considered as the polypectomy technique of choice for colorectal polyps.
鉴于冷圈套息肉切除术（CSP）的有效性和安全性，其在结直肠息肉切除中的应用日益广泛。本研究旨在比较CSP与热圈套息肉切除术（HSP）用于切除小（<10mm）和大（10 - 20mm）结直肠病变的效果。
从Cochrane图书馆、Embase、谷歌学术、PubMed和Web of Science数据库中获取相关出版物。出版物检索限于英文和人体研究。计算感兴趣结局的合并平均差和比值比（OR）。
本荟萃分析纳入了23项研究。CSP组与HSP组相比，息肉切除术后延迟出血（DPPB）的合并OR为0.29（P = 0.0001，I² = 29%）。根据病变大小进行的亚组分析显示，在10 - 20mm（合并OR 0.08，P = 0.003，I² = 0%）和<10mm（合并OR 0.35，P = 0.001，I² = 27%）的病变中，DPPB率显著降低。CSP组大出血的合并OR为0.23（P = 0.0004，I² = 0%）。按病变大小进行的亚组分析显示，在10 - 20mm（合并OR 0.11，P = 0.04）和<10mm（合并OR 0.26，P = 0.003）的病变中，CSP组大出血率均显著降低。两组的完整切除、整块切除和复发率相当。
与HSP相比，冷圈套息肉切除术在大小息肉中均与较低的DPPB率和较低的大出血风险相关。CSP应被视为结直肠息肉切除的首选技术。
