Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing, China.
J Gastroenterol Hepatol. 2023 Nov;38(11):1892-1899. doi: 10.1111/jgh.16308. Epub 2023 Aug 22.
Neoplastic polyp removal is important for colorectal cancer prevention. Endoscopists have proposed cold snare endoscopic mucosal resection (CS-EMR) as a solution to solve positive cutting edges and postoperative bleeding. However, many controversies regarding its specific performance in practice have been reported. The aim of this pooled analysis was to report the efficacy and safety of CS-EMR.
PubMed/Medline, Embase, Google Scholar, and the Cochrane Library searched up to January 2022 to identify studies in which CS-EMR was performed for the removal of colorectal polyps measuring less than 20 mm. The primary outcome was the complete resection rate (CRR), and the secondary outcome was the rate of adverse events.
Eleven studies were included in the final analysis, which included 861 colorectal polyps. The overall CRR with CS-EMR was 96.3% (95% CI, 93.9-98.2%). The early and delayed bleeding rates of CS-EMR were 3.1% (95% CI, 1.2-5.5%) and 1.4% (95% CI, 0.6-2.4%), respectively. There were no statistical significances between CS-EMR and cold snare polypectomy (CSP) in terms of the CRR and adverse events, as well as CS-EMR and hot snare endoscopic mucosal resection (HS-EMR).
For resecting colorectal polyps measuring ≤20 mm, CS-EMR is an effective attempt. However, compared with CSP and HS-EMR, CS-EMR did not improve the efficiency and safety of polypectomy as expected. Multicenter randomized controlled trials are needed to compare CSP with CS-EMR in the resection of <10 mm polyps and HSP with CS-EMR in the resection of ≥10 mm polyps.
肿瘤性息肉的切除对于结直肠癌的预防至关重要。内镜医师提出冷圈套内镜黏膜切除术（CS-EMR），以解决阳性切缘和术后出血的问题。然而，关于其在实践中的具体表现仍存在诸多争议。本荟萃分析旨在报告 CS-EMR 的疗效和安全性。
检索 PubMed/Medline、Embase、Google Scholar 和 Cochrane Library 数据库，截至 2022 年 1 月，以识别 CS-EMR 用于切除直径＜20mm 的结直肠息肉的研究。主要结局为完全切除率（CRR），次要结局为不良事件发生率。
最终有 11 项研究纳入分析，共纳入 861 个结直肠息肉。CS-EMR 的总体 CRR 为 96.3%（95%CI：93.9-98.2%）。CS-EMR 的早期和延迟出血率分别为 3.1%（95%CI：1.2-5.5%）和 1.4%（95%CI：0.6-2.4%）。CS-EMR 与冷圈套息肉切除术（CSP）、CS-EMR 与热圈套内镜黏膜切除术（HS-EMR）在 CRR 和不良事件方面均无统计学差异。
对于切除直径≤20mm 的结直肠息肉，CS-EMR 是一种有效的尝试。然而，与 CSP 和 HS-EMR 相比，CS-EMR 并没有像预期的那样提高息肉切除术的效率和安全性。需要开展多中心随机对照试验，比较 CSP 与 CS-EMR 切除＜10mm 息肉，以及 HSP 与 CS-EMR 切除≥10mm 息肉的效果。
