Khan Rishad, Samnani Sunil, Vaska Marcus, Grover Samir C, Walsh Catharine M, Mosko Jeffrey, Bourke Michael, Heitman Steven J, Forbes Nauzer
Department of Medicine, University of Toronto, Toronto, Canada.
Knowledge Resource Service, Tom Baker Cancer Centre, Calgary, Canada.
Endosc Int Open. 2024 Jan 19;12(1):E99-E107. doi: 10.1055/a-2221-7792. eCollection 2024 Jan.
Cold-snare polypectomy (CSP) is considered the standard of care for resection of colorectal polyps ≤10 mm. Data on the efficacy of CSP performed with thin-wire snares compared0 with thick-wire snares are conflicting. We performed a meta-analysis comparing complete resection (CR) and adverse event rates of CSP using thin-wire and thick-wire snares. Comparative studies of adult patients with ≧1 colorectal polyp(s) ≦10 mm who underwent CSP with thin-wire or thick-wire snares were included. We collected data on study, patient, polyp, and snare characteristics. The primary outcome was CR rate. Secondary outcomes were polyp retrieval rate, intraprocedural bleeding, delayed post-polypectomy bleeding, deep mural injury or perforation, patient discomfort, total sedation, and procedure time. We used random-effects models to calculate risk ratios for outcomes. We performed risk of bias assessments, rated the certainty of evidence, and assessed publication bias for all studies. We included four randomized controlled trials (RCTs) and two observational studies including 1316 patients with 1679 polyps (826 thin-wire CSPs and 853 thick-wire CSPs). There was no significant difference between thin-wire CSP (92.1%) and thick-wire CSP (87.7%) for RCTs (risk ratio [RR] 1.05, 95% confidence interval [CI] 0.94-1.16) or observational studies (78.1% versus 79.6%, RR 1.03, 95% CI 0.99-1.08). There were no significant differences in polyp retrieval rate or intraprocedural bleeding. There were no cases of delayed bleeding or perforation. We found no differences in CR rates for CSP between thin-wire and thick-wire snares. CSP, regardless of snare type, is safe and effective for resection of small colorectal polyps.
冷圈套息肉切除术（CSP）被认为是切除直径≤10mm结直肠息肉的标准治疗方法。关于使用细圈套器与粗圈套器进行CSP的疗效数据存在冲突。我们进行了一项荟萃分析，比较使用细圈套器和粗圈套器的CSP的完整切除率（CR）和不良事件发生率。纳入了对直径≧1mm且≦10mm的1个或多个结直肠息肉进行细圈套器或粗圈套器CSP的成年患者的比较研究。我们收集了关于研究、患者、息肉和圈套器特征的数据。主要结局是CR率。次要结局包括息肉取出率、术中出血、息肉切除术后延迟出血、深部肠壁损伤或穿孔、患者不适、全镇静和手术时间。我们使用随机效应模型计算结局的风险比。我们对所有研究进行了偏倚风险评估、证据确定性评级和发表偏倚评估。我们纳入了4项随机对照试验（RCT）和2项观察性研究，包括1316例患者的1679个息肉（826例细圈套器CSP和853例粗圈套器CSP）。对于RCT，细圈套器CSP（92.1%）和粗圈套器CSP（87.7%）之间无显著差异（风险比[RR]1.05，95%置信区间[CI]0.94 - 1.16）；对于观察性研究，二者分别为78.1%和79.6%，RR为1.03，95%CI为0.99 - 1.08。息肉取出率或术中出血方面无显著差异。无延迟出血或穿孔病例。我们发现细圈套器和粗圈套器CSP的CR率无差异。无论圈套器类型如何，CSP对于切除小的结直肠息肉都是安全有效的。
