Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, Sichuan, China.
Department of Gastroenterology and Hepatology, Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
Dig Dis Sci. 2024 Apr;69(4):1411-1420. doi: 10.1007/s10620-024-08353-5. Epub 2024 Feb 28.
The impact of submucosal injection during cold snare polypectomy (CSP) remains uncertain. We conducted an evidence-based comparison of conventional CSP (C-CSP) and CSP with submucosal injection (SI-CSP) for colorectal polyp resection.
PubMed, Embase, and the Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing C-CSP with SI-CSP. Major outcomes included the rates of complete resection, en bloc resection, polyp retrieval, and adverse events, as well as the duration of polypectomy. Data were analyzed by using a random-effects model.
A total of seven RCTs were included. Complete resection rates for all polyps (RR 0.98; 95% CI 0.93-1.03), polyps ≤ 10 mm (RR 0.99; 95% CI 0.96-1.02) and polyps > 10 mm (RR 0.92; 95% CI 0.69-1.12) were not substantially different between C-CSP and SI-CSP groups. En bloc resection rate (RR 0.93; 95% CI 0.79-1.09) and polyp retrieval rate (RR 1.00; 95% CI 0.99-1.01) were also not significantly different between the two groups. The SI-CSP group required a prolonged polypectomy time than the C-CSP group (SMD - 0.89; 95% CI -1.29 to -0.49). Adverse events were rare in both groups.
SI-CSP is not an optimal substitute for CSP in the resection of colorectal polyps, particularly diminutive and small polyps.
黏膜下注射在冷圈套息肉切除术（CSP）中的影响仍不确定。我们对常规 CSP（C-CSP）和黏膜下注射辅助 CSP（SI-CSP）治疗结直肠息肉切除进行了基于证据的比较。
检索 PubMed、Embase 和 Cochrane 图书馆数据库，以比较 C-CSP 与 SI-CSP 的随机对照试验（RCT）。主要结局包括完全切除率、整块切除率、息肉取出率和不良事件发生率，以及息肉切除术的持续时间。采用随机效应模型进行数据分析。
共纳入 7 项 RCT。所有息肉（RR 0.98；95%CI 0.93-1.03）、 ≤ 10 mm 息肉（RR 0.99；95%CI 0.96-1.02）和 > 10 mm 息肉（RR 0.92；95%CI 0.69-1.12）的完全切除率在 C-CSP 和 SI-CSP 组之间无显著差异。整块切除率（RR 0.93；95%CI 0.79-1.09）和息肉取出率（RR 1.00；95%CI 0.99-1.01）也无显著差异。SI-CSP 组的息肉切除术时间长于 C-CSP 组（SMD -0.89；95%CI -1.29 至 -0.49）。两组不良事件均少见。
SI-CSP 不是 CSP 切除结直肠息肉的理想替代方法，尤其是微小和小息肉。
