Ali Saeed, Khetpal Neelam, Fatima Munazza, Hussain Sana, Ali Asad, Khan Muhammad Ali, Childs Christopher, Hasan Muhammad K
Division of Gastroenterology and Hepatology, University of Illinois Chicago, Chicago, USA.
Department of Hospital Medicine, Hartford Hospital, Hartford, USA.
Cureus. 2024 Apr 17;16(4):e58462. doi: 10.7759/cureus.58462. eCollection 2024 Apr.
Colonoscopy remains the primary method for preventing colorectal cancer. Traditionally, hot snare polypectomy (HSP) was the method of choice for removing polyps larger than 5 mm. Yet, for polyps smaller than 10 mm, cold snare polypectomy (CSP) has become the favored approach. Lately, the use of CSP has expanded to include the removal of sessile polyps that are between 10 and 20 mm in size. Our systematic review and meta-analysis aimed to evaluate the safety of cold snare polypectomy (CSP) compared to hot snare polypectomy (HSP) for resecting polyps measuring 10-20 mm. We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, and Cochrane databases up to April 2020 to find studies that directly compared CSP to HSP for polyps larger than 10 mm. Our main focus was on assessing the risk of delayed bleeding after polypectomy; a secondary focus was the incidence of any adverse events that required medical intervention post procedure. Our search yielded three comparative studies, two observational studies, and one randomized controlled trial (RCT), together encompassing 1,193 polypectomy procedures. Of these, 485 were performed using CSP and 708 with HSP. The pooled odds ratio (OR) for post-polypectomy bleeding (PPB) was 0.36 (95% confidence interval {CI}: 0.02, 7.13), with a Cochran Q test P-value of 0.11 and an I of 53%. For the risk of any adverse events necessitating medical care, the pooled OR was 0.15 (95% CI: 0.01, 2.29), with a Cochran Q test P-value of 0.21 and an I of 35%. The quality of the two observational studies was deemed moderate, and the RCT was only available in abstract form, preventing quality assessment. Our analysis suggests that there is no significant difference in the incidence of delayed post-polypectomy bleeding or other adverse events requiring medical attention between CSP and HSP for polyps measuring 10-20 mm.
结肠镜检查仍然是预防结直肠癌的主要方法。传统上，热圈套息肉切除术（HSP）是切除大于5mm息肉的首选方法。然而，对于小于10mm的息肉，冷圈套息肉切除术（CSP）已成为首选方法。最近，CSP的应用范围已扩大到包括切除大小在10至20mm之间的无蒂息肉。我们的系统评价和荟萃分析旨在评估与热圈套息肉切除术（HSP）相比，冷圈套息肉切除术（CSP）切除10 - 20mm息肉的安全性。我们检索了截至2020年4月的医学文献分析与联机检索系统（MEDLINE）、Embase和Cochrane数据库，以查找将CSP与HSP直接比较用于大于10mm息肉的研究。我们的主要重点是评估息肉切除术后延迟出血的风险；次要重点是术后需要医疗干预的任何不良事件的发生率。我们的检索产生了三项比较研究、两项观察性研究和一项随机对照试验（RCT），总共涵盖1193例息肉切除手术。其中，485例使用CSP进行，708例使用HSP进行。息肉切除术后出血（PPB）的合并比值比（OR）为0.36（95%置信区间{CI}：0.02，7.13），Cochran Q检验P值为0.11，I²为53%。对于需要医疗护理的任何不良事件的风险，合并OR为0.15（95%CI：0.01，2.29），Cochran Q检验P值为0.21，I²为35%。两项观察性研究的质量被认为中等，而RCT仅以摘要形式提供，无法进行质量评估。我们的分析表明，对于10 - 20mm的息肉，CSP和HSP在息肉切除术后延迟出血或其他需要医疗关注的不良事件的发生率上没有显著差异。
