Wang Shouqi, Zhang Qi, Meng Li Rong, Wu Ying, Fong Pedro, Zhou Weixia
The Second Affiliated Hospital, Soochow University, Soochow, China.
Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, China.
PeerJ. 2024 Dec 19;12:e18757. doi: 10.7717/peerj.18757. eCollection 2024.
Colorectal polyps are commonly treated with surgical procedures, with cold snare polypectomy (CSP) and endoscopic mucosal resection (EMR) being the two most prevalent techniques. This meta-analysis (PROSPERO ID: CRD42022336152) aimed to compare the efficacy and safety of CSP and EMR in the management of colorectal polyps. Comprehensive searches were conducted in PubMed, Embase, CINAHL, Web of Science, and Cochrane Library databases, covering publications up until June 2024. The primary outcome was complete resection rate, and secondary outcomes included en bloc resection rate, immediate and delayed bleeding, perforation, and procedure time. The Mantel-Haenszel method was employed for the analysis of binary endpoints, while the inverse variance method was used for continuous outcomes. Subgroup analysis was performed to explore potential sources of heterogeneity. Six studies involving 15,296 patients and 17,971 polyps were included in the meta-analysis. CSP had a significantly lower complete resection rate compared to EMR (OR: 0.44, 95% CI [0.21-0.94], = 0.0334). However, there was no significant difference between CSP and EMR in en bloc resection rate, perforation, or procedure time. Interestingly, CSP had a significantly lower delayed bleeding rate compared to EMR (OR: 0.45, 95% CI [0.27-0.77], = 0.0034), but there was no significant difference in immediate bleeding rate. In conclusion, CSP is a safe, efficient, and effective technique comparable to EMR. The choice of technique should be based on the individual patient and polyp characteristics.
结直肠息肉通常采用外科手术治疗，冷圈套息肉切除术（CSP）和内镜黏膜切除术（EMR）是两种最常用的技术。本荟萃分析（PROSPERO编号：CRD42022336152）旨在比较CSP和EMR治疗结直肠息肉的疗效和安全性。在PubMed、Embase、CINAHL、Web of Science和Cochrane图书馆数据库中进行了全面检索，涵盖截至2024年6月的出版物。主要结局是完全切除率，次要结局包括整块切除率、即时和延迟出血、穿孔及手术时间。采用Mantel-Haenszel法分析二元终点，采用逆方差法分析连续结局。进行亚组分析以探索异质性的潜在来源。六项研究共纳入15296例患者和17971枚息肉，纳入了本荟萃分析。与EMR相比，CSP的完全切除率显著较低（OR：0.44，95%CI[0.21-0.94]，P = 0.0334）。然而，CSP和EMR在整块切除率、穿孔或手术时间方面无显著差异。有趣的是，与EMR相比，CSP的延迟出血率显著较低（OR：0.45，95%CI[0.27-0.77]，P = 0.0034），但即时出血率无显著差异。总之，CSP是一种与EMR相当的安全、高效且有效的技术。技术的选择应基于个体患者和息肉特征。
