Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis

Viveksandeep Thoguluva Chandrasekar, Marco Spadaccini, Muhammad Aziz, Roberta Maselli, Seemeen Hassan, Lorenzo Fuccio, Abhiram Duvvuri, Leonardo Frazzoni, Madhav Desai, Alessandro Fugazza, Ramprasad Jegadeesan, Matteo Colombo, Chandra Skekhar Dasari, Cesare Hassan, Prateek Sharma, Alessandro Repici

Research output: Contribution to journalReview articlepeer-review

79 Scopus citations


Background and Aims: Hot snare polypectomy and EMR are the standard of care in resecting colorectal polyps ≥10 mm. To avoid the risk of electrocautery-induced damage, there is recent evidence about using cold snare polypectomy and cold EMR for such lesions. The aim of this pooled analysis is to report outcomes of cold snare resection for polyps ≥10 mm. Methods: PubMed/Medline, Embase, Google Scholar, and Cochrane databases were searched up to July 2018 to identify studies that performed cold snare resection for colorectal polyps ≥10 mm. Primary outcomes were adverse events (bleeding, perforation, and postpolypectomy abdominal pain), and secondary outcomes were the rates of complete resection, overall residual polyp rates, and rates for adenomas versus sessile serrated polyps (SSPs). Subgroup analysis was performed focusing on lesion size, location, and resection technique. Results: Eight studies were included in the final analysis that included 522 colorectal polyps with a mean polyp size of 17.5 mm (range, 10-60). The overall adverse event rate was 1.1% (95% confidence interval, CI, 0.2%-2.0%; I 2 = 0%). Intra- and postprocedural bleeding rates were.7% (95% CI, 0%-1.4%) and.5% (95% CI,.1%-1.2%), respectively, with abdominal pain rate being.6% (95% CI,.1%-1.3%). Polyps ≥20 mm had a higher intraprocedural bleeding rate of 1.3% (95% CI,.7%-3.3%) and abdominal pain rate of 1.2% (95% CI,.7%-3.0%) but no delayed bleedings. No perforations were reported. The complete resection rate was 99.3% (95% CI, 98.6%-100%). Overall pooled residual rates of polyps of any histology, adenomas, and SSPs were 4.1% (95% CI,.2%-8.4%), 11.1% (95% CI, 4.1%-18.1%), and 1.0% (95% CI,.4%-2.4%), respectively, during a follow-up period ranging from 154 to 258 days. Conclusions: The results of this systematic review and pooled analysis were excellent with cold snare resection of colorectal polyps >10 mm in terms of postpolypectomy bleeding, complete resection, and residual polyp rates. Randomized controlled trials comparing cold snare resection with hot snare resections of polyps ≥10 mm are required for further investigation.

Original languageEnglish (US)
Pages (from-to)929-936.e3
JournalGastrointestinal endoscopy
Issue number5
StatePublished - May 2019
Externally publishedYes

Bibliographical note

Funding Information:
DISCLOSURE: Dr Sharma received grant support from Fujifilm, US Endoscopy, and Medtronic, and was consultant for Boston Scientific and Olympus. All other authors disclosed no financial relationships relevant to this publication.

Publisher Copyright:
© 2019 American Society for Gastrointestinal Endoscopy


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