Comparative efficacy of cold polypectomy techniques for diminutive colorectal polyps: a systematic review and network meta-analysis
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Although cold polypectomy techniques are preferred over polypectomy with electrocautery in the management of diminutive polyps, comprehensive comparisons among various cold polypectomy techniques have not yet been fully performed.
We searched for all relevant randomized controlled trials published up until October 2016 examining the efficacy of cold polypectomy techniques for diminutive polyps. Cold polypectomy techniques were classified as cold forceps polypectomy (CFP), jumbo forceps polypectomy (JFP), traditional cold snare polypectomy (CSP), and dedicated CSP, according to the type of device. A network meta-analysis was performed to calculate the direct and indirect estimates of efficacy among the cold polypectomy techniques.
Seven studies with 703 patients and 968 polyps were included in the meta-analysis. Regarding comparative efficacy for complete histological eradication, there was no inconsistency in the network (Cochran’s Q test, df = 4, P = 0.22; I 2 = 30%). In terms of complete histological eradication, both dedicated and traditional CSP were superior to CFP (odds ratio [OR] [95% confidence interval [CI]] 4.31 [1.92–9.66] and 2.45 [1.30–4.63], respectively); dedicated CSP was superior to traditional CSP (OR [95% CI] 1.76 [1.07–2.89]); and there was no difference between JFP versus CFP (OR [95% CI] 1.36 [0.40–4.61]). Regarding tissue retrieval rate, there was no difference between dedicated versus traditional CSP (OR [95% CI] 1.03 [0.44–2.38]). The procedure time for CSP was comparable to that of CFP.
Dedicated CSP was shown to be superior to other cold polypectomy techniques in terms of complete histological eradication. Cold polypectomy using a dedicated snare can be recommended for the removal of diminutive colorectal polyps.
KeywordsDiminutive polyp Cold forceps polypectomy Cold snare polypectomy Efficacy Network meta-analysis
Compliance with ethical standards
Yoon Suk Jung, Chan Hyuk Park, Eunwoo Nam, Chang Soo Eun, Dong Il Park, and Dong Soo Han have no conflicts of interest or financial ties to disclose.
- 7.Abu Dayyeh BK, Thosani N, Konda V, Wallace MB, Rex DK, Chauhan SS, Hwang JH, Komanduri S, Manfredi M, Maple JT, Murad FM, Siddiqui UD, Banerjee S (2015) ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 81(3):502CrossRefPubMedGoogle Scholar
- 10.Shin SJ, Lee SH, Park DI, Hong SN, Kim SE, Yang DH, Hong SP, Lee BI, Kim HS, Kim YH, Yang SK, Kim HJ, Kim SH; Multi-Society Task Force for the Guidelines for Colorectal Polyp Screening, Surveillance and Management (2011) A Korean National Survey for treatment modality in colon polypectomy. Intestig Res 9(3):196–205CrossRefGoogle Scholar
- 14.Jansen JP, Fleurence R, Devine B, Itzler R, Barrett A, Hawkins N, Lee K, Boersma C, Annemans L, Cappelleri JC (2011) Interpreting indirect treatment comparisons and network meta-analysis for health-care decision making: report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: part 1. Value Health 14(4):417–428CrossRefPubMedGoogle Scholar
- 15.Higgins J, Altman DG, Sterne J (2016) Cochrnae handbook for systematic reviews of interventions, Version 5.1.0, Chapter 8: assessing risk of bias in included studies. http://handbook.cochrane.org/chapter_8/8_assessing_risk_of_bias_in_included_studies.htm. Accessed 31 Jan 2016
- 16.J H, S G Cochrane handbook for systematic reviews of interventions, Version 5.1.0, Chapter 16.9.2 Studies with zero-cell counts. http://handbook.cochrane.org/chapter_16/16_9_2_studies_with_zero_cell_counts.htm. Accessed 31 January 2016
- 18.Higgins J, Green S (2016) Cochrane handbook for systematic reviews of interventions, Version 5.1.0, Chapter 10.4.3.1 Recommendations on testing for funnel plot asymmetry. http://handbook.cochrane.org/chapter_10/10_4_3_1_recommendations_on_testing_for_funnel_plot_asymmetry.htm. Accessed 31 January 2016
- 22.Noda H, Ogasawara N, Sugiyama T, Yoshimine T, Tamura Y, Izawa S, Kondo Y, Ebi M, Funaki Y, Sasaki M, Kasugai K (2016) The Influence of Snare Size on the Utility and Safety of Cold Snare Polypectomy for the Removal of Colonic Polyps in Japanese Patients. J Clin Med Res 8(9):662–666CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Draganov PV, Chang MN, Alkhasawneh A, Dixon LR, Lieb J, Moshiree B, Polyak S, Sultan S, Collins D, Suman A, Valentine JF, Wagh MS, Habashi SL, Forsmark CE (2012) Randomized, controlled trial of standard, large-capacity versus jumbo biopsy forceps for polypectomy of small, sessile, colorectal polyps. Gastrointest Endosc 75(1):118–126CrossRefPubMedGoogle Scholar
- 26.Gomez V, Badillo RJ, Crook JE, Krishna M, Diehl NN, Wallace MB (2015) Diminutive colorectal polyp resection comparing hot and cold snare and cold biopsy forceps polypectomy. Results of a pilot randomized, single-center study. Endosc Int Open 3(1):76–80Google Scholar
- 33.Fujiya M, Sato H, Ueno N, Sakatani A, Tanaka K, Dokoshi T, Fujibayashi S, Nomura Y, Kashima S, Gotoh T, Sasajima J, Moriichi K, Watari J, Kohgo Y (2016) Efficacy and adverse events of cold vs hot polypectomy: a meta-analysis. World J Gastroenterol 22(23):5436–5444CrossRefPubMedPubMedCentralGoogle Scholar