A0101 - Cold Snare Endoscopic Mucosal Resection for Colon Polyps: A Systematic Review and Meta-Analysis

Mohamed Abdallah, MD¹, Khalid Ahmed, MD², Daniyal Abbas, MD³, Gaurav Suryawanshi, MD¹, Nicholas McDonald, MD⁴, Mouhand F. Mohamed, MD, MSc⁵, Shifa Umar, MD⁶, Saurabh Chandan, MD⁷, Brian Hanson, MD⁸, Mohammad Bilal, MD^9
1University of Minnesota Medical Center, Minneapolis, MN; ²The Wright Center for GME, Scranton, PA; ³East Carolina University, Greenville, NC; ⁴University of Minnesota, Minneapolis, MN; ⁵Warren Alpert Medical School of Brown University, Providence, RI; ⁶Mayo Clinic, Rochester, MN; ⁷University of Nebraska, Omaha, NE; ⁸Minneapolis Veterans Affairs Health Care System, Minneapolis, MN; ⁹University of Minnesota, Minneapolis VA Medical Center, Minneapolis, MN

Introduction: Cold snare endoscopic mucosal resection (CS-EMR) has become increasingly popular for the removal of colon polyps > 10 mm. CS-EMR can potentially avert some of the risks associated with the use of electrocautery during polyp resection without compromising clinical efficacy. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of CS-EMR in removing colon polyps.

Methods: We conducted a comprehensive literature search of MEDLINE, EMBASE, Cochrane, ClinicalTrials.gov, and Scopus databases for studies published in the English language addressing outcomes of CS-EMR for colon polyps from database inceptions through April 2022. The weighted pooled estimates with the 95% confidence interval (CI) were calculated. Cochran Q test and I² statistics were used to evaluate heterogeneity.

Results: We identified 3599 articles on the initial search, and 32 full-text studies were assessed for eligibility. Fifteen studies met inclusion criteria. There were three randomized controlled trials, six prospective, and six retrospective studies. Six studies were from the United States, two each from Australia, China, and Japan, one from the United Kingdom, and one from Greece. A total of 2382 polyps were removed from 1756 patients. 45% were females. Polyps ranged from 6-80 mm in size, and 72.4% were proximal to the splenic flexure. In addition, 50.4% of the polyps were NICE I or serrated lesions and 48.5% were NICE II, and 0.1% were NICE III.

Polyp recurrence rate after CS-EMR was 9.4 % (95% CI: 3.3-15.6%, I²= 95.8%), piecemeal resection rate 59.4% (95% CI: 46.3-72.4%, I2= 99.9%), and complete histological resection rate (defined by post polypectomy biopsies) was 93.1% (95% CI: 88.7-97.6%, I²=90.8%). For adverse events, delayed post-polypectomy bleeding rate was 0.8% (95% CI: 0.3-1.3%, I²= 21.4%), perforation and the post-polypectomy syndrome rate was 0.3% (95% CI: 0-0.5%, I²= 0%) (Figure). Given significant heterogeneity in recurrence rate, subgroup analyses were performed. Recurrence rate in serrated lesions (n=484) was 3.8% (95% CI: 0.2-7.4%, I²= 76.7%), in polyps < 20 mm (n= 137) 0.8% (95% CI: -0.7-2.3%, I²= 0%), and in polyps ≥ 20 mm (n=617) 15.7% (95% CI: 2.6-28.7%, I²= 95.2%).

Discussion: CS-EMR has an excellent safety profile and acceptable recurrence rate for resection of colon polyps, especially for polyps < 20 mm and serrated lesions. However, large prospective studies to validate safety and efficacy are needed.



Disclosures:


Mohamed Abdallah, MD¹, Khalid Ahmed, MD², Daniyal Abbas, MD³, Gaurav Suryawanshi, MD¹, Nicholas McDonald, MD⁴, Mouhand F. Mohamed, MD, MSc⁵, Shifa Umar, MD⁶, Saurabh Chandan, MD⁷, Brian Hanson, MD⁸, Mohammad Bilal, MD⁹. A0101 - Cold Snare Endoscopic Mucosal Resection for Colon Polyps: A Systematic Review and Meta-Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.