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Cold Snare Polypectomy With or Without Submucosal Injection for Endoscopic Resection of Colorectal Polyps: A Meta-Analysis of Randomized Controlled Trials

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Abstract

Background and Aims

The impact of submucosal injection during cold snare polypectomy (CSP) remains uncertain. We conducted an evidence-based comparison of conventional CSP (C-CSP) and CSP with submucosal injection (SI-CSP) for colorectal polyp resection.

Methods

PubMed, Embase, and the Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing C-CSP with SI-CSP. Major outcomes included the rates of complete resection, en bloc resection, polyp retrieval, and adverse events, as well as the duration of polypectomy. Data were analyzed by using a random-effects model.

Results

A total of seven RCTs were included. Complete resection rates for all polyps (RR 0.98; 95% CI 0.93–1.03), polyps ≤ 10 mm (RR 0.99; 95% CI 0.96–1.02) and polyps > 10 mm (RR 0.92; 95% CI 0.69–1.12) were not substantially different between C-CSP and SI-CSP groups. En bloc resection rate (RR 0.93; 95% CI 0.79–1.09) and polyp retrieval rate (RR 1.00; 95% CI 0.99–1.01) were also not significantly different between the two groups. The SI-CSP group required a prolonged polypectomy time than the C-CSP group (SMD − 0.89; 95% CI -1.29 to -0.49). Adverse events were rare in both groups.

Conclusions

SI-CSP is not an optimal substitute for CSP in the resection of colorectal polyps, particularly diminutive and small polyps.

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Data availability

No datasets were generated or analysed during the current study.

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Funding

This study is funded by the National Natural Science Foundation of China (Grant No. 82173253, 82103539) and the Sichuan Province Cadres Health Research Project (Grant No.2023104).

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Author notes

  1. Xiu-He Lv and Tong Liu contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, Sichuan, China

    Xiu-He Lv, Tong Liu, Zi-Jing Wang, Tao Gan & Jin-Lin Yang

  2. Department of Gastroenterology and Hepatology, Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China

    Xiu-He Lv, Tong Liu, Zi-Jing Wang, Tao Gan & Jin-Lin Yang

Authors
  1. Xiu-He Lv
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  2. Tong Liu
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  4. Tao Gan
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Contributions

Conception and design: Xiu-He Lv, Tao Gan and Jin-Lin Yang; analysis and interpretation of the data: Xiu-He Lv, Tong Liu, and Zi-Jing Wang; drafting of the article: Xiu-He Lv and Tong Liu; critical revision of the article for important intellectual content: Tao Gan and Jin-Lin Yang; final approval of the article: all authors.

Corresponding author

Correspondence to Jin-Lin Yang.

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Disclosures

Drs. Xiu-He Lv, Tong Liu, Zi-Jing Wang, Tao Gan and Jin-Lin Yang have no conflicts of interest or financial ties to disclose.

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Lv, XH., Liu, T., Wang, ZJ. et al. Cold Snare Polypectomy With or Without Submucosal Injection for Endoscopic Resection of Colorectal Polyps: A Meta-Analysis of Randomized Controlled Trials. Dig Dis Sci 69, 1411–1420 (2024). https://doi.org/10.1007/s10620-024-08353-5

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