| SYSTEMATIC REVIEW/META ANALYSIS |
|
| Year : 2021 | Volume
: 27
| Issue : 6 | Page : 331-341 |
|
|
Effectiveness and safety of the different endoscopic resection methods for 10- to 20-mm nonpedunculated colorectal polyps: A systematic review and pooled analysis
Xin Yuan1, Hui Gao1, Cenqin Liu2, Hongyao Cui3, Zhixin Zhang2, Jiarong Xie2, Hongpeng Lu2, Lei Xu2
1 School of Medicine, Ningbo University, Ningbo First Hospital, Zhejiang, China
2 Department of Gastroenterology, Ningbo First Hospital, Zhejiang, China
3 Department of Gastroenterology, Haishu Second Hospital, Zhejiang, China
Correspondence Address:
Dr. Lei Xu
Department of Gastroenterology, Ningbo First Hospital. No. 59 Liuting Street, Ningbo - 315010
China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/sjg.sjg_180_21
|
|
|
Background: We performed a systematic review and pooled analysis to assess the effectiveness and safety of different endoscopic resection methods for 10- to 20-mm nonpedunculated colorectal polyps.
Methods: Articles in PubMed, EMBASE, and the Cochrane Library related to the common endoscopic treatment of 10- to 20-mm nonpedunculated polyps published as of April 2020 were searched. Primary outcomes were the R0 resection rate and en bloc resection rate. Secondary outcomes were safety and the recurrence rate. Meta-regression and subgroup analysis were also performed.
Results: A total of 36 studies involving 3212 polyps were included in the final analysis. Overall, the effectiveness of resection methods with a submucosal uplifting effect, including endoscopic mucosal resection (EMR), cold EMR and underwater EMR (UEMR), was better than that of methods without a nonsubmucosal uplifting effect [R0 resection rate, 90% (95% confidence interval (CI) 0.81–0.94, I2 = 84%) vs 82% (95% CI 0.78–0.85, I2 = 0%); en bloc resection rate 85% (95% CI 0.79–0.91, I2 = 83%) vs 74% (95% CI 0.47–0.94, I2 = 94%)]. Regarding safety, the pooled data showed that hot resection [hot snare polypectomy, UEMR and EMR] had a higher risk of intraprocedural bleeding than cold resection [3% (95% CI 0.01–0.05, I2 = 68%) vs 0% (95% CI 0–0.01, I2 = 0%)], while the incidences of delayed bleeding, perforation and post-polypectomy syndrome were all low.
Conclusions: Methods with submucosal uplifting effects are more effective than those without for resecting 10- to 20-mm nonpedunculated colorectal polyps, and cold EMR is associated with a lower risk of intraprocedural bleeding than other methods. Additional research is needed to verify the advantages of these methods, especially cold EMR.
|
|
|
|
| [FULL TEXT] [PDF]* |
|
 |
|
