Saudi Journal of Gastroenterology

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

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.


How to cite this article:
Yuan X, Gao H, Liu C, Cui H, Zhang Z, Xie J, Lu H, Xu L. Effectiveness and safety of the different endoscopic resection methods for 10- to 20-mm nonpedunculated colorectal polyps: A systematic review and pooled analysis.Saudi J Gastroenterol 2021;27:331-341


How to cite this URL:
Yuan X, Gao H, Liu C, Cui H, Zhang Z, Xie J, Lu H, Xu L. Effectiveness and safety of the different endoscopic resection methods for 10- to 20-mm nonpedunculated colorectal polyps: A systematic review and pooled analysis. Saudi J Gastroenterol [serial online] 2021 [cited 2021 Dec 4 ];27:331-341
Available from: https://www.saudijgastro.com/article.asp?issn=1319-3767;year=2021;volume=27;issue=6;spage=331;epage=341;aulast=Yuan;type=0