Cold snare versus cold forceps polypectomy for endoscopic resection of diminutive polyps: meta-analysis of randomized controlled trials.

Abstract

The practices for resection of diminutive colon polyps vary among endoscopists and US Multi-Society Task force (USMSTF) guidelines recommend use of cold snare polypectomy (CSP) for this purpose. In this meta-analysis, we have compared CSP and cold forceps polypectomy (CFP) for resection of diminutive polyps. We reviewed several databases to identify randomized controlled trials (RCTs) that compared CSP and CFP for resection of diminutive polyps. Our outcomes of interest were complete resection of all diminutive polyps, complete resection of polyps ≤ 3mm in size, failure of tissue retrieval and polypectomy time. For categorical variables, we calculated pooled odds ratios (OR) with 95% confidence intervals (CI); for continuous variables, we calculated mean difference (MD) with 95% CI. Data were analyzed using random effects model and heterogeneity was assessed using the I2 statistic RESULTS: We included 9 studies with 1037 patients. Rate of complete resection of all diminutive polyps was significantly higher in the CSP group, OR (95% CI) 1.68 (1.09, 2.58). Subgroup analysis including jumbo or large capacity forceps, found no significant difference in complete resection between groups, OR (95% CI) 1.43 (0.80, 2.56). We found no significant difference in the rates of complete resection of ≤ 3mm polyps between groups, OR (95% CI) 0.83 (0.30, 2.31). Rate of failure of tissue retrieval was significantly higher in CSP group, OR (95% CI): 10.13 (2.29, 44.74). We found no significant difference in polypectomy time between groups. CFP using large capacity or jumbo biopsy forceps is non-inferior to CSP for complete resection of diminutive polyps.