Cold snare endoscopic mucosal resection for colon polyps: a systematic review and meta-analysis

Background Cold snare endoscopic mucosal resection (CS-EMR) can reduce the risks associated with electrocautery during colon polyp resection. Data on efficacy are variable. This systematic review and meta-analysis aimed to estimate the pooled efficacy and safety rates of CS-EMR.Methods We conducted a comprehensive literature search of multiple databases, from inception to March 2023, for studies addressing outcomes of CS-EMR for colon polyps. The weighted pooled estimates with 95 %CIs were calculated using the random effects model. I-2 statistics were used to evaluate heterogeneity.Results 4137 articles were reviewed, and 16 studies, including 2592 polyps in 1922 patients (51.4% female), were included. Overall, 54.4% of polyps were adenomas, 45% were sessile serrated lesions (SSLs), and 0.6% were invasive carcinomas. Polyp recurrence after CS-EMR was 6.7% (95% CI 2.4 %-17.4 %, I-2= 94 %). The recurrence rate was 12.3% (95 %CI 3.4 %-35.7 %, I-2= 94 %) for polyps = 20 mm, 17.1 (95 %CI 4.6 %-46.7 %, I-2= 93 %) for adenomas, and 5.7% (95 %CI 3.2 %-9.9 %, I-2= 50 %) for SSLs. The pooled intraprocedural bleeding rate was 2.6% (95 %CI 1.5 %-4.5 %, I-2= 51 %), the delayed bleeding rate was 1.5% (95 % CI 0.8 %-2.7 %, I-2= 18 %), and no perforations or post-polypectomy syndromes were reported, with estimated rates of 0.6% (95% CI 0.3 %-1.3 %, I-2= 0 %) and 0.6% (95 %CI 0.3 %-1.4 %, I-2= 0 %), respectively.Conclusion CS-EMR demonstrated an excellent safety profile for colon polyps, with variable recurrence rates based on polyp size and histology. Large prospective studies are needed to validate these findings.