University of Iowa Hospitals and Clinics Iowa City, IA
Award: Presidential Poster Award
Saeed Ali, MD1, Neelam Khetpal, MD2, Sana Hussain, MBBS3, Munazza Fatima, MBBS1, Maham Khan, MD4, Asad Ali, MD1, Irteza Inayat, MD5, Muhammad Ali Khan, MD6, Muhammad K. Hasan, MD5; 1University of Iowa Hospitals and Clinics, Iowa City, IA; 2Hartford Healthcare, Hartford, CT; 3Khyber Teaching Hospital, Iowa City, IA; 4University of Oklahoma Health Sciences Center, Oklahoma City, OK; 5AdventHealth Orlando, Orlando, FL; 6University of Alabama, Birmingham, AL
Introduction: Colonoscopy continues to be gold standard for colorectal cancer prevention. Conventionally, hot snare polypectomy has been widely used for resection of adenomas > 5mm. However, cold snare polypectomy has been increasingly used for adenomas < 10mm with great efficacy and safety. Recently, cold snare polypectomy has been utilized for sessile polyps between 10-20mm with satisfactory results. We conducted this systematic review and meta-analysis to compare the safety of cold snare polypectomy with conventional hot snare polypectomy in sessile polyps 10-20mm in size. Methods: We searched Medline, Embase, Scopus, Cochrane Registries and Web of Science from inception through May 2020 to identify studies comparing hot snare polypectomy with cold snare polypectomy in polyps > 10mm. Our primary outcome of interest was occurrence of delayed post-polypectomy bleeding. We also compared occurrence of overall adverse events (which required medical attention) after either type of polypectomy. Odds ratio (OR) with 95% confidence interval were calculated and analyzed using random effects model. Newcastle Ottawa Scale was used for quality assessment of observational studies. Results: A total of 3 comparative studies (2 observational studies and 1 RCT) were included in this systematic review and meta-analysis. 1193 polypectomies were analyzed. 485 underwent cold snare polypectomy while the remaining 708 underwent hot snare polypectomy. Pooled OR with 95% confidence interval (CI) for risk of post-polypectomy bleeding was 0.36 (0.02, 7.13), Cochran Q test P=0.11, I2= 53%. For overall risk of adverse events (requiring medical attention), pooled OR with 95% CI was 0.15 (0.01, 2.29), Cochran Q test P=0.21, I2=35%. Both observational studies were of moderate quality. The included RCT was in the form of abstract, so quality assessment could not be done. Discussion: There was no difference in delayed post-polypectomy bleeding and overall adverse events, requiring medical attention with either method of polypectomy in polyps 10-20mm in size.
Figure 1: Forest plot for delayed post polypectomy bleeding comparing CSP and HSP
Figure 2: Forest plot for adverse events during follow-up comparing CSP and HSP
Disclosures: Saeed Ali indicated no relevant financial relationships. Neelam Khetpal indicated no relevant financial relationships. Sana Hussain indicated no relevant financial relationships. Munazza Fatima indicated no relevant financial relationships. Maham Khan indicated no relevant financial relationships. Asad Ali indicated no relevant financial relationships. Irteza Inayat indicated no relevant financial relationships. Muhammad Ali Khan indicated no relevant financial relationships. Muhammad Hasan: Boston Scientific – Consultant. Olympus – Consultant.