Post written by Faisal Kamal, MD, from Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.

In this study, our focus was to compare cold snare polypectomy with cold forceps polypectomy for endoscopic resection of diminutive colorectal polyps by conducting a meta-analysis of randomized controlled trials.

The practices for resection of diminutive colorectal polyps vary among endoscopists. The US Multi-Society Task Force guidelines recommend cold snare polypectomy for resection of diminutive polyps and recommend against use of cold forceps polypectomy to remove these polyps because of high rates of incomplete resection.

Cold biopsy forceps are sometimes easier to use than snares, especially for diminutive polyps in the left side of the endoscopic field of view that cannot be positioned appropriately to allow use of snares. Studies comparing cold snares and forceps for resection of diminutive polyps have shown conflicting results. Therefore, we conducted this meta-analysis to compare the 2 modalities for resection of diminutive polyps.

We found that the rate of complete resection of diminutive polyps was significantly higher in the cold snare group than the cold forceps group using all cold biopsy forceps. However, subgroup analysis using large-capacity or jumbo biopsy forceps showed no significant difference in the rate of complete resection between groups. The rate of failure of tissue retrieval was significantly higher in the cold snare group than the cold forceps group.

Our findings support the use of cold forceps polypectomy using large-capacity or jumbo biopsy forceps for diminutive polyps, especially in locations where the use of cold snares is technically challenging and for polyps ≤3 mm in size. Future large multicenter randomized controlled trials with standardized and homogenous polypectomy techniques and procedures are required to make any firm conclusions.

Preferred Reporting Items for Systematic Review and Meta-Analysis flowchart.

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