Post written by Aamir Saeed, MD, from Vanderbilt University Medical Center, Nashville, Tennessee, USA.
We aimed to conduct a meta-analysis of randomized controlled trials (RCTs) to compare cold EMR versus hot EMR for colorectal polyps.
Interest in cold EMR for colorectal polyps has been growing, and cold EMR has gained popularity owing to its lower risk of delayed bleeding and perforation compared with hot EMR. Recently published RCTs comparing cold EMR with hot EMR for large nonpedunculated colorectal polyps have shown that cold EMR is a safer option than hot EMR; however, cold EMR has been associated with higher rates of recurrent or residual neoplasia.
We included 7 RCTs (6 full-length publications and 1 abstract) with 930 patients with 1138 polyps in the cold EMR group and 923 patients with 1117 polyps in the hot EMR group in our final analysis. Our study results showed that pooled rates of recurrent or residual neoplasia on follow-up colonoscopy in cold and hot EMR groups were 22.2% and 10.7%, respectively. The rate of recurrent or residual neoplasia was significantly higher in the cold EMR group: RR, 2.03; 95% CI, 1.19-3.48; I2 = 51%.
Subgroup analysis that included 15-mm polyps produced similar results: RR, 2.13; 95% CI, 1.24-3.65; I2 = 60%. The rate of delayed bleeding was significantly lower in the cold snare group: RR, 0.42; 95% CI, 0.21-0.86; I2 = 2%. Subgroup analysis for 15-mm polyps yielded similar results: RR, 0.37; 95% CI, 0.15-0.93; I2 = 13%. The rate of perforation was significantly lower in the cold snare group: RR, 0.13; 95% CI, 0.03-0.59; I2 = 0%.
There was no significant difference in en bloc resection (RR, 0.86; 95% CI, 0.70-1.06; I2 = 93%), incomplete resection (RR, 1.12; 95% CI, 0.44-2.85; I2 = 38%), and intraprocedural bleeding (RR, 1.07; 95% CI, 0.48-2.37; I2 = 59%) between the groups.
This systematic review and meta-analysis of RCTs showed that cold EMR was associated with a lower risk of delayed bleeding and perforation than hot EMR. We also found that the rate of recurrence was significantly higher with cold EMR. This meta-analysis demonstrates the safety of cold EMR in reducing the risk of delayed bleeding and perforation, but at the cost of a higher risk of recurrent or residual neoplasia. Future research should focus on modifications in the cold EMR technique to decrease the risk of recurrence and better identification of patients and lesions more suitable for cold EMR.
Comparison of (A) recurrent/residual neoplasia and (B) incomplete resection between groups.
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