Clinical Endoscopy

Systematic Review and Meta-Analysis

Prevalence of intestinal metaplasia, dysplasia, and esophageal adenocarcinoma in patients with irregular Z-line: a systematic review and meta-analysis: Vishali Moond, Pradeep Yarra, Mannat Bhatia, Sheza Malik, Vineel Malavarappu, Hassam Ali, Saurabh Chandan, Douglas G. Adler, Babu P. Mohan; Clin Endosc 2025;58(3):377-385. Published online March 31, 2025; DOI: https://doi.org/10.5946/ce.2024.211

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Background
/Aims: The irregular Z-line, defined as a segment of columnar mucosa less than 1 cm in the distal esophagus, is often biopsied despite guidelines advising against it due to a low risk of progression to esophageal adenocarcinoma (EAC). However, the clinical significance of an irregular Z-line remains unclear. This meta-analysis examines the prevalence of Barrett’s esophagus, dysplasia, and EAC in patients with an irregular Z-line.
Methods
We searched Medline, Embase, and Scopus databases up to October 2023 for studies on the prevalence of Barrett’s esophagus, dysplasia, and EAC in these patients. A random-effects model was used for meta-analysis, and heterogeneity was assessed using I2 statistics.
Results
Nine studies involving 17,637 patients were analyzed. Among those with an irregular Z-line, the prevalence of intestinal metaplasia was 29.4%. In patients with intestinal metaplasia, dysplasia was found in 6.2%, low-grade dysplasia in 5.9%, high-grade dysplasia in 1.6%, and EAC in 1.5%. These rates were higher compared to those without intestinal metaplasia.
Conclusions
Patients with an irregular Z-line and intestinal metaplasia may be at higher risk and could benefit from endoscopic surveillance. Further studies are needed to determine the necessity of biopsying irregular Z-lines.

Citations

Citations to this article as recorded by

Screening for Barrett Esophagus and Esophageal Adenocarcinoma: Approaches and Outcomes
Natalie J. Wilson, Nicholas Mordan, Cole Potrock, Nicholas J. Shaheen
American Journal of Gastroenterology.2026; 121(2): 302. CrossRef
Barrett's Esophagus
Antonio Al Hazzouri, Philippe Attieh, Tony Azizi, Karl Kfoury, Kelly Katherine Karam, Karam Karam, Elias Fiani
Journal of Gastroenterology and Hepatology.2026; 41(1): 41. CrossRef

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Systematic Review and Meta-analysis

Cold snare polypectomy versus cold endoscopic mucosal resection for small colorectal polyps: a meta-analysis of randomized controlled trials: Vishali Moond, Priyadarshini Loganathan, Sheza Malik, Dushyant Singh Dahiya, Babu P. Mohan, Daryl Ramai, Michele McGinnis, Deepak Madhu, Mohammad Bilal, Aasma Shaukat, Saurabh Chandan; Clin Endosc 2024;57(6):747-758. Published online August 23, 2024; DOI: https://doi.org/10.5946/ce.2024.081

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Background
/Aims: Cold snare polypectomy (CSP) is routinely performed for small colorectal polyps (≤10 mm). However, challenges include insufficient resection depth and immediate bleeding, hindering precise pathological evaluation. We aimed to compare the outcomes of cold endoscopic mucosal resection (CEMR) with that of CSP for colorectal polyps ≤10 mm, using data from randomized controlled trials (RCTs).
Methods
Multiple databases were searched in December 2023 for RCTs reporting outcomes of CSP versus CEMR for colorectal polyps ≤10 mm in size. Our primary outcomes were rates of complete and en-bloc resections, while our secondary outcomes were total resection time (seconds) and adverse events, including immediate bleeding, delayed bleeding, and perforation.
Results
The complete resection rates did not significantly differ (CSP, 91.8% vs. CEMR 94.6%), nor did the rates of en-bloc resection (CSP, 98.9% vs. CEMR, 98.3%) or incomplete resection (CSP, 6.7% vs. CEMR, 4.8%). Adverse event rates were similarly insignificant in variance. However, CEMR had a notably longer mean resection time (133.51 vs. 91.30 seconds).
Conclusions
Our meta-analysis of seven RCTs showed that while both CSP and CEMR are equally safe and effective for resecting small (≤10 mm) colorectal polyps, the latter is associated with a longer resection time.

Citations

Citations to this article as recorded by

Recent advancement in size measurement during endoscopy
Hye Kyung Jeon, Gwang Ha Kim
Clinical Endoscopy.2026; 59(1): 1. CrossRef
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Seongwoo Choi, Jaeyoung Chun, Geunhyuk Choi, Yoojin Lee, Taegeun Gweon, Yunho Jung
Intestinal Research.2026; 24(1): 76. CrossRef
Iatrogenic colon perforation: endoscopic management or surgery
Seung Bum Lee
Clinical Endoscopy.2026; 59(1): 33. CrossRef
Efficacy and safety ranking of endoscopic resection techniques for colorectal polyps: a systematic review and network meta-analysis
Shirui Li, Yue Lei, Yunfan Deng, Sheng Dai, Dehai Xiong, Qi Fan, Xiuyang Li
Therapeutic Advances in Gastroenterology.2026;[Epub] CrossRef
Histopathologic outcomes comparison between cold snare polypectomy and cold snare EMR for colorectal polyps: a full-thickness serial sectioning analysis
Ran Chen, Shiya Hong, Jie Gao, Zhi Ni, Peichun Peng, Shuling Lai, Xiaoqing Huang, Yueping Zheng, Qingyong Zhang, Tingting Lin, Bo Hu, Rongchun Zhang
Gastroenterology Report.2026;[Epub] CrossRef
Effective Polypectomy Practice
Malique Delbrune, Thomas Enke, Mohammad Bilal
Gastrointestinal Endoscopy Clinics of North America.2026; 36(4): 719. CrossRef
Cost-Minimization and Procedural Outcomes of Cold Snare Versus Cold Forceps Polypectomy for Small Colorectal Polyps: A Prospective Cohort Study Using Real Institutional Pricing
Güney Özkaya, İsmail Ege Subaşı, Sangar Abdullah, Sertaç Doğan, Şiva Nafez
Healthcare.2026; 14(16): 2656. CrossRef

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