1Department of Internal Medicine, Saint Peter's University Hospital/Robert Wood Johnson Medical School, New Brunswick, NJ, USA
2Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
3Department of Medicine, Rochester General Hospital, Rochester, New York, NY, USA
4Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, KS, USA
5Department of Gastroenterology, Orlando Gastroenterology PA, Orlando, FL, USA
6Department of Gastroenterology, University of Utah, Salt Lake City, UT, USA
7Mayo Clinic Libraries, Rochester, MN, USA
8Department of Gastroenterology, Lisie Institute of Gastroenterology, Lisie Hospital, Kochi, India
9Division of Gastroenterology, University of Minnesota & Minneapolis VA Health Care System, Minneapolis, MN, USA
10Division of Gastroenterology and Hepatology, NYU Grossman School of Medicine, New York, NY, USA
11Center for Interventional Endoscopy, Advent Health, Orlando, FL, USA
© 2024 Korean Society of Gastrointestinal Endoscopy
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ethical Statements
Not applicable.
Conflicts of Interest
The authors have no potential conflicts of interest.
Funding
None.
Author Contributions
Conceptualization: VM, MB, AS, SC; Data curation: VM, SM, BPM, DR, DM, SC; Formal analysis: PL, MM, BPM; Investigation: SM, DSD, DR, BPM, MM, DM; Software: VM; Writing–original draft: SC, VM PL, DSD, MB, AS; Writing–review & editing: all authors.
Study | Year published | Study details |
Total patients |
Age (mean±SD, y) |
Male/female |
Polyp number (total) |
Polyp size (mean±SD, mm) |
Polyp location |
Polyp pathology |
Type of snares (CSP & CEMR) |
Type of injection used |
|||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
CSP | CEMR | CSP | CEMR | CSP | CEMR | CSP | CEMR | CSP | CEMR | CSP | CEMR | CSP | CEMR | (CSP & CEMR) | CSP | |||
Kim et al.15 | 2023 | Prospective, RCT, Jan. 2018 to Feb. 2021, multicenter, Korea | 161 | 166 | 63.5±11.1 | 62.0±10.5 | 102/51 | 111/55 | 215 (6–8 mm, 155; 9–10 mm, 60) | 210 (6–8 mm, 169; 9–10 mm, 41) | 7.0±1.2 | 7.2±1.4 | Cecum/ascending 63 (29.3); HFa/transverse/SFb 73 (34.0); descending/sigmoid 66 (30.7); rectum 13 (6.0) | Cecum/ascending 67 (31.9); HFa/transverse/SFb 50 (23.8); descending/sigmoid 80 (38.1); rectum 13 (6.2) | Tubular adenoma 196 (91.2); hyperplastic polyp 14 (6.5); serrated polyp 5 (2.3); adenocarcinoma 0 (0) | Tubular adenoma 186 (88.6); hyperplastic polyp 16 (7.6); serrated polyp 5 (2.4); adenocarcinoma 3 | Traditional oval snare | Normal saline solution mixed with indigo carmine (0.04%) and epinephrine (1:10,000) |
Katagiri et al.14 | 2023 | Prospective RCT, Apr. 2019 to Apr. 2021, single-center, Japan | 59 | 59 | 63.7±13.3 | 67.9±10.2 | 36/23 | 33/26 | <5 mm, 76 (67.9%); ≥5 mm, 36 (32.1%) | <5 mm, 91 (61.1%); ≥5 mm, 58 (38.9%) | 4.2±1.8 | 4.4±1.8 | Right side 73 (65.2%); left side 39 (34.8%) | Right side 108 (72.5%); left side 41 (27.5%) | Low-grade adenoma 86 (76.8%); high grade adenoma 0 (0%); sessile serrated adenoma/polyp 10 (8.9%); hyperplastic polyp 13 (11.6%); inflammatory polyp 3 (2.7%); loss of tissue 0 (0%) | Low-grade adenoma 110 (73.8%); high grade adenoma 1 (0.7); sessile serrated adenoma/polyp 7 (4.7%); hyperplastic polyp 29 (19.5%); inflammatory polyp 1 (0.7%); loss of tissue 1 (0.7%) | NR | Epinephrine (0.001%)-added saline |
Li et al.16 | 2020 | Prospective, RCT, Jul. 2017 and Mar. 2019, single-center, China | 131 | 135 | 51.63±14.395 | 51.77±14.545 | 77/52 | 73/59 | 244 | 252 | 11.95±3.35 | 12.03±3.36 | Caecum and ascending colon 57/88; transverse colon 54/61; descending colon 46/50; sigmoid colon and rectum 42/45 | Caecum and ascending colon 68/75; transverse colon 54/58; descending colon 57/59; sigmoid colon and rectum 57/58 | Submucosal adenocarcinoma 0; advanced adenoma 123/159; adenoma 60/64; sessile/traditional serrated adenoma 16/21 | Submucosal adenocarcinoma 1/1; advanced adenoma 160/171; adenoma 59/61; sessile/traditional serrated adenoma 17/19 | Snares (Boston Scientific CAPTIVATORTM 13 mm; JHY-SD-23-230-15-AI 15 mm) | Normal saline solution, epinephrine (1:10 0000), and methylene blue |
Mou et al.13 | 2023 | RCT, Jul. 2020 to Sep. 2020, multicenter, China | 150 | 150 | 53 (11, 18–79) | 54 (10, 28–74) | 90/60 | 92/58 | 216 (3–5 mm, 139 [64.4%]; 6–9 mm, 77 [35.6%]) | 150 (3–5 mm, 146 [62.4%], 6–9 mm, 88 [37.6%]) | 5 (2, 3–8) | 5 (2, 3–9) | Cecum 7; ascending colon 27; hepatic flexure 14; transverse colon 41; splenic flexure 0; descending colon 24; sigmoid colon 72; rectum 31 | Cecum 9; ascending colon 35; hepatic flexure 14; transverse colon 53; splenic flexure 3; descending colon 35; sigmoid colon 50; rectum 35 | Tubular adenoma 136; villous/tubulovillous adenoma 6; sessile serrated lesion 4; hyperplastic polyp 53; inflammatory polyp 14 | Tubular adenoma 146; villous/tubulovillous adenoma 6; sessile serrated lesion 8; hyperplastic polyp 51; inflammatory polyp 22 | CSP-dedicated or traditional snares | Saline solution mixed with methylene blue and epinephrine |
Rex et al.12 | 2022 | Prospective, RCT, Aug. 10, 2018 and Mar. 26, 2021, multicenter, USA | 59 | 63 | 66.2 (9.9) | 65.0 (8.0) | 25/34 | 28/35 | 68 | 82 | 9.4±3.1 | 9.5±2.8 | Ascending colon 24 (35.3); cecum 7 (10.3); descending colon 8 (11.8); hepatic flexure 5 (7.4); ileocecal valve 1 (1.5); rectum 2 (2.9); sigmoid colon 3 (4.4); transverse colon 18 (26.5) | Ascending colon 26 (31.7); cecum 8 (9.8); descending colon 13 (15.9); hepatic flexure 3 (3.7); ileocecal valve 0 (0); rectum 1 (1.2); sigmoid colon 6 (7.3); transverse colon 25 (30.5) | Adenoma 53 (77.9); hyperplastic 3 (4.4); normal mucosa 1 (1.5); sessile serrated lesion 10 (14.7); no tissue 1 (1.5) | Adenoma 61 (74.4); hyperplastic 2 (2.4); normal mucosa 0 (0); sessile serrated lesion 19 (23.2); no tissue 0 (0) | Dedicated cold snare (Boston CapCold [Boston Scientific] or Exacto Cold Snare [Steris Corporation) | Saline solution, hydroxyethyl starch, or any commercially available injection fluid |
Shimodate et al.6 | 2020 | Prospective RCT, Nov. 2017 to Sep. 2019, single-center, Japan | 107 | 107 | 68 (median) | 65 (median) | 60/47 | 61/46 | 97 | 100 | 5 mm (median) | 5 mm (median) | Cecum 4; ascending colon 23; transverse colon 23; descending colon 10; sigmoid colon 30; rectum 7 | Cecum 5; ascending colon 24; transverse colon 15; descending colon 14; sigmoid colon 34; rectum 8 | Low-grade adenoma 92; high grade adenoma 0; sessile serrated adenoma/polyp 2; hyperplastic polyp 1; inflammatory polyp 1; adenocarcinoma 1 | Low-grade adenoma 95; high grade adenoma 1; sessile serrated adenoma/polyp 1; hyperplastic polyp 1; inflammatory polyp 2; adenocarcinoma 0 | Cold polypectomy snare (Exacto cold snare) or SnareMaster plus | Normal saline solution mixed with indigo carmine (.04%) and epinephrine |
Wei et al.9 | 2022 | Prospective, RCT, Sep. 16, 2020, and May 31, 2021, single-center, USA | 105 | 109 | 68.7 (7.8) | 68.9 (7.9) | 107/2 | 102/3 | 149 | 142 | 5.3 (1.5) | 5.3 (1.5) | Cecum 13; ascending 42; hepatic flexure 7; transverse 50; descending 14; sigmoid 20; rectum 3 | Cecum 13; ascending, 39; hepatic flexure 5; transverse 48; descending, 19; sigmoid 14; rectum 4 | NR | NR | Open Exacto cold snare | Everlift injection |
Study | Year published | Study details | Total patients |
Age (mean±SD, y) |
Male/female |
Polyp number (total) |
Polyp size (mean±SD, mm) |
Polyp location |
Polyp pathology |
Type of snares (CSP & CEMR) |
Type of injection used |
|||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
CSP | CEMR | CSP | CEMR | CSP | CEMR | CSP | CEMR | CSP | CEMR | CSP | CEMR | CSP | CEMR | (CSP & CEMR) | CSP | |||
Kim et al.15 | 2023 | Prospective, RCT, Jan. 2018 to Feb. 2021, multicenter, Korea | 161 | 166 | 63.5±11.1 | 62.0±10.5 | 102/51 | 111/55 | 215 (6–8 mm, 155; 9–10 mm, 60) | 210 (6–8 mm, 169; 9–10 mm, 41) | 7.0±1.2 | 7.2±1.4 | Cecum/ascending 63 (29.3); HFa/transverse/SFb 73 (34.0); descending/sigmoid 66 (30.7); rectum 13 (6.0) | Cecum/ascending 67 (31.9); HFa/transverse/SFb 50 (23.8); descending/sigmoid 80 (38.1); rectum 13 (6.2) | Tubular adenoma 196 (91.2); hyperplastic polyp 14 (6.5); serrated polyp 5 (2.3); adenocarcinoma 0 (0) | Tubular adenoma 186 (88.6); hyperplastic polyp 16 (7.6); serrated polyp 5 (2.4); adenocarcinoma 3 | Traditional oval snare | Normal saline solution mixed with indigo carmine (0.04%) and epinephrine (1:10,000) |
Katagiri et al.14 | 2023 | Prospective RCT, Apr. 2019 to Apr. 2021, single-center, Japan | 59 | 59 | 63.7±13.3 | 67.9±10.2 | 36/23 | 33/26 | <5 mm, 76 (67.9%); ≥5 mm, 36 (32.1%) | <5 mm, 91 (61.1%); ≥5 mm, 58 (38.9%) | 4.2±1.8 | 4.4±1.8 | Right side 73 (65.2%); left side 39 (34.8%) | Right side 108 (72.5%); left side 41 (27.5%) | Low-grade adenoma 86 (76.8%); high grade adenoma 0 (0%); sessile serrated adenoma/polyp 10 (8.9%); hyperplastic polyp 13 (11.6%); inflammatory polyp 3 (2.7%); loss of tissue 0 (0%) | Low-grade adenoma 110 (73.8%); high grade adenoma 1 (0.7); sessile serrated adenoma/polyp 7 (4.7%); hyperplastic polyp 29 (19.5%); inflammatory polyp 1 (0.7%); loss of tissue 1 (0.7%) | NR | Epinephrine (0.001%)-added saline |
Li et al.16 | 2020 | Prospective, RCT, Jul. 2017 and Mar. 2019, single-center, China | 131 | 135 | 51.63±14.395 | 51.77±14.545 | 77/52 | 73/59 | 244 | 252 | 11.95±3.35 | 12.03±3.36 | Caecum and ascending colon 57/88; transverse colon 54/61; descending colon 46/50; sigmoid colon and rectum 42/45 | Caecum and ascending colon 68/75; transverse colon 54/58; descending colon 57/59; sigmoid colon and rectum 57/58 | Submucosal adenocarcinoma 0; advanced adenoma 123/159; adenoma 60/64; sessile/traditional serrated adenoma 16/21 | Submucosal adenocarcinoma 1/1; advanced adenoma 160/171; adenoma 59/61; sessile/traditional serrated adenoma 17/19 | Snares (Boston Scientific CAPTIVATORTM 13 mm; JHY-SD-23-230-15-AI 15 mm) | Normal saline solution, epinephrine (1:10 0000), and methylene blue |
Mou et al.13 | 2023 | RCT, Jul. 2020 to Sep. 2020, multicenter, China | 150 | 150 | 53 (11, 18–79) | 54 (10, 28–74) | 90/60 | 92/58 | 216 (3–5 mm, 139 [64.4%]; 6–9 mm, 77 [35.6%]) | 150 (3–5 mm, 146 [62.4%], 6–9 mm, 88 [37.6%]) | 5 (2, 3–8) | 5 (2, 3–9) | Cecum 7; ascending colon 27; hepatic flexure 14; transverse colon 41; splenic flexure 0; descending colon 24; sigmoid colon 72; rectum 31 | Cecum 9; ascending colon 35; hepatic flexure 14; transverse colon 53; splenic flexure 3; descending colon 35; sigmoid colon 50; rectum 35 | Tubular adenoma 136; villous/tubulovillous adenoma 6; sessile serrated lesion 4; hyperplastic polyp 53; inflammatory polyp 14 | Tubular adenoma 146; villous/tubulovillous adenoma 6; sessile serrated lesion 8; hyperplastic polyp 51; inflammatory polyp 22 | CSP-dedicated or traditional snares | Saline solution mixed with methylene blue and epinephrine |
Rex et al.12 | 2022 | Prospective, RCT, Aug. 10, 2018 and Mar. 26, 2021, multicenter, USA | 59 | 63 | 66.2 (9.9) | 65.0 (8.0) | 25/34 | 28/35 | 68 | 82 | 9.4±3.1 | 9.5±2.8 | Ascending colon 24 (35.3); cecum 7 (10.3); descending colon 8 (11.8); hepatic flexure 5 (7.4); ileocecal valve 1 (1.5); rectum 2 (2.9); sigmoid colon 3 (4.4); transverse colon 18 (26.5) | Ascending colon 26 (31.7); cecum 8 (9.8); descending colon 13 (15.9); hepatic flexure 3 (3.7); ileocecal valve 0 (0); rectum 1 (1.2); sigmoid colon 6 (7.3); transverse colon 25 (30.5) | Adenoma 53 (77.9); hyperplastic 3 (4.4); normal mucosa 1 (1.5); sessile serrated lesion 10 (14.7); no tissue 1 (1.5) | Adenoma 61 (74.4); hyperplastic 2 (2.4); normal mucosa 0 (0); sessile serrated lesion 19 (23.2); no tissue 0 (0) | Dedicated cold snare (Boston CapCold [Boston Scientific] or Exacto Cold Snare [Steris Corporation) | Saline solution, hydroxyethyl starch, or any commercially available injection fluid |
Shimodate et al.6 | 2020 | Prospective RCT, Nov. 2017 to Sep. 2019, single-center, Japan | 107 | 107 | 68 (median) | 65 (median) | 60/47 | 61/46 | 97 | 100 | 5 mm (median) | 5 mm (median) | Cecum 4; ascending colon 23; transverse colon 23; descending colon 10; sigmoid colon 30; rectum 7 | Cecum 5; ascending colon 24; transverse colon 15; descending colon 14; sigmoid colon 34; rectum 8 | Low-grade adenoma 92; high grade adenoma 0; sessile serrated adenoma/polyp 2; hyperplastic polyp 1; inflammatory polyp 1; adenocarcinoma 1 | Low-grade adenoma 95; high grade adenoma 1; sessile serrated adenoma/polyp 1; hyperplastic polyp 1; inflammatory polyp 2; adenocarcinoma 0 | Cold polypectomy snare (Exacto cold snare) or SnareMaster plus | Normal saline solution mixed with indigo carmine (.04%) and epinephrine |
Wei et al.9 | 2022 | Prospective, RCT, Sep. 16, 2020, and May 31, 2021, single-center, USA | 105 | 109 | 68.7 (7.8) | 68.9 (7.9) | 107/2 | 102/3 | 149 | 142 | 5.3 (1.5) | 5.3 (1.5) | Cecum 13; ascending 42; hepatic flexure 7; transverse 50; descending 14; sigmoid 20; rectum 3 | Cecum 13; ascending, 39; hepatic flexure 5; transverse 48; descending, 19; sigmoid 14; rectum 4 | NR | NR | Open Exacto cold snare | Everlift injection |
Outcome | Pooled proportions (95% CI) (%) |
Pooled RR | p-value | |||
---|---|---|---|---|---|---|
CSP | I2 | CEMR | I2 | |||
Complete resection | 91.8 (82.5–96.3) | 67 | 94.6 (90.6–97.0) | 51 | 0.94 (0.87–1.02) | 0.001 |
En-bloc resection | 98.9 (96.6–99.6) | 0 | 98.3 (94.2–99.5) | 0 | 1.01 (0.96–1.06) | 0.06 |
Incomplete resection | 6.7 (1.9–21.5) | 96 | 4.8 (1.3–16.6) | 95 | 1.60 (0.95–2.68) | 0.15 |
Immediate bleeding | 2.9 (1.0–7.8) | 0 | 3.1 (1.7–4.9) | 40 | 1.28 (0.64–2.55) | 0.001 |
Delayed bleeding | 1.3 (0.4–4.0) | 0 | 1.4 (0.6–3.5) | 55 | 0.94 (0.36–2.45) | 0.90 |
Perforation | 0.3 (0.1–1.2) | 0 | 0.3 (0.1–1.1) | 0 | 1.27 (0.29–3.5) | 1.00 |
Other complications | 0.4 (0.1–2.1) | 0 | 0.3 (0.1–1.5) | 0 | 1.03 (0.2–4.1) | 1.00 |
SD, standard deviation; CSP, cold snare polypectomy; CEMR, cold endoscopic mucosal resection; HFa, hepatic flexure area; SFb, splenic flexure band; NR, not reported; RCT, randomized controlled trial.
CSP, cold snare polypectomy; CEMR, cold endoscopic mucosal resection; CI, confidence interval; RR, relative risk.