Comparative efficacy and safety of resection techniques for treating 6 to 20mm, nonpedunculated colorectal polyps: A systematic review and network meta-analysis

Georgios Tziatzios; Apostolis Papaefthymiou; Antonio Facciorusso; Ioannis S Papanikolaou; Giulio Antonelli; Spadaccini Marco; Leonardo Frazzoni; Lorenzo Fuccio; Konstantina D Paraskeva; Cesare Hassan; Alessandro Repici; Prateek Sharma; Douglas K Rex; Konstantinos Triantafyllou; Helmut Messmann; Paraskevas Gkolfakis

doi:10.1016/j.dld.2022.10.011

Comparative efficacy and safety of resection techniques for treating 6 to 20mm, nonpedunculated colorectal polyps: A systematic review and network meta-analysis

Dig Liver Dis. 2023 Jul;55(7):856-864. doi: 10.1016/j.dld.2022.10.011. Epub 2022 Nov 4.

Authors

Georgios Tziatzios¹, Apostolis Papaefthymiou², Antonio Facciorusso³, Ioannis S Papanikolaou⁴, Giulio Antonelli⁵, Spadaccini Marco⁶, Leonardo Frazzoni⁷, Lorenzo Fuccio⁷, Konstantina D Paraskeva⁸, Cesare Hassan⁹, Alessandro Repici⁹, Prateek Sharma¹⁰, Douglas K Rex¹¹, Konstantinos Triantafyllou⁴, Helmut Messmann¹², Paraskevas Gkolfakis¹³

Affiliations

¹ Hepatogastroenterology Unit, Second Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, ''Attikon" University General Hospital, Athens, Greece. Electronic address: [email protected].
² Department of Gastroenterology, University Hospital of Larissa, Larissa, Greece.
³ Gastroenterology Unit, Department of Medical Sciences, University of Foggia AOU, Ospedali Riunity Viale Pinto, Foggia, Italy.
⁴ Hepatogastroenterology Unit, Second Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, ''Attikon" University General Hospital, Athens, Greece.
⁵ Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Rome, Italy; Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy.
⁶ Department of Endoscopy, Humanitas Research Hospital, IRCCS, Rozzano, Italy.
⁷ Gastroenterology Unit, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy.
⁸ Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital, Athens, Greece.
⁹ IRCCS Humanitas Research Hospital, Endoscopic Unit, Department of Gastroenterology, Milan, Italy.
¹⁰ Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Kansas School of Medicine, Kansas, United States; Division of Gastroenterology, Veteran Affairs Medical Center, Kansas, Missouri, United States.
¹¹ Division of Gastroenterology/Hepatology, Indiana University Hospital, Indianapolis, Indiana, United States.
¹² Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany.
¹³ Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium.

PMID: 36336608
DOI: 10.1016/j.dld.2022.10.011

Abstract

Introduction: Various endoscopic resection techniques have been proposed for the treatment of nonpedunculated colorectal polyps sized 6-20 mm, however the optimal technique still remains unclear.

Methods: A comprehensive literature review was conducted for randomized controlled trials (RCTs), investigating the efficacy of endoscopic treatments for the management of 6-20 mm nonpedunculated colorectal polyps. Primary outcomes were complete and en bloc resection rates and adverse event rate was the secondary. Effect size on outcomes is presented as risk ratio (RR; 95% confidence interval [CI]).

Results: Fourteen RCTs (5219 polypectomies) were included. Endoscopic mucosal resection(EMR) significantly outperformed cold snare polypectomy(CSP) in terms of complete [(RR 95%CI): 1.04(1.00-1.07)] and en bloc resection rate [RR:1.12(1.04-1.21)]. EMR was superior to hot snare polypectomy (HSP) [RR:1.04(1.00-1.08)] regarding complete resection, while underwater EMR (U-EMR) achieved significantly higher rate of en bloc resection compared to CSP [RR:1.15(1.01-1.30)]. EMR yielded the highest ranking for complete resection(SUCRA-score 0.81), followed by cold-snare EMR(CS-EMR,SUCRA-score 0.76). None of the modalities was different regarding adverse event rate compared to CSP, however EMR and CS-EMR resulted in fewer adverse events compared to HSP [RR:0.44(0.26-0.77) and 0.43(0.21-0.87),respectively].

Conclusion: EMR achieved the highest performance in resecting 6-20 mm nonpedunculated colorectal polyps, with this effect being consistent for polyps 6-9 and ≥10 mm; findings supported by very low quality of evidence.

Keywords: Colonoscopy; Colorectal; Meta-analysis; Polyp; Polypectomy; Resection; Treatment.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Colonic Polyps* / surgery
Colonoscopy / methods
Colorectal Neoplasms* / etiology
Colorectal Neoplasms* / surgery
Endoscopic Mucosal Resection* / adverse effects
Endoscopic Mucosal Resection* / methods
Humans
Network Meta-Analysis