Endoscopy 2024; 56(07): 503-511
DOI: 10.1055/a-2275-5349
Systematic review

Cold endoscopic mucosal resection versus cold snare polypectomy for colorectal lesions: a systematic review and meta-analysis of randomized controlled trials

1   Diagnostic Imaging and Specialized Diagnosis Unit, University Hospital of Federal University of São Carlos, São Carlos, Brazil
2   Department of Internal Medicine (Division of Gastroenterology), FEEVALE University, Novo Hamburgo, Brazil (Ringgold ID: RIN125099)
3   Department of Endoscopy, Barretos Cancer Hospital, Barretos, Brazil (Ringgold ID: RIN67766)
4   Department of Internal Medicine, Evangelical University of Goias, Anápolis, Brazil
› Author Affiliations


Background Cold resection of colorectal lesions is widely performed because of its safety and effectiveness; however, it remains uncertain whether adding submucosal injection could improve the efficacy and safety. We aimed to compare cold endoscopic mucosal resection (C-EMR) versus cold snare polypectomy (CSP) for colorectal lesions.

Methods We performed a systematic review of randomized controlled trials (RCTs) identified from PubMed, Cochrane Library, and Embase. The primary outcome was complete resection. Secondary outcomes were procedure time, en bloc resection, and adverse events (AEs). Prespecified subgroup analyses based on the size and morphology of the polyps were performed. The random-effects model was used to calculate the pooled risk ratio (RR) and mean difference, with corresponding 95%CIs, for dichotomous and continuous variables, respectively. Heterogeneity was assessed using the Cochran Q test and I 2 statistics.

Results 7 RCTs were included, comprising 1556 patients, with 2287 polyps analyzed. C-EMR and CSP had similar risk ratios for complete resection (RR 1.02, 95%CI 0.98–1.07), en bloc resection (RR 1.08, 95%CI 0.82–1.41), and AEs (RR 0.74, 95%CI 0.41–1.32). C-EMR had a longer procedure time (mean difference 42.1 seconds, 95%CI 14.5–69.7 seconds). In stratified subgroup analyses, the risk was not statistically different between C-EMR and CSP for complete resection in polyps<10 mm or ≥10 mm, or for complete resection, en bloc resection, and AEs in the two groups among nonpedunculated polyps.

Conclusions The findings of this meta-analysis suggest that C-EMR has similar efficacy and safety to CSP, but significantly increases the procedure time.

PROSPERO: CRD42023439605.

Supplementary Material

Publication History

Received: 13 September 2023

Accepted after revision: 12 February 2024

Article published online:
19 March 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany