Cold Endoscopic Mucosal Resection (c-EMR) Of Non-Pedunculated Colorectal Polyps≥20 mm: A Systematic Review And Meta-Analysis

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Aims There is increasing evidence that cold EMR (c-EMR) can effectively treat large colorectal polyps. We aim to appraise the current literature and evaluate outcomes following c-EMR for non-pedunculated colonic polyps≥20 mm. Methods Major databases were searched. Primary outcomes included recurrence rate and adverse events. Meta-analysis was performed using a random effects model. Results Nine articles were included in the final analysis which included 817 patients and 1,077 colorectal polyps. Average polyp size was 28.8 (±5.1) mm. Pooled recurrence rate of polyps of any histology at 4 to 6 months was 21.0% (95% C 9.0% – 32.0%, P<0.001, I2=97.3, P<0.001). Subgroup analysis showed that recurrence was 10% for proximal lesions (95% CI 0.0% – 20.0%, P=0.054, I2=93.7%, P=0.054) and 9% for distal lesions (95% CI 2.0% – 21.0%, P=0.114, I2=95.8%, P=0.114). Furthermore, subgroup analysis showed that recurrence was 12% for adenoma (95% CI 4.0% – 19.0%, P=0.003, I2=98.0%, P=0.003), and 3% for sessile serrated polyps (SSP) (95% CI 1.0% – 5.0%, P=0.002, I2=34.4%, P=0.002). Post-polypectomy bleeding occurred in 1% (n=8/817) of patients while abdominal pain occurred in 0.2% (n=2/817) of patients. Conclusions C-EMR for non-pedunculated colorectal polyps≥20 mm show an excellent safety profile with a very low rate of delayed bleeding as well as significantly less recurrence for SSP than adenomas. Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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