S1569 Safety and Efficacy of Cold Snare Resection of Non Ampullary Duodenal Epithelial Adenomas: An Updated Systematic Review and Meta-Analysis

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Introduction: Cautery-based resection has been associated with delayed adverse events after endoscopic resection of lesions. Cold-snare techniques have been increasingly used in the resection of gastrointestinal lesions to minimize these adverse events. The literature on use of cold resection techniques for duodenal adenomas is limited. To amplify current evidence, we conducted a systematic review and meta-analysis evaluating the safety and efficacy of cold snare resection (CSR) of non-ampullary duodenal adenomas. Methods: Multiple databases were searched through June 2024 for studies reporting outcomes after the use of CSR for duodenal non-ampullary adenoma resection. Meta-analysis with a random effects model was performed to determine the pooled proportions and odds ratios (ORs) of outcomes of interest. Results: We included 11 studies studying 407 patients and 758 lesions ranging from 4-70 mm that underwent CSR. Pooled rates of immediate and delayed bleeding were 2.2% [95% CI 0.9, 5.3] and 1% [95% CI 0.4, 2.5] respectively. There were 2 intraprocedural perforations and 0 delayed perforations among patients undergoing CSR. ORs of CSR vs hot-snare-resection for immediate bleeding were comparable at 0.57 [95% CI 0.08, 3.34] but those for delayed bleeding were significantly lower with CSR at 0.11 [95% CI 0.015, 0.79]. Adenoma recurrence rates were 2.5% [95% CI 0.6, 9.4] for adenomas under 10 mm and 29% [95% CI 20.4, 39.4] for those over 10 mm. Meta-regression analysis confirmed a significant association between increased adenoma size and rate of recurrence, P < 0.05. Endoscopic adenoma eradication was achieved in 98.8% [95% CI 86.6, 99.9] patients after CSR. Conclusion: CSR is associated with a good safety profile and acceptable efficacy for the resection of non-ampullary duodenal adenomas. Surveillance endoscopy is crucial especially after the resection of large adenomas due to the considerable recurrence rate (see Figure 1, Table 1).Figure 1.: Pooled proportion of recurrent adenoma at surveillance endoscopy. Table 1. - Study Characteristics Study Year Country Study Design Sample Size Lesions (n) Age (years); Mean (SD) Male/Female Choksi et al 2015 USA Retrospective 15 15 63.6 9/6 Brooks et al 2017 USA Retrospective 19 21 66.7 7/12 Maruoka et al 2017 Japan Prospective 22 30 64.7 (11.4) 16/6 Hamada et al 2018 Japan Prospective 10 332 39.3 6/4 Okimoto et al 2021 Japan Retrospective 35 46 66.6 (10.6) 24/11 Takizawa et al 2021 Japan Prospective 21 21 median 71 [range 49-80] 16/5 Trivedi et al 2022 USA Retrospective 41 46 median 72 [range 62-76.5] 28/13 Dang et al 2022 USA Retrospective 39 39 66.8 (10.1) 12/27 Capogreco et al. 2022 Europe Retrospective 31 31 63.1 (10.4) 17/14 Wang et al. 2023 Australia Prospective 49 50 70 (9.2) 32/17 Wilson et al. 2024 USA Retrospective 125 127 69 (60-73) 75/50

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