Cold Versus Hot Endoscopic Mucosal Resection for Sessile Serrated Colorectal Polyps ≥10 mm: A Systematic Review and...

Area of Science:

• Gastroenterology
• Endoscopy
• Oncology

Background:

• Sessile serrated polyps (SSPs) ≥10 mm pose a resection challenge.
• Endoscopic mucosal resection (EMR) is a key technique for SSP removal.
• Comparing cold versus hot EMR is crucial for optimizing patient outcomes.

Purpose of the Study:

• To systematically review and meta-analyze the efficacy and safety of cold versus hot EMR for SSPs ≥10 mm.
• To compare residual SSP rates, technical success, R0 resection, and adverse events between cold and hot EMR.
• To provide evidence-based recommendations for SSP management.

Main Methods:

• Systematic review and meta-analysis of studies comparing cold and hot EMR for SSPs ≥10 mm.
• Searched multiple databases until January 2023.
• Primary outcome: residual SSP rate. Secondary outcomes: technical success, R0 resection, and adverse events.

Main Results:

• 13 studies with 1896 SSPs (mean size 23.7 mm) were analyzed.
• Residual SSP rates were comparable: 4.5% for cold EMR vs. 5.1% for hot EMR (P=0.9).
• Hot EMR showed higher en-bloc resection (41.4% vs. 1.4%) but increased delayed bleeding (4% vs. 0.7%) compared to cold EMR.

Conclusions:

• Cold EMR demonstrates comparable efficacy to hot EMR for large SSP resection.
• Hot EMR offers higher en-bloc resection rates but is associated with increased delayed bleeding risk.
• Further research may clarify optimal EMR techniques for SSPs based on polyp size and characteristics.