Cold- versus hot-snare endoscopic mucosal resection of colorectal polyps: meta-analysis of randomized controlled trials

Gastrointest Endosc. 2025 Jun;101(6):1239-1243.e2. doi: 10.1016/j.gie.2024.12.032. Epub 2024 Dec 25.

Abstract

Background and aims: Interest in cold endoscopic mucosal resection (EMR) for colorectal polyps has been growing. We conducted a meta-analysis of randomized controlled trials to compare cold and hot EMR for colorectal polyps.

Methods: We reviewed several databases from inception to October 6, 2024. Outcomes of interest were recurrent or residual neoplasia, en-bloc resection, incomplete resection, perforation, and intraprocedural and delayed bleeding. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated by means of a random-effects model.

Results: Rate of recurrent or residual neoplasia was significantly higher in the cold EMR group: RR, 2.03 (95% CI, 1.19-3.48). Rates of delayed bleeding RR, 0.42 (95% CI, 0.21-0.86) and perforation RR, 0.13 (95% CI, 0.03-0.59) were significantly lower with cold EMR. We found no significant difference in other outcomes between groups.

Conclusions: Cold EMR is associated with lower risk of delayed bleeding and perforation but higher risk of recurrent or residual neoplasia compared with hot EMR.

Publication types

  • Meta-Analysis
  • Comparative Study
  • Systematic Review

MeSH terms

  • Colonic Polyps* / pathology
  • Colonic Polyps* / surgery
  • Colonoscopy* / methods
  • Colorectal Neoplasms* / pathology
  • Colorectal Neoplasms* / surgery
  • Cryosurgery* / methods
  • Endoscopic Mucosal Resection* / adverse effects
  • Endoscopic Mucosal Resection* / methods
  • Humans
  • Intestinal Perforation / epidemiology
  • Intestinal Perforation / etiology
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm, Residual
  • Postoperative Hemorrhage / epidemiology
  • Postoperative Hemorrhage / etiology
  • Randomized Controlled Trials as Topic