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Is jumbo biopsy forceps comparable to cold snare for diminutive colorectal polyps? - a meta-analysis.

ABSTRACT: Background and study aims? Diminutive colorectal polyps are increasingly being detected and it is not clear whether jumbo biopsy forceps (JBF) has comparable efficacy to that of cold snare polypectomy (CSP) for management of these lesions. Methods? An electronic literature search was performed for studies comparing resection rates of JBF and CSP for diminutive polyps (??5?mm). The primary outcome was incomplete resection rate (IRR). Secondary outcomes included failure of tissue retrieval and complication rates (post-polypectomy bleeding, perforation etc.). Leave-one-out analysis was performed to examine the disproportionate role of any of the studies. Meta-analysis outcomes and heterogeneity (I ² ) were computed using Comprehensive meta-analysis software. Results? A total of 4 studies (3 randomized controlled trials and 1 retrospective study) with 407 patients and 569 total polyps (mean size of 3.62?mm) was included for analysis. IRR of JBF was slightly higher than that of CSP (10.2?% vs 7.2?%) but this was not statistically significantly different (Pooled OR 1.76; 95?% CI 0.94-3.28; I ² ?=?0 ). Leave-one-out analysis showed no significant difference in the pooled OR comparison either. Two of the 4 studies reported 0?% failure of tissue retrieval for JBF and 1?% and 4.3?% for CSP. There were no complications for either group from the 2 studies that reported this outcome. The quality of the included studies was moderate to high. Conclusions? This systematic review with only limited data shows that JBF and CSP are not statistically different in completely removing diminutive polyps, although careful endoscopic assessment is needed to ensure complete removal of all polyp tissue.

SUBMITTER: Srinivasan S

PROVIDER: S-EPMC7775805 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Is jumbo biopsy forceps comparable to cold snare for diminutive colorectal polyps? - a meta-analysis.

Srinivasan Sachin S Siersema Peter D PD Desai Madhav M

Endoscopy international open 20210101 1

<b>Background and study aims </b> Diminutive colorectal polyps are increasingly being detected and it is not clear whether jumbo biopsy forceps (JBF) has comparable efficacy to that of cold snare polypectomy (CSP) for management of these lesions. <b>Methods </b> An electronic literature search was performed for studies comparing resection rates of JBF and CSP for diminutive polyps (≤ 5 mm). The primary outcome was incomplete resection rate (IRR). Secondary outcomes included failure of tissue ret ...[more]

PMID: 33403230

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Project description:Background and study aims:?The majority of polyps removed at colonoscopy are diminutive (??5?mm) to small (<?10?mm) and there are few guidelines for the best way for these polyps to be removed. We aimed to assess the feasibility and effectiveness of cold biopsy forceps polypectomy with pre-lift (CBPP) for polyps ??7?mm. Our aims were to assess completeness of histological resection of this technique, to identify factors contributing to this and assess secondary considerations such as timing, retrieval and complication rates. Patients and methods?:We conducted a prospective cohort study on consecutive patients receiving a colonoscopy at Cheltenham General Hospital, as part of the National Bowel Cancer Screening Program (BCSP) in England. The study included only polyps that were judged as ??7?mm by the colonoscopist. A small sub-mucosal pre-lift injection was administered prior to removal of the polyp using cold biopsy forceps. One or more biopsies were taken until the polyp was confidently assessed visually as being completely removed by the colonoscopist. The entire polypectomy site was then removed en bloc by endomucosal resection (EMR) with a margin of at least 1 to 2?mm around defect. This was sent for histopathological analysis to assess completeness of resection. Polypectomy timing, tissue retrieval, number of bites required for visual resection and complications were recorded at the time of the procedure. Results?:Sixty-four patients were recruited and consented. Of them, 42 patients had a total of 60 polyps resected. Three patients had inflammatory polyps and were excluded from the study, leaving 57/60 polyps for final analysis. Seventeen were hyperplastic and 40 adenomatous polyps. Retrieval was complete for all 57 polyps and there were no complications both during or post- polypectomy. The complete resection rate (CRR) was 86?%. The technique was more effective in smaller polyps with 91.7?% of diminutive polyps (??5?mm) completely excised. Conclusions?:CBPP is a safe and highly effective technique for polyps <?5?mm with a high complete resection and retrieval rate. The time taken for the procedure is significantly greater than cold forceps alone, or cold snare as seen in other studies.

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Is jumbo biopsy forceps comparable to cold snare for diminutive colorectal polyps? - a meta-analysis.

Publications

Is jumbo biopsy forceps comparable to cold snare for diminutive colorectal polyps? - a meta-analysis.

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