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TOPLINE:

Cold endoscopic mucosal resection (EMR) demonstrates lower rates of delayed bleeding and perforation but a higher risk for recurrent or residual neoplasia than hot EMR in colorectal polyp treatment.

METHODOLOGY:

• Researchers conducted a meta-analysis of randomized controlled trials comparing cold EMR and hot EMR for the management of colorectal polyps.
• A comprehensive literature search of several databases was performed to identify eligible studies published from 1996 to October 6, 2024, with no language restrictions.
• Outcomes included recurrent or residual neoplasia, en bloc resection, incomplete resection, and adverse events such as intraprocedural bleeding, delayed bleeding, and perforation.

TAKEAWAY:

• The literature search identified seven eligible randomized controlled trials (six full-length publications and one abstract), which provided data on 930 patients with 1138 polyps in the cold EMR group and 923 patients with 1117 polyps in the hot EMR group.
• Compared with the hot EMR group, the cold EMR group had a higher risk for recurrent or residual neoplasia (risk ratio [RR], 2.03) and a lower risk for delayed bleeding (RR, 0.42) and perforation (RR, 0.13).
• These risk associations were also observed in a subgroup analysis of larger polyps (≥ 15 mm in size).
• No significant differences were observed between the groups in the rates of incomplete resection, en bloc resection, and intraprocedural bleeding.

IN PRACTICE:

"Recurrent/residual neoplasia post-EMR is a major concern as these polyps become challenging to manage endoscopically due to scar tissue at the EMR site," the authors wrote. "Cold EMR can be considered in selected patients where adverse events can be detrimental, such as patients with multiple medical comorbidities, poor surgical candidates, and patients with uninterrupted anticoagulation use," they added.

SOURCE:

The study, led by Aamir Saeed, MD, Vanderbilt University Medical Center, Nashville, Tennessee, was published online in Gastrointestinal Endoscopy.

LIMITATIONS:

Substantial heterogeneity was observed in the analyses of recurrent or residual neoplasia, intraprocedural bleeding, and en bloc resection, potentially limiting the generalizability of the findings. The relevant outcomes were not assessed in all studies, leading to varying study inclusion across different analyses.

DISCLOSURES:

The study did not receive any specific funding. Three authors reported being consultants for various companies. One author reported being an associate editor of Gastrointestinal Endoscopy, and another is the editor in chief.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.