Cold EMR Safer for Colorectal Polyp Removal

TOPLINE:

Cold endoscopic mucosal resection (EMR) showed a superior safety profile over traditional hot EMR for large nonpedunculated colorectal polyps measuring ≥ 20 mm, with significantly lower risks of bleeding and perforation.

METHODOLOGY:

• Although hot EMR has traditionally been the standard technique for resecting larger polyps, it is associated with significant adverse events, including delayed bleeding and perforation.
• Researchers conducted a systematic literature review (SLR) to identify studies for inclusion in a meta-analysis evaluating the safety and efficacy of cold EMR vs hot EMR for large nonpedunculated colorectal polyps ≥ 20 mm in size.
• The SLR identified comparative studies of cold EMR vs hot EMR for the primary analyses and cohort studies of cold EMR for the secondary analyses.
• The primary outcome was the odds of delayed bleeding (defined in most studies as bleeding that occurred > 24 hours after the procedure) in cold EMR vs hot EMR; secondary outcomes included early bleeding (bleeding that occurred during the procedure or < 24 hours after the procedure), perforation, technical success, and rate of polyp recurrence.

TAKEAWAY:

• The SLR identified 11 studies (seven comparative studies of cold EMR vs hot EMR and four cohort studies of cold EMR) with 3104 patients, of whom 1127 and 1977 underwent cold EMR and hot EMR, respectively.
• Cold EMR was associated with a pooled 75% lower risk of delayed bleeding than hot EMR across all available studies (P = .001).
• In five comparative studies, the cold EMR group had significantly lower risks for early bleeding than the hot EMR group (pooled odds ratio, 0.34; P < .001); the pooled rate of early bleeding with cold EMR was only 1.4% in the four cohort studies.
• No cases of perforation were reported in patients who underwent cold EMR in any of the studies; however, several confirmed cases of perforation were documented among those who underwent hot EMR.
• The cold EMR group had an 81% higher risk for the recurrence of polyps than the hot EMR group across all studies (P = .045); most cases could be managed with follow-up procedures.

IN PRACTICE:

“This analysis supports a change in the standard of care to include routine use of cold EMR in an endoscopist’s repertoire for the removal of large, sessile, nonpedunculated colorectal polyps,” the authors wrote.

SOURCE:

This study was led by Bashar Qumseya, MD, MPH, Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, and published online in The American Journal of Gastroenterology.

LIMITATIONS:

Definitions of adverse events varied widely across studies , with that of early bleeding ranging from visible oozing at the site to brisk bleeding requiring blood transfusion. Identified studies were limited to the United States, Germany, and Australia, with no published studies from East Asia. Estimation of polyp recurrence was influenced by incomplete follow-ups in some studies, varying definitions of recurrence across studies, and polyp recurrence being reported as a binary rather than a time-to-event outcome, which may have introduced ecological bias.

DISCLOSURES:

This study did not receive any funding. One author reported being a consultant and receiving travel reimbursement from certain pharmaceutical companies.

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