SP6.11 Hot Snare Versus Cold Snare Polypectomy for the Subcentimeter Colorectal Polyps - A Systematic Review and Meta-Analysis

Background Colorectal cancer is the fourth most common cause of cancer in the UK. The screening colonoscopy relies on a safe technique and completes the resection of abnormal tissue. Objective The goal of this study was to compare the two popular choices for the resection of the polyps (up to 10mm) hot snare polypectomy (HSP) and cold snare polypectomy (CSP). Methods A systematic approach was used following the PICO search strategy through research databases PUBMED and Embase to identify the studies. The meta-analysis was performed following the PRISMA guidelines. Outcomes compared included Immediate and delayed bleeding, incomplete resection and polypectomy time. Results Eighteen RCTs and two comparative trials involving 8338 patients were identified. HSP had lower immediate bleeding (OR, 0.36; 95%CI 0.18,0.72]; P=0.004; I 2=71%). The odds of delayed bleeding were similar between HSP and CSP (OR 2.28; 95%CI [1.09, 4.78]; P=0.03; I2=14%) also the odds of incomplete resection were similar among both techniques (OR 0.82; 95%CI [0.61, 1.10]; P=0.18; I 2=35%). CSP was associated with shorter polypectomy time (MD 34.07 seconds; 95%CI [24.65, 43.49]; P<0.00001; I 2=100%). Conclusion HSP had fewer odds of immediate bleeding while CSP was associated with shorter procedure time. On comparing the odds of delayed bleeding and incomplete resection rates, both techniques were statistically similar. Therefore, this meta-analysis cannot confirm the superiority of one approach over another and the decision to use an approach will depend upon the preference and judgement of the endoscopist.