Meta-Analysis
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2016; 22(23): 5436-5444
Published online Jun 21, 2016. doi: 10.3748/wjg.v22.i23.5436
Efficacy and adverse events of cold vs hot polypectomy: A meta-analysis
Mikihiro Fujiya, Hiroki Sato, Nobuhiro Ueno, Aki Sakatani, Kazuyuki Tanaka, Tatsuya Dokoshi, Shugo Fujibayashi, Yoshiki Nomura, Shin Kashima, Takuma Gotoh, Junpei Sasajima, Kentaro Moriichi, Jiro Watari, Yutaka Kohgo
Mikihiro Fujiya, Hiroki Sato, Nobuhiro Ueno, Aki Sakatani, Kazuyuki Tanaka, Tatsuya Dokoshi, Shugo Fujibayashi, Yoshiki Nomura, Shin Kashima, Takuma Gotoh, Junpei Sasajima, Kentaro Moriichi, Yutaka Kohgo, Division of Gastroenterology and Hematological Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
Jiro Watari, Hyogo College of Medicine, Division of Gastroenteroelogy, Department of Internal Medicine, Nishinomiya City 663-8501, Japan
Author contributions: Fujiya A and Sato H contributed equally to this article; Fujiya M is the lead author, contributed to data statistical analysis; Sato H contributed to data statistical analysis; Ueno N, Sakatani A, Tanaka K, Dokoshi T, Fujibayashi S, Nomura Y and Kashima S contributed to data collection and review; all the authors contributed to this manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest in association with this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mikihiro Fujiya, MD, PhD, Division of Gastroenterology and Hematological Oncology, Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka-higashi, Asahikawa, Hokkaido 078-8510, Japan. fjym@asahikawa-med.ac.jp
Telephone: +81-166-682462 Fax: +81-166-682469
Received: January 29, 2016
Peer-review started: March 11, 2016
First decision: March 21, 2016
Revised: April 4, 2016
Accepted: May 21, 2016
Article in press: May 23, 2016
Published online: June 21, 2016
Processing time: 135 Days and 19.8 Hours
Abstract

AIM: To compare previously reported randomized controlled studies (RCTs) of cold and hot polypectomy, we systematically reviewed and clarify the utility of cold polypectomy over hot with respect to efficacy and adverse events.

METHODS: A meta-analysis was conducted to evaluate the predominance of cold and hot polypectomy for removing colon polyps. Published articles and abstracts from worldwide conferences were searched using the keywords “cold polypectomy”. RCTs that compared either or both the effects or adverse events of cold polypectomy with those of hot polypectomy were collected. The patients’ demographics, endoscopic procedures, No. of examined lesions, lesion size, macroscopic and histologic findings, rates of incomplete resection, bleeding amount, perforation, and length of procedure were extracted from each study. A forest plot analysis was used to verify the relative strength of the effects and adverse events of each procedure. A funnel plot was generated to assess the possibility of publication bias.

RESULTS: Ultimately, six RCTs were selected. No significant differences were noted in the average lesion size (less than 10 mm) between the cold and hot polypectomy groups in each study. Further, the rates of complete resection and adverse events, including delayed bleeding, did not differ markedly between cold and hot polypectomy. The average procedural time in the cold polypectomy group was significantly shorter than in the hot polypectomy group.

CONCLUSION: Cold polypectomy is a time-saving procedure for removing small polyps with markedly similar curability and safety to hot polypectomy.

Keywords: Cold polypectomy; Hot polypectomy; Colon adenoma; Conventional polypectomy; Colon neoplasm; Endoscopic mucosal resection; Bleeding

Core tip: We conducted a meta-analysis to evaluate the predominance of cold and hot polypectomy for removing colon polyps. The patients’ demographics, endoscopic procedures, No. of examined lesions, lesion size, macroscopic and histologic findings, rates of incomplete resection, bleeding, and perforation, and length of procedure were extracted from six randomized controlled studies. The rates of complete resection and adverse events did not markedly differ between cold and hot polypectomy. However, the procedural time was significantly shorter in the cold polypectomy group. These results suggest that cold polypectomy is a time-saving procedure for removing small polyps with similar curability and safety to hot polypectomy.