Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2022; 28(29): 4007-4018
Published online Aug 7, 2022. doi: 10.3748/wjg.v28.i29.4007
Recurrence rates after endoscopic resection of large colorectal polyps: A systematic review and meta-analysis
Carola Rotermund, Roupen Djinbachian, Mahsa Taghiakbari, Markus D Enderle, Axel Eickhoff, Daniel von Renteln
Carola Rotermund, Markus D Enderle, Research and Basic Technologies, ERBE Elektromedizin GmbH, Tuebingen 72072, Germany
Roupen Djinbachian, Division of Internal Medicine, Montreal University Hospital Center, Montreal QC H2X 3E4, Canada
Mahsa Taghiakbari, Daniel von Renteln, Montreal University Hospital Research Center, Montreal University Hospital Center, Montreal QC H2X 3E4, Canada
Axel Eickhoff, Department of Internal Medicine II, Klinikum Hanau, Hanau 63450, Germany
Author contributions: von Renteln D designed the research study; von Renteln D, Rotermund C, Djinbachian R, Taghiakbari M, Enderle MD, and Eickhoff A performed the research; von Renteln D, Rotermund C, Djinbachian R, and Taghiakbari M analyzed the data; and von Renteln D, Rotermund C, and Djinbachian R wrote the manuscript; and All authors have read and approve the final manuscript.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Daniel von Renteln, MD, Associate Professor, Montreal University Hospital Research Center, Montreal University Hospital Center, 1051 Rue Sanguinet, Montreal QC H2X 3E4, Canada. danielrenteln@gmail.com
Received: March 30, 2022
Peer-review started: March 30, 2022
First decision: April 25, 2022
Revised: May 11, 2022
Accepted: July 8, 2022
Article in press: July 8, 2022
Published online: August 7, 2022
Processing time: 126 Days and 1.4 Hours
ARTICLE HIGHLIGHTS
Research background

Complete resection is the aim of endoscopic therapy for large colonic polyps. Endoscopic mucosal resection (EMR) is the most common endoscopic treatment for such polyps. In recent years, endoscopic resection techniques have evolved, including cold snare polypectomy (CSP), cold EMR, EMR with margin ablation, underwater EMR, and endoscopic submucosal dissection (ESD).

Research motivation

Efficacy of these newer polypectomy techniques with regard to local recurrence rates (LRRs) vs traditional hot snare polypectomy and standard EMR remains unclear.

Research objectives

These developments have sparked our interest in providing an up-to-date meta-analysis of LRRs and incomplete resection rates (IRRs) for large (≥ 10 mm) colorectal polyps, and to evaluate the impact of the novel or modified endoscopic resection techniques on LRRs.

Research methods

A systematic literature search was performed within MEDLINE, EMBASE, EBM Reviews, and CINAHL databases. All articles published between January 2011 and July 2021 reporting on IRR and/or LRR for colorectal polyps 10 mm or larger removed by endoscopic resection techniques were included in the search.

Research results

LRR were lowest when EMR with systematic margin ablation (3.3%) or ESD (1.7%) were used for endoscopic removal of large (> 10 mm) colorectal polyps. When standard EMR (without margin ablation) or with partial margin ablation were used, LRRs were high (15.2% and 16.5%, respectively).

Research conclusions

Local recurrence after resection of large colonic polyps occurs frequently when standard EMR is used, but can be reduced by performing ESD or EMR with routine and complete margin ablation. Other techniques, such as CSP, cold EMR, and underwater EMR require further evaluation in prospective studies before their routine implementation in clinical practice can be recommended.

Research perspectives

ESD or EMR with margin ablation should be considered standard of care for endoscopic removal of large colorectal polyps in order to avoid recurrence. At present, cold snare resection techniques or underwater EMR should only be performed within clinical trials, pending the availability of high-quality evidence.