Introduction: Colonoscopic polypectomy is a very effective technique for the prevention of colon cancer, and the vast majority of polyps found during colonoscopy are diminutive polyps. Currently the standard of practice for diminutive polyp resection is cold biopsy. The primary aim of this study was to compare the complete eradication rate of diminutive polyps using cold biopsy versus other techniques, as randomized controlled trials (RCTs) have shown conflicting results.
Methods: In March 2014, we searched for RCTs in Medline, Web of Science and Embase, starting with their dates of inception as well as abstracts of pertinent scientific meetings (AGA, ACG, DDW). The primary outcome was complete eradication rate of diminutive polyps, and the secondary outcome was procedural time. Using RevMan (Cochrane), the Mantel-Haenszel random effects model was used for binary endpoints and the inverse variance method for continuous outcomes. GRADE was used to rate the quality of evidence for each outcome.
Results: Five randomized controlled trials included a total of 610 patients. The mean polyp size was 4.5 mm, with a range of 2-10 mm. Removal techniques included cold biopsy, jumbo biopsy and cold snare polypectomy. Based on histological criteria, incomplete polyp eradication was significantly lower with cold snare/jumbo forceps biopsy than with cold biopsy (relative risk 0.48, 95% CI 0.30; 0.77), with little heterogeneity (I2 9%). Total procedure time was an average of 4.1 minutes shorter for cold snare/jumbo forceps biopsy compared to cold biopsy (95% CI, -8; -0.2).
Conclusion: There is moderate quality evidence that cold snare or jumbo biopsy techniques reduces the risk of incomplete diminutive polyp removal by 52%. In addition, the improved histological eradication rate was associated with a shorter procedure time. To our knowledge, this is the first meta-analysis that compared techniques for diminutive polyp removal. Adequately-powered randomized clinical trials are warranted to confirm these findings.