S308 Cold Snare vs Hot Snare Polypectomy for Subcentimeter Colorectal Polyps: An Updated Meta-Analysis of Randomized Controlled Trials

Introduction: Hot snare polypectomy (HSP) and cold snare polypectomy (CSP) are established endoscopic methods to remove colorectal polyps. Multiple randomized clinical trials (RCTs) and meta-analyses have shown conflicting results in efficacy and safety of CSP over HSP. We performed an updated meta-analysis of all the RCTs till date comparing CSP and HSP for small (≤ 10mm) colorectal polyps. Methods: RCTs published since inception until April 15, 2023, describing CSP vs HSP in patients with subcentimeter colorectal polyps (≤ 10mm), were searched from the Cochrane, Embase, and MEDLINE databases. The primary endpoints of interest were complete resection rate, en bloc resection, procedure time (minutes), delayed bleeding, and perforation rate. Standard meta-analysis methods were employed using a random-effects model. Results: A total of 17 RCTs with 7,495 patients were included in this meta-analysis. Sixty five percent of patients were males and the mean age was 64 years. The mean size of the polyps was 5.7mm and 6mm in the CSP and HSP groups respectively. The polyps in the CSP group were 44% in proximal colon and 56% in distal colon. The polyps in the HSP group were 41.4% in proximal colon and 58.6% in distal colon. There was no significant difference between CSP and HSP groups with regards to complete resection rate (RR 0.99, 95% CI [0.97 to 1.01, P = 0.31, I2 = 57%]) and en bloc resection (RR 1.02, 95% CI [0.95 to 1.11, P = 0.54, I2 = 97%]). Only 1 immediate perforation event was reported in each group (RR 0.99, 95% CI [0.10 to 9.51, P = 1, I2 = 0%]). The CSP group, however, was associated with improved procedure times (SMD -0.51, 95% CI [-0.89 to -0.13, P = 0.009, I2 = 95%]) and slightly significant reduction in delayed bleeding (RR 0.52, 95% CI [0.28 to 0.97, P = 0.04, I2 = 36%]) (Table 1). Conclusion: Based on the findings, cold snare polypectomy has less procedure time and delayed bleeding than HSP for subcentimeter colorectal polyps. Although the results are limited by heterogeneity, our updated meta-analysis with the largest patient population reiterates the current guidelines recommending CSP for diminutive (5 mm) and small (6–9 mm) lesions. Table 1. - Clinical Outcomes Results Outcome Result (Risk ratio/standardized mean difference, 95% Confidence Interval, P value) Complete resection rate RR 0.99, 95% CI [0.97 to 1.01], P = 0.31 En bloc resection RR 1.02, 95% CI [0.95 to 1.11], P = 0.54 Procedure time SMD -0.51, 95% CI [-0.89 to -0.13], P = 0.009 Delayed bleeding RR 0.52, 95% CI [0.28 to 0.97], P = 0.04 Perforation RR 0.99, 95% CI [0.10 to 9.51], P = 1