Interest in cold endoscopic mucosal resection (EMR) for treating colorectal polyps has been gaining traction, as a recent meta-analysis published in the Gastrointestinal Endoscopy journal highlighted its distinct advantages and challenges when compared to the traditional hot EMR technique.
This analysis was based on randomized controlled trials (RCTs) which highlighted the critical outcomes such as recurrence rates, bleeding risk, and procedural safety. This extensive review of multiple databases covered studies up to October 6, 2024. Using a random effects model, this studies calculated pooled risk ratios (RR) and 95% confidence intervals (CI) to compare the 2 EMR methods across key clinical outcomes.
One of the standout finding of this study was the difference in the rates of delayed bleeding between the 2 approaches. Cold EMR demonstrated a significantly lower risk of delayed bleeding, with an RR of 0.42 (95% CI: 0.21–0.86). This reduced bleeding risk aligns with the absence of thermal injury in the cold technique by making it a safer option in certain patient populations.
Also, the analysis found a markedly lower risk of perforation with cold EMR by reporting an RR of 0.13 (95% CI: 0.03–0.59). The lack of heat application appears to reduce the risk of bowel wall damage which can lead to perforation.
However, the cold EMR method showed a higher rate of recurrent or residual neoplasia. The patients undergoing cold EMR were twice as likely to experience neoplasia recurrence when compared to the ones treated with hot EMR, with an RR of 2.03 (95% CI: 1.19–3.48). This highlights a trade-off in its use, as recurrence could necessitate additional interventions.
The study found no significant differences between cold and hot EMR in outcomes such as en bloc resection or incomplete resection which indicated similar efficacy in achieving complete removal of targeted polyps during the initial procedure.
The findings offer valuable insights for clinicians choosing between cold and hot EMR techniques. While cold EMR offers a safer profile with respect to bleeding and perforation, its higher recurrence risk necessitates careful patient selection and possibly improved surveillance post-procedure. As interest in non-thermal methods like cold EMR grows, these results illuminate the importance of weighing individual patient factors and clinical priorities.
Source:
Saeed, A., Yousuf, S., Noverati, N., Chen, A., Saleem, N., Farooq, U., Muniraj, T., Persaud, A., Xiao, Y., Kumar, A., Schlachterman, A., Kowalski, T., Adler, D., & Kamal, F. (2024). Cold versus hot snare endoscopic mucosal resection of colorectal polyps: meta-analysis of randomized controlled trials. In Gastrointestinal Endoscopy. Elsevier BV. https://doi.org/10.1016/j.gie.2024.12.032
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