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
Abstract
BACKGROUND

Complete polyp resection is the main goal of endoscopic removal of large colonic polyps. Resection techniques have evolved in recent years and endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR) with margin ablation, cold snare polypectomy (CSP), cold EMR, and underwater EMR have been introduced. Yet, efficacy of these techniques with regard to local recurrence rates (LRRs) vs traditional hot snare polypectomy and standard EMR remains unclear.

AIM

To analyze LRR of large colonic polyps in a systematic review and meta-analysis.

METHODS

MEDLINE, EMBASE, EBM Reviews, and CINAHL were searched for prospective studies reporting LRR or incomplete resection rate (IRR) after colonic polypectomy of polyps ≥ 10 mm, published between January 2011 and July 2021. Primary outcome was LRR for polyps ≥ 10 mm.

RESULTS

Six thousand nine hundred and twenty-eight publications were identified, of which 34 prospective studies were included. LRR for polyps ≥ 10 mm at up to 12 mo’ follow-up was 11.0% (95%CI, 7.1%-14.8%; 15 studies; 4904 polyps). ESD (1.7%; 95%CI, 0%-3.4%; 3 studies, 221 polyps) and endoscopic mucosal resection with margin ablation (3.3%; 95%CI, 2.2%-4.5%; 2 studies, 947 polyps) significantly reduced LRR vs standard EMR without (15.2%; 95%CI, 12.5%-18.0%; 4 studies, 650 polyps) or with unsystematic margin ablation (16.5%; 95%CI, 15.2%-17.8%; 6 studies, 3031 polyps).

CONCLUSION

LRR is significantly lower after ESD or EMR with routine margin ablation; thus, these techniques should be considered standard for endoscopic removal of large colorectal polyps. 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.

Keywords: Colonoscopy; Adenoma; Polyp; Endoscopic mucosal resection; Colorectal cancer

Core Tip: Complete polyp resection is the main goal of endoscopic removal of large colonic polyps. Resection techniques have evolved in recent years and endoscopic submucosal dissection, endoscopic mucosal resection (EMR) with margin ablation, cold snare polypectomy, cold EMR, and underwater EMR have been introduced. Yet, efficacy of these techniques with regard to local recurrence rates (LRRs) vs traditional hot snare polypectomy and standard EMR remains unclear. We aimed to analyze LRR of large colonic polyps in a systematic review and meta- analysis.