Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2025; 17(2): 99510
Published online Feb 27, 2025. doi: 10.4240/wjgs.v17.i2.99510
Efficacy-cost analysis of endoscopic mucosal resection and cold snare polypectomy: A propensity score matching analysis
Shi-Yi Zhang, Ying-Chun Wang, Lei-Lei Liu, Zhi-Heng Wang, Xue-Mei Guan
Shi-Yi Zhang, Department of Digestive, Linfen Central Hospital, Linfen 041000, Shanxi Province, China
Ying-Chun Wang, Department of Nursing, Ezhou Central Hospital, Ezhou 436000, Hubei Province, China
Lei-Lei Liu, Zhi-Heng Wang, Department of Oncology, Linfen Central Hospital, Linfen 041000, Shanxi Province, China
Xue-Mei Guan, Medical Examination Center, Shanxi Cancer Hospital, Taiyuan 030013, Shanxi Province, China
Co-first authors: Shi-Yi Zhang and Ying-Chun Wang.
Author contributions: Zhang SY designed this study and drafted the manuscript; Wang YC designed this study and collected case data; Liu LL and Wang ZH organized and analyzed the data; Guan XM designed this study and reviewed the manuscript. Zhang SY and Wang YC contributed equally to this work. Zhang SY and Wang YC contributed equally to this work as co-first authors.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Ezhou Central Hospital.
Informed consent statement: This is a retrospective study, approved and exempted from informed consent form.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: Without authorization to share data, data sharing was not supported.
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: Xue-Mei Guan, Medical Examination Center, Shanxi Cancer Hospital, No. 3 Gonggongxin Village, Xinghualing District, Taiyuan 030013, Shanxi Province, China. szlfbgxm@163.com
Received: October 11, 2024
Revised: November 21, 2024
Accepted: December 9, 2024
Published online: February 27, 2025
Processing time: 103 Days and 1.4 Hours
Abstract
BACKGROUND

Although substantial evidence supports the advantages of cold snare polypectomy (CSP) in terms of polypectomy efficacy and reduced postoperative adverse events, few studies have examined the cost differences between CSP and traditional endoscopic mucosal resection (EMR) for the treatment of intestinal polyps.

AIM

To compare the efficacy-cost of EMR and CSP in the treatment of intestinal polyps.

METHODS

A total of 100 patients with intestinal polyps were included in the retrospective data of our hospital from April 2022 to May 2023. According to the treatment methods, they were divided into EMR (n = 46) group and CSP (n = 54) group. The baseline data of the two groups were balanced by 1:1 propensity score matching (PSM), and the cost-effectiveness analysis was performed on the two groups after matching. The recurrence rate of the two groups of patients was followed up for 1 year, and they were divided into recurrence group and non-recurrence group according to whether they recurred. Multivariate logistic regression analysis was used to screen out the influencing factors affecting the recurrence of intestinal polyps after endoscopic resection.

RESULTS

Significant disparities were observed in the number of polyps and smoking background between the two groups before PSM (P < 0.05). Following PSM, the number of polyps and smoking history were well balanced between the EMR and CSP groups. The direct cost incurred by the CSP group was markedly higher than that incurred by the EMR group. Concurrently, the cost-effectiveness ratio in the CSP group was substantially reduced when juxtaposed with that in the EMR group (P < 0.05). Upon completion of the 1-year follow-up, the rate of recurrence after endoscopic intestinal polypectomy was 38.00%. Multivariate methods revealed that age ≥ 60 years, male sex, number of polyps ≥ 3, and pathological type of adenoma were risk factors for recurrence after endoscopic intestinal polypectomy (all P < 0.05).

CONCLUSION

CSP was more cost-effective for the treatment of intestinal polyps. An age ≥ 60 years, male sex, having a number of polyps ≥ 3, and pathological type of adenoma are independent influencing factors for recurrence.

Keywords: Propensity score matching method; Endoscopic mucosal resection; Cold snare polypectomy; Intestinal polyps; Curative effect; Cost analysis

Core Tip: This study utilizes propensity score matching to evaluate the efficacy and cost-effectiveness of cold snare polypectomy (CSP) vs endoscopic mucosal resection in colorectal polyp treatment. CSP shows a higher rate of complete resection and a more favorable cost-to-effectiveness ratio. The research also identifies an age over 60 years, male sex, presence of three or more polyps, and adenomatous histology as key predictors of polyp recurrence, advocating for CSP's adoption and personalized patient follow-up strategies.