Safety of Cold Resection of Non-ampullary Duodenal Polyps: A Systematic Review and Meta-analysis

Abstract

Introduction: Endoscopic resection has traditionally involved electrosurgical cautery (hot snare) to resect premalignant polyps. Recent data have suggested superior safety of cold resection. We aimed to assess the safety of cold compared to traditional (hot) resection for non-ampullary duodenal polyps. Methods: We performed a systematic review ending in September 2022. The primary outcome of interest was the adverse event (AE) rate for cold compared to hot polyp resection. We reported odds ratios with 95% confidence intervals (CIs). Secondary outcomes included rates of polyp recurrence and post-polypectomy syndrome. We assessed publication bias with the classic fail-safe test and used forest plots to report pooled effect estimates. We assessed heterogeneity using I2 index. Results: Our systematic review identified 1,215 unique citations. 8 of these met inclusion criteria, 7 of which were published manuscripts and 1 of which was a recent meeting abstract. On random effect modeling, cold-resection was associated with significantly lower odds of delayed bleeding compared to hot-resection. The difference in the odds of perforation (OR 0.31 [95% CI:0.05 – 2.87], p=0.2, I2=0) and polyp recurrence (OR 0.75 [95% CI:0.15 – 3.73], p=0.72, I2=0) between hot and cold resection was not statistically significant. There were no cases of post-polypectomy syndrome reported with either hot or cold techniques. Conclusion: Cold resection is associated with lower odds of delayed bleeding compared to hot resection for duodenal tumors. There was a trend toward higher odds of perforation and recurrence following hot resection, but this trend was not statistically significant.