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BACKGROUND: Colorectal cancer is the third most common cancer, and prevention relies on screening programs with resection complete resection of neoplastic lesions. OBJECTIVE: We aimed to evaluate the best snare polypectomy technique for colorectal lesions up to 10 mm, focusing on complete resection rate, and adverse events. METHODS: A comprehensive search using electronic databases was conducted to identify randomized controlled trials comparing hot versus cold snare resection for polyps sized up to 10 mm, and following PRISMA guidelines, a meta-analysis was performed. Outcomes included complete resection rate, en bloc resection rate, polypectomy, procedure times, immediate, delayed bleeding, and perforation. RESULTS: Nineteen RCTs involving 8720 patients and 17588 polyps were included. Hot snare polypectomy showed a higher complete resection rate (RD, 0.02; 95%CI [+0.00,0.04]; P=0.03; I 2=63%), but also a higher rate of delayed bleeding (RD 0.00; 95%CI [0.00, 0.01]; P=0.01; I 2=0%), and severe delayed bleeding (RD 0.00; 95%CI [0.00, 0.00]; P=0.04; I 2=0%). Cold Snare was associated with shorter polypectomy time (MD -46.89 seconds; 95%CI [-62.99, -30.79]; P<0.00001; I 2=90%) and shorter total colonoscopy time (MD -7.17 minutes; 95%CI [-9.10, -5.25]; P<0.00001; I 2=41%). No significant differences were observed in en bloc resection rate or immediate bleeding. CONCLUSION: Hot snare polypectomy presents a slightly higher complete resection rate, but, as it is associated with a longer procedure time and a higher rate of delayed bleeding compared to Cold Snare, it cannot be recommended as the gold standard approach. Individual analysis and personal experience should be considered when selecting the best approach.
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Pólipos do Colo , Colonoscopia , Neoplasias Colorretais , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Pólipos do Colo/cirurgia , Colonoscopia/métodos , Colonoscopia/efeitos adversos , Neoplasias Colorretais/cirurgia , Duração da CirurgiaRESUMO
Background and study aims Noninvasive ampullary neoplasms may be removed by surgery or endoscopy. However, given the morbidity and mortality associated with surgery, endoscopic papillectomy (EP) is the preferred approach. Radiofrequency ablation (RFA) after EP has emerged as a promising alternative therapy to avoid surgery after incomplete EP. Our goal was to evaluate the efficacy and safety of RFA for residual or recurrent lesions with intraductal extension after endoscopic papillectomy. Patients and methods The inclusion criteria include clinical trials, cohort studies, and case series evaluating patients with residual or recurrent lesions with intraductal extension after EP treated with RFA. Case reports, duplicated data, and studies with follow-up periods < 10 months were excluded. The metanalysis evaluated adverse events, surgical conversion rate, clinical success and recurrence. Results Seven studies were selected, totaling 124 patients. RFA was associated with a clinical success rate of 75.7% (95% confidence interval [CI] 65.0-88.0%; I 2 = 23.484) in a mean follow-up period < 10 months. However, the biliary stricture rate was 22.2% (95% CI 12.1-28.4%; I 2 = 61.030), 14.3% of pancreatitis (95% CI 8.8-22.3%; I 2 < 0.001), 7.0% of cholangitis (95% CI 3.3-14.5%; I 2 < 0.001), 4.0% of bleeding (95% CI 1.7-9.3%; I 2 < 0.001), and recurrence of 24.3% (95% CI 16.0-35.0%; I 2 = 23.484). Conclusions RFA is feasible and appears to be effective for managing residual or recurrent lesions with intraductal extension after EP. However, long-term follow-up and high-quality studies are required to confirm our findings.
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[This corrects the article DOI: 10.1055/a-2204-8316.].
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Background and study aims Recurrent biliary stent occlusion and tumor ingrowth remain a major concern among patients with malignant biliary obstruction (MBO) with significant impact on patient morbidity and survival. Intraductal radiofrequency ablation (RFA) has emerged as a promising treatment that seeks to extend stent patency. This study aimed to evaluate the impact of RFA on overall survival (OS) and stent patency among patients with unresectable MBO. Methods A comprehensive search of electronic databases was performed for randomized controlled trials (RCTs) comparing RFA plus biliary stent (RFA+S) versus biliary stent alone (S-alone). Outcomes assessed included overall survival, stent patency, and adverse events (AEs) with mean difference (MD) calculated from pooled proportions. Subgroup analyses were performed for hilar strictures and cholangiocarcinoma (CCA). Results Six RCTs (n=439 patients) were included and demonstrated improved survival among patients who received RFA+S (MD 85.80 days; 95% confidence interval [CI] 35.02-136.58; I 2 =97%; P <0.0009). The pooled MD for total stent patency was 22.25 days (95% CI 17.38-61.87; I 2 =97%; P =0.27). There was no difference in AEs between RFA+S vs S-alone ( P >0.05). On subgroup analyses, RFA+S was associated with improved stent patency (MD 76.73 days; 95% CI 50.11-103.34; I 2 =67%; P <0.01) and OS (MD 83.14 (95% CI 29.52-136.77; I 2 =97%; P <0.01] for CCA. For hilar strictures, stent patency was improved among patients with RFA+S [MD 83.71 days (95% CI 24.85-142.56; I 2 =84%; P <0.01]. Conclusions RFA+S improved OS in the treatment of MBO when compared with S-alone. Moreover, the RFA therapy prolonged stent patency in hilar strictures and CCA, with similar rates of AEs.
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ABSTRACT Background: Colorectal cancer is the third most common cancer, and prevention relies on screening programs with resection complete resection of neoplastic lesions. Objective: We aimed to evaluate the best snare polypectomy technique for colorectal lesions up to 10 mm, focusing on complete resection rate, and adverse events. Methods: A comprehensive search using electronic databases was conducted to identify randomized controlled trials comparing hot versus cold snare resection for polyps sized up to 10 mm, and following PRISMA guidelines, a meta-analysis was performed. Outcomes included complete resection rate, en bloc resection rate, polypectomy, procedure times, immediate, delayed bleeding, and perforation. Results: Nineteen RCTs involving 8720 patients and 17588 polyps were included. Hot snare polypectomy showed a higher complete resection rate (RD, 0.02; 95%CI [+0.00,0.04]; P=0.03; I 2=63%), but also a higher rate of delayed bleeding (RD 0.00; 95%CI [0.00, 0.01]; P=0.01; I 2=0%), and severe delayed bleeding (RD 0.00; 95%CI [0.00, 0.00]; P=0.04; I 2=0%). Cold Snare was associated with shorter polypectomy time (MD -46.89 seconds; 95%CI [-62.99, -30.79]; P<0.00001; I 2=90%) and shorter total colonoscopy time (MD -7.17 minutes; 95%CI [-9.10, -5.25]; P<0.00001; I 2=41%). No significant differences were observed in en bloc resection rate or immediate bleeding. Conclusion: Hot snare polypectomy presents a slightly higher complete resection rate, but, as it is associated with a longer procedure time and a higher rate of delayed bleeding compared to Cold Snare, it cannot be recommended as the gold standard approach. Individual analysis and personal experience should be considered when selecting the best approach.
RESUMO Contexto: O câncer colorretal é o terceiro câncer mais comum na população, e a prevenção é principalmente baseada em programas de screening, com a ressecção completa de lesões neoplásicas. Múltiplas técnicas de ressecção estão disponíveis, mas ainda há controvérsias sobre a melhor abordagem, especialmente em relação à taxa de ressecção completa e à taxa de sangramento tardio. Objetivo: Nosso objetivo foi avaliar a melhor técnica de polipectomia com alça para lesões colorretais de até 10 mm. Métodos: Foi realizada uma busca abrangente em bancos de dados eletrônicos (MEDLINE e EMBASE) para identificar ensaios clínicos randomizados que comparassem a ressecção com alça quente versus alça fria para pólipos de até 10 mm, seguindo as diretrizes PRISMA. Os desfechos incluíram taxa de ressecção completa, taxa de ressecção em bloco, tempo de polipectomia, tempo total do procedimento, sangramento imediato, sangramento tardio e perfuração. Resultados: Dezenove ensaios clínicos randomizados foram incluídos, totalizando 8.720 pacientes e 17.588 pólipos. A polipectomia com alça quente foi associada a uma maior taxa de ressecção completa (RD, 0,02; IC95% [+0,00, 0,04]; P=0,03; I 2=63%), embora também tenha sido associada a uma taxa mais alta de sangramento tardio (RD 0,00; IC95% [0,00, 0,01]; P=0,01; I 2=0%) e de sangramento tardio grave (RD 0,00; IC95% [0,00, 0,00]; P=0,04; I 2=0%). A polipectomia com alça fria foi associada a um menor tempo de polipectomia (MD -46,89 segundos; IC95% [-62,99, -30,79]; P<0,00001 I 2=90%) e a um menor tempo total de colonoscopia (DM -7,17 minutos; IC95% [-9,10, -5,25]; P<0,00001 I 2=41%). Não houve diferença significativa na taxa de ressecção em bloco (RD, 0,00; IC95% [-0,01, 0,01]; P=0,20; I 2=30%) ou na taxa de sangramento imediato (RD -0,00; IC95% [-0,01, 0,00]; P=0,34; I 2=11%). Não foram relatados casos de perfuração em nenhum dos grupos. Conclusão: A polipectomia com alça quente apresenta uma taxa ligeiramente mais alta de ressecção completa, mas, como está associada a um tempo de procedimento mais longo e a uma taxa mais alta de sangramento tardio em comparação com a polipectomia com alça fria, não pode ser recomendada como a abordagem padrão. A análise individualizada e a experiência pessoal devem ser consideradas ao escolher a melhor abordagem.