Efficacy and Safety of Various Endoscopic Resection Methods for 3-10mm Colorectal Polyps: A Systematic Review and Network Meta-Analysis

This study systematically evaluated five endoscopic resection techniques for colorectal polyps measuring 3-10mm using a Bayesian network meta-analysis of 26 randomized controlled trials (RCTs) involving 10,375 patients and 18,413 polyps. The techniques included Cold Snare Polypectomy (CSP), Hot Snare Polypectomy (HSP), Cold Endoscopic Mucosal Resection (Cold EMR), Hot Endoscopic Mucosal Resection (Hot EMR), and Underwater Snare Polypectomy (USP). No significant differences were observed in intraoperative safety, En bloc resection, tissue retrieval, or polypectomy time across modalities. However, Hot EMR demonstrated the highest complete resection rates, making it the preferred option for polyps with neoplastic potential. USP exhibited the lowest adverse event rates, highlighting its superior safety for high-risk patients. CSP was associated with a higher recurrence rate compared to HSP (RR: 5.12, 95% CI: 1.12-23.42), suggesting it may be less suitable for polyps with suspected neoplasia. Notably, no perforation events were reported for any technique. The study identified heterogeneity in follow-up durations and outcome definitions, underscoring the need for standardization in future trials. Additionally, further research should incorporate cost-effectiveness analyses and patient-reported outcomes to enhance clinical decision-making. In conclusion, Hot EMR is optimal for complete resection of potentially neoplastic polyps, while USP is safer for high-risk patients, and CSP should be cautiously used for neoplastic lesions due to its higher recurrence rates.