S0234 Safety of Cold vs Hot Snare Polypectomy in Polyps 10–20 mm: A Systematic Review and Meta-analysis
Bibliographic record
Abstract
INTRODUCTION: Colonoscopy continues to be gold standard for colorectal cancer prevention. Conventionally, hot snare polypectomy has been widely used for resection of adenomas >5 mm. However, cold snare polypectomy has been increasingly used for adenomas < 10 mm with great efficacy and safety. Recently, cold snare polypectomy has been utilized for sessile polyps between 10 and 20 mm with satisfactory results. We conducted this systematic review and meta-analysis to compare the safety of cold snare polypectomy with conventional hot snare polypectomy in sessile polyps 10–20 mm in size. METHODS: We searched Medline, Embase, Scopus, Cochrane Registries and Web of Science from inception through May 2020 to identify studies comparing hot snare polypectomy with cold snare polypectomy in polyps > 10 mm. Our primary outcome of interest was occurrence of delayed post-polypectomy bleeding. We also compared occurrence of overall adverse events (which required medical attention) after either type of polypectomy. Odds ratio (OR) with 95% confidence interval were calculated and analyzed using random effects model. Newcastle Ottawa Scale was used for quality assessment of observational studies. RESULTS: A total of 3 comparative studies (2 observational studies and 1 RCT) were included in this systematic review and meta-analysis. 1193 polypectomies were analyzed. 485 underwent cold snare polypectomy while the remaining 708 underwent hot snare polypectomy. Pooled OR with 95% confidence interval (CI) for risk of post-polypectomy bleeding was 0.36 (0.02–7.13), Cochran Q test P = 0.11, I2 = 53%. For overall risk of adverse events (requiring medical attention), pooled OR with 95% CI was 0.15 (0.01–2.29), Cochran Q test P = 0.21, I2 = 35%. Both observational studies were of moderate quality. The included RCT was in the form of abstract, so quality assessment could not be done. CONCLUSION: There was no difference in delayed post-polypectomy bleeding and overall adverse events, requiring medical attention with either method of polypectomy in polyps 10–20 mm in size.Figure 1.: Forest plot for delayed post polypectomy bleeding comparing CSP and HSP.Figure 2.: Forest plot for adverse events during follow-up comparing CSP and HSP.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.028 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.037 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".