Thermal ablation of mucosal defect margins to prevent local recurrence of large colorectal polyps: a systematic review and meta-analysis
Background and study aims Endoscopic mucosal resection of large non-pedunculated colorectal polyps is characterized by a high risk of recurrence. Thermal ablation of the mucosal defect margins may reduce recurrence in these lesions, but a systematic overview of the current evidence is lacking....
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Georg Thieme Verlag KG
2022-08-01
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| Series: | Endoscopy International Open |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/a-1869-2446 |
| _version_ | 1811321392252059648 |
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| author | Lonne W.T. Meulen Roel M.M. Bogie Bjorn Winkens Ad A.M. Masclee Leon M.G. Moons |
| author_facet | Lonne W.T. Meulen Roel M.M. Bogie Bjorn Winkens Ad A.M. Masclee Leon M.G. Moons |
| author_sort | Lonne W.T. Meulen |
| collection | DOAJ |
| description | Background and study aims Endoscopic mucosal resection of large non-pedunculated colorectal polyps is characterized by a high risk of recurrence. Thermal ablation of the mucosal defect margins may reduce recurrence in these lesions, but a systematic overview of the current evidence is lacking.
Methods We searched PubMed, Embase and Cochrane until July 2021, for studies on thermal ablation of mucosal defect margins of large non-pedunculated colorectal polyps. Main goal of this meta-analysis was to identify pooled risk difference of recurrence between thermal ablation vs. no adjuvant treatment. Secondary goal was to identify pooled recurrence rate after snare tip soft coagulation (STSC) and argon plasma coagulation (APC).
Results Ten studies on thermal ablation of mucosal defect margins were included, with three studies on argon plasma coagulation, six studies on snare tip soft coagulation and one study comparing both treatment modalities, representing a total of 316 APC cases and 1598 STSC cases. Overall pooled risk difference of recurrence was –0.17 (95 % confidence interval [CI] –0.22 to –0.12) as compared to no adjuvant treatment. Pooled risk difference was –0.16 (95 % CI –0.19 to –0.14) for STSC and –0.26 (95 % CI –0.80 to 0.28) for APC. Pooled recurrence rate was 4 % (95 % CI 2 % to 8 %) for STSC and 9 % (95 % CI 4 % to 19 %) for APC.
Conclusions Thermal ablation of mucosal defect margins significantly reduces recurrence rate in large non-pedunculated colorectal lesions compared to no adjuvant treatment. While no evidence for superiority exists, STSC may be preferred over APC, because this method is the most evidence-based, and cost-effective modality. |
| first_indexed | 2024-04-13T13:15:56Z |
| format | Article |
| id | doaj.art-1a67aca39c8544808ff8a8d237bdde62 |
| institution | Directory Open Access Journal |
| issn | 2364-3722 2196-9736 |
| language | English |
| last_indexed | 2024-04-13T13:15:56Z |
| publishDate | 2022-08-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Endoscopy International Open |
| spelling | doaj.art-1a67aca39c8544808ff8a8d237bdde622022-12-22T02:45:27ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362022-08-011008E1127E113510.1055/a-1869-2446Thermal ablation of mucosal defect margins to prevent local recurrence of large colorectal polyps: a systematic review and meta-analysisLonne W.T. Meulen0Roel M.M. Bogie1Bjorn Winkens2Ad A.M. Masclee3Leon M.G. Moons4Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The NetherlandsDepartment of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The NetherlandsDepartment of Methodology and Statistics, Maastricht University, Maastricht, The NetherlandsDepartment of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The NetherlandsDepartment of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The NetherlandsBackground and study aims Endoscopic mucosal resection of large non-pedunculated colorectal polyps is characterized by a high risk of recurrence. Thermal ablation of the mucosal defect margins may reduce recurrence in these lesions, but a systematic overview of the current evidence is lacking. Methods We searched PubMed, Embase and Cochrane until July 2021, for studies on thermal ablation of mucosal defect margins of large non-pedunculated colorectal polyps. Main goal of this meta-analysis was to identify pooled risk difference of recurrence between thermal ablation vs. no adjuvant treatment. Secondary goal was to identify pooled recurrence rate after snare tip soft coagulation (STSC) and argon plasma coagulation (APC). Results Ten studies on thermal ablation of mucosal defect margins were included, with three studies on argon plasma coagulation, six studies on snare tip soft coagulation and one study comparing both treatment modalities, representing a total of 316 APC cases and 1598 STSC cases. Overall pooled risk difference of recurrence was –0.17 (95 % confidence interval [CI] –0.22 to –0.12) as compared to no adjuvant treatment. Pooled risk difference was –0.16 (95 % CI –0.19 to –0.14) for STSC and –0.26 (95 % CI –0.80 to 0.28) for APC. Pooled recurrence rate was 4 % (95 % CI 2 % to 8 %) for STSC and 9 % (95 % CI 4 % to 19 %) for APC. Conclusions Thermal ablation of mucosal defect margins significantly reduces recurrence rate in large non-pedunculated colorectal lesions compared to no adjuvant treatment. While no evidence for superiority exists, STSC may be preferred over APC, because this method is the most evidence-based, and cost-effective modality.http://www.thieme-connect.de/DOI/DOI?10.1055/a-1869-2446 |
| spellingShingle | Lonne W.T. Meulen Roel M.M. Bogie Bjorn Winkens Ad A.M. Masclee Leon M.G. Moons Thermal ablation of mucosal defect margins to prevent local recurrence of large colorectal polyps: a systematic review and meta-analysis Endoscopy International Open |
| title | Thermal ablation of mucosal defect margins to prevent local recurrence of large colorectal polyps: a systematic review and meta-analysis |
| title_full | Thermal ablation of mucosal defect margins to prevent local recurrence of large colorectal polyps: a systematic review and meta-analysis |
| title_fullStr | Thermal ablation of mucosal defect margins to prevent local recurrence of large colorectal polyps: a systematic review and meta-analysis |
| title_full_unstemmed | Thermal ablation of mucosal defect margins to prevent local recurrence of large colorectal polyps: a systematic review and meta-analysis |
| title_short | Thermal ablation of mucosal defect margins to prevent local recurrence of large colorectal polyps: a systematic review and meta-analysis |
| title_sort | thermal ablation of mucosal defect margins to prevent local recurrence of large colorectal polyps a systematic review and meta analysis |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/a-1869-2446 |
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