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Endoscopic Resection Effective for SSPs ≥10 mm in Meta-analysis; Cold EMR May Be Best

Douglas K. Rex, MD, FASGE reviewing Chandrasekar VT, et al. Clin Gastroenterol Hepatol 2019 Nov 28.

This systematic review and meta-analysis identified 911 patients with 1137 sessile serrated polyps (SSPs) ≥10 mm in 14 studies, in which resection was performed by hot EMR in 8 studies, hot EMR and a second technique in 2, cold EMR in 2, and standard snare resection in 1. Overall, technical success was 99.5%, with a rate of residual polyp at follow-up of 4.3%, which was related to lesion size: 5.9% for lesions ≥20 mm and 1.2% for 10- to 19-mm lesions. The perforation rate was 0.3%, and the overall delayed hemorrhage rate was 1.3%, but there were no delayed hemorrhages with cold EMR. Residual polyp rates were numerically lower with cold EMR.

Given the limitations of a systematic review and meta-analysis, these data suggest that cold EMR is as effective as hot EMR for resection of SSPs ≥10 mm, yet safer. A direct comparison of hot and cold EMRs for serrated lesions is warranted.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Douglas K. Rex, MD, FASGE


Chandrasekar VT, Aziz M, Patel HK, et al. Efficacy and safety of endoscopic resection of sessile serrated polyps 10 mm or larger: a systematic review and meta-analysis: resection of sessile serrated polyps ≥10 mm. Clin Gastroenterol Hepatol 2019 Nov 28. (Epub ahead of print) (

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