S1261 A Systematic Review and Meta-Analysis of Clinical Efficacy and Safety Comparing Cold Snare Polypectomy Using Thin-Wire Versus Thick-Wire Snares for Small Colorectal Polyps

Introduction: Cold snare polypectomy (CSP) is an established technique for the removal of small polyps (<10 mm) owing to its safety and effectiveness. The comparative effectiveness of the different types of snares used in CSP is uncertain. We aimed to examine the usefulness of thin-wire snare (TN) versus thick-wire snare (TK) during CSP in small colorectal polyps. Methods: We systematically searched Medline and Embase from their inception till May 15,2025. The primary outcome of interest in this meta-analysis was the complete resection rate (CR), defined as endoscopic en bloc resection of the entire lesion with histologically tumor-free margins, both horizontally and vertically. The secondary outcomes were adverse events, intraprocedural bleeding, polyp retrieval rates, presence of submucosa (SM) in the resected specimen, and factors associated with CR. The random-effects model was used to calculate the odds ratio (OR) with corresponding 95% confidence intervals of the desired outcomes. A P value of <0.05 was considered statistically significant. Heterogeneity was assessed using the I2 Index. Study quality was assessed using the ROBINS-1 tool. Data analysis was performed using the Revman software (version 5.4.1). Results: Eight studies, with a total population of 1, 553 were included in our meta-analysis. The participants had an average age of 63.9 and female comprised 40.5% of the population, respectively. The most common location for polyps was the proximal colon (57%), morphology was sessile (67%), and pathology was adenoma (92%). The mean polyp size was 6.5 mm ± 2 mm in both groups. Comparing both groups, no difference was found in CR (OR 1.25, 95% CI 0.75 to 2.06, I2 = 47%), adverse events (OR 1.36, 95% CI .78 to 2.39, I2 = 6%), polyp retrieval rates (OR 1.42, 95% CI .68 to 2.95), intraprocedural bleeding (OR 1.39, 95% CI .77 to 2.52), and SM in resected specimen (OR 1.33, 95% CI 0.82 to 2.18). Polyps size, and morphology were statistically significant factors associated with complete resection. Conclusion: Our findings suggest that snare thickness does not have an additional beneficial effect on cold snare polypectomies. However, larger randomized studies are needed to evaluate factors beyond the snare design in CSP to improve outcomes.