S2255 Comparing Different Endoscopic Treatments in the Management of Small Colorectal Polyps: A Systematic Review and Network Meta-Analysis

Introduction: Small colorectal polyps are commonly detected during routine screening and may pose a risk for colorectal cancer if left untreated. Various endoscopic treatments are available for their management, but these approaches' relative efficacy and safety remain unclear. This network meta-analysis aims to compare the effectiveness of different endoscopic treatments for small colorectal polyps, providing comprehensive insights to guide clinical decision-making. Methods: PubMed, Cochrane Central, and ScienceDirect were comprehensively searched from inception until January 2025 for studies comparing endoscopic interventions for small colorectal polyps (<10 mm). This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A frequentist network meta-analysis was performed using R version 4.2.1 and employing the “netmeta” package. Risk Ratios (RR) and 95% Confidence interval (CI) were pooled using the random effects model for dichotomous outcomes. The relative ranking of the interventions for various outcomes was estimated using the p-scores. The studies were evaluated for quality with the Cochrane Rob 2 tool, while publication bias was assessed through funnel plots and Egger’s regression test. Results: Thirty-three RCTS were included in this systematic review and network meta-analysis. Compared to CSP, both underwater Cold snare polypectomy (U-CSP) (RR = 1.44,95% CI: [1.16, 1.77]) and hot snare endoscopic mucosal resection (HS-EMR) (RR = 1.15, 95% CI: [1.01,1.32]) significantly increased the rate of complete histological resection and U-CSP showed the highest rate (P-score = 0.99). Regarding immediate bleeding, endoscopic mucosal resection (EMR) was ranked as the best treatment (0.94), and jumbo forceps polypectomy (JFP) as the worst (P-score = 0.22). The risk of delayed bleeding was lowest in the underwater EMR (U-EMR) group (P-score = 0.83) and highest in the hot snare polypectomy (HSP) group (P-score = 0.08). Conclusion: U-CSP demonstrated the highest rate of complete histological resection, while U-EMR had the lowest risk of delayed bleeding, making them the most effective and safest interventions, respectively. These findings provide evidence-based guidance for selecting optimal endoscopic treatments for small colorectal polyps.