Recurrence rates after endoscopic resection of large colorectal polyps: A systematic review and meta-analysis

Table 1 Factors influencing local recurrence for polyps ≥ 10 mm at 0–12 mo’ follow-up

Subgroups	LRR % (95%CI)	I2 %	Studies, n	Polyps, n
Resection method, polyps ≥ 10 mm
Hot EMR, no margin ablation	15.2 (12.5–18.0)	0	4	650
Hot EMR, some margin ablation	16.5 (15.2–17.8)	0	6	3013
Hot EMR, with margin ablation	3.3 (2.2–4.5)	NA	2	947
ESD	1.7 (0.0–3.4)	NA	3	221
Resection method, polyps ≥ 20 mm
Hot EMR, no margin ablation	14.8 (11.0–18.5)	NA	2	334
Hot EMR, some margin ablation	16.5 (15.2–17.8)	0	6	3013
Hot EMR, with margin ablation	3.3 (2.2–4.5)	NA	2	947
ESD	2.4 (0–5.7)	NA	2	83
Polyp size
≥ 10 mm	11.0 (7.1–14.8)	95.6	15	4904
≥ 20 mm	11.2 (6.8–15.6)	95.8	12	4431
Expert level
Only expert endoscopists	13.3 (11.1–15.6)	NA	2	3712
Including non-expert endoscopists	11.8 (6.8–16.8)	95.8	9	837
Not defined	9.2 (1.5–16.9)	93.7	4	524

NA: Number of studies insufficient for estimation; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; LRR: Local recurrence rate.

Table 2 Factors influencing incomplete resection

Subgroups	IRR % (95%CI)	I2 %	Studies, n	Polyps, n
Resection method, polyps 10–19 mm
Hot EMR	18.5 (8.9–28.1)	93.2	8	655
HSP	16.2 (10.6–21.7)	NA	2	167
U-EMR	25.5 (18.9–32.2)	NA	2	160
Cold EMR1	14.01 (1.8–26.3)	NA	3	334
Resection method, polyps ≥ 20 mm
ESD	12.5 (6.2–18.8)	95.0	9	1452
Hot EMR	29.3 (19.3–39.2)	NA	3	88
Submucosal injection, polyps 10–19 mm
No injection	14.4 (5.4–23.3)	95.8	6	836
Injection	20.0 (11.9–28.0)	93.9	10	989
Submucosal injection, polyps ≥ 20 mm
No injection	32.4 (0–76.3)	96.2	3	124
Injection	12.6 (7.7–17.6)	94.4	13	1614
Injection solution, polyps ≥ 10 mm
Saline solution	15.8 (7.1–24.6)	95. 6	6	774
Hyaluronic acid	16.3 (8.5–24.1)	95.1	8	916
Expert level
Only expert endoscopists	7.0 (3.5, 10.4)	93. 7	8	1451
Including non-expert endoscopists	20.3 (13.5–27.1)	96.0	13	2092
Method of margin evaluation, polyps 10–19 mm
Margin assessment	18.6 (10.9, 26.2)	75.1	5	380
Margin biopsy	5.7 (1.1, 10.3)	95.1	5	1150
Method of margin evaluation, polyps ≥ 20 mm
Margin assessment	21.8 (9.4–34.2)	92.1	4	429
Margin assessment and en bloc resection	14.1 (5.7–22.6)	96.0	7	1106
Margin biopsy	0.4 (0–2.5)	55.8	3	203

¹Data exhibit high variance; calculated mean should be handled with care.

NA: Number of studies insufficient for estimation; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; HSP: Hot snare polypectomy; IRR: Incomplete resection rate; U-EMR: Underwater endoscopic mucosal resection.