Mapping of Posterior Talar Dome Access through Standard Posteromedial and Posterolateral Approaches With or Without an External Fixator Distraction: A Match-paired Cadaveric Study

Category: Trauma; Ankle; Other Introduction/Purpose: Posterior talar body fractures (AO/OTA 81.1.B/C) are rare injuries that present unique challenges in their access to the treating surgeon. Accessibility to this structure has been investigated extensively in the context of osteochondral lesion interventions, normally requiring perpendicular access to perform operative procedures. However, techniques in gaining this access regarding fracture repair, requiring only adequate visualization, has not been described in literature. Generally, a pre-operative decision is made between a posterior, soft-tissue based approach or a peri-articular osteotomy, which is associated with comparatively higher morbidity and complication rates. The aim of this study is to evaluate the accessible area of the talar dome via two standard posterior approaches (posteromedial; PM, and posterolateral; PL) with and without external fixator distraction. Methods: Eight male through-knee matched-paired cadaveric legs (mean age: 49.0 +- 14.6; mean BMI: 24.5+- 3.9 kg/m2) were included in this study. A standard PM or PL approach was performed using a randomized crossover design for surgical sequences. The accessible area without distraction was initially outlined by drilling a 1.6-mm Kirschner wire around the periphery of the visualized talus. Five millimeters of distraction, confirmed with fluoroscopy, was then applied to the specimens using an external fixator. The accessible area was again marked using the same method. The tali specimens were then explanted and imaged using a Micro-CT scanner to acquire 3 dimensional reconstructions. The accessible area was calculated as a percentage of the total talar dome surface area. The Mann-Whitney U test was used to compare the reported areas among the two surgical approaches, where the Wilcoxon signed rank test was utilized to compare values among distracted and non-distracted conditions. Results: In reference, the average total surface area of the talus is 16.94 +- 2.47 cm2. No statistically significant differences were found among match-paired specimens (p=0.63). The PM approach allowed access to 17.1% (11.1 to 23.6%, SD 5.4) of the talar dome surface without distraction and 29.3% (20.0 to 38.6%, SD 8.6) of the talar dome surface with distraction. The PL approach provided access to 7.4% (4.7 to 11.8%, SD 3.1) and 17.0% (11.0 to 26.1%, SD 6.5) of the talar dome surface with and without distraction, respectively. A statistically significant difference was observed in talar dome accessibility among distracted and non- distracted conditions in both surgical approaches (p=0.008). Additionally, the PM approach provided significantly more access to the talar dome relative to the PL approach (p=0.043). Conclusion: This matched-paired cadaveric study provides roadmap that can assist in the pre-operative planning of talar dome access in the treatment of talar body and posterior tubercle fractures. We found no advantage to a PL approach over a PM approach to access these challenging fractures. Additionally, added distraction using an external fixator consistently increased visualization of the talar dome by a magnitude of at least 40% greater than the non-distracted conditions. These methods can be applied clinically to gain appropriate access to the talar dome, allowing fracture repair.

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Minimally invasive spine surgery for adult degenerative lumbar scoliosis

Neurosurgical FOCUS ◽

10.3171/2014.3.focus144 ◽

2014 ◽

Vol 36 (5) ◽

pp. E7 ◽

Cited By ~ 45

Author(s):

Sean Dangelmajer ◽

Patricia L. Zadnik ◽

Samuel T. Rodriguez ◽

Ziya L. Gokaslan ◽

Daniel M. Sciubba

Keyword(s):

Minimally Invasive ◽

Cobb Angle ◽

Open Surgery ◽

Meta Analysis ◽

Surgical Approaches ◽

Degenerative Lumbar Scoliosis ◽

Complication Rates ◽

Minimally Invasive Surgical ◽

Significant Difference ◽

Lateral Interbody

Object Historically, adult degenerative lumbar scoliosis (DLS) has been treated with multilevel decompression and instrumented fusion to reduce neural compression and stabilize the spinal column. However, due to the profound morbidity associated with complex multilevel surgery, particularly in elderly patients and those with multiple medical comorbidities, minimally invasive surgical approaches have been proposed. The goal of this meta-analysis was to review the differences in patient selection for minimally invasive surgical versus open surgical procedures for adult DLS, and to compare the postoperative outcomes following minimally invasive surgery (MIS) and open surgery. Methods In this meta-analysis the authors analyzed the complication rates and the clinical outcomes for patients with adult DLS undergoing complex decompressive procedures with fusion versus minimally invasive surgical approaches. Minimally invasive surgical approaches included decompressive laminectomy, microscopic decompression, lateral and extreme lateral interbody fusion (XLIF), and percutaneous pedicle screw placement for fusion. Mean patient age, complication rates, reoperation rates, Cobb angle, and measures of sagittal balance were investigated and compared between groups. Results Twelve studies were identified for comparison in the MIS group, with 8 studies describing the lateral interbody fusion or XLIF and 4 studies describing decompression without fusion. In the decompression MIS group, the mean preoperative Cobb angle was 16.7° and mean postoperative Cobb angle was 18°. In the XLIF group, mean pre- and postoperative Cobb angles were 22.3° and 9.2°, respectively. The difference in postoperative Cobb angle was statistically significant between groups on 1-way ANOVA (p = 0.014). Mean preoperative Cobb angle, mean patient age, and complication rate did not differ between the XLIF and decompression groups. Thirty-five studies were identified for inclusion in the open surgery group, with 18 studies describing patients with open fusion without osteotomy and 17 papers detailing outcomes after open fusion with osteotomy. Mean preoperative curve in the open fusion without osteotomy and with osteotomy groups was 41.3° and 32°, respectively. Mean reoperation rate was significantly higher in the osteotomy group (p = 0.008). On 1-way ANOVA comparing all groups, there was a statistically significant difference in mean age (p = 0.004) and mean preoperative curve (p = 0.002). There was no statistically significant difference in complication rates between groups (p = 0.28). Conclusions The results of this study suggest that surgeons are offering patients open surgery or MIS depending on their age and the severity of their deformity. Greater sagittal and coronal correction was noted in the XLIF versus decompression only MIS groups. Larger Cobb angles, greater sagittal imbalance, and higher reoperation rates were found in studies reporting the use of open fusion with osteotomy. Although complication rates did not significantly differ between groups, these data are difficult to interpret given the heterogeneity in reporting complications between studies.

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Cost Comparison of Kirschner Wire Versus Intramedullary Screw Fixation of Metacarpal and Phalangeal Fractures

Hand ◽

10.1177/15589447211030690 ◽

2021 ◽

pp. 155894472110306

Author(s):

Christopher F. Brewer ◽

Quillian Young-Sing ◽

Adam Sierakowski

Keyword(s):

Health Care ◽

Screw Fixation ◽

Kirschner Wire ◽

Complication Rates ◽

Hand Fractures ◽

Significant Difference ◽

Wire Fixation ◽

Phalangeal Fractures ◽

Intramedullary Screw

Background Intramedullary screw fixation is a relatively new technique for fixation of metacarpal and phalangeal fractures. The objective of this study was to compare health care–associated costs and outcomes for intramedullary screw versus Kirschner wire (K-wire) fixation of hand fractures. Methods A retrospective review of patients undergoing intramedullary screw fixation of hand fractures at a single center during 2016-2019 inclusive was conducted. Health care–associated costs were compared with age-matched and fracture pattern–matched controls who underwent K-wire fixation. Results Fifty patients met the study inclusion criteria, incorporating 62 fractures (29 K-wire, 33 intramedullary screw fixation). The median age was 34.6 years (18.0-90.1 years). There was no significant difference in primary operative costs (£1130.4 ± £162.7 for K-wire vs £1087.0 ± £104.2 for intramedullary screw), outpatient follow-up costs (£958.7 ± £149.4 for K-wire vs £782.4 ± £143.8 for intramedullary screw), or total health care–associated costs (£2089.1 ± £209.0 for K-wire vs £1869.4 ± £195.3 for intramedullary screw). However, follow-up costs were significantly lower for the uncomplicated intramedullary screw cohort (£847.1 ± £109.1 for K-wire vs £657.5 ± £130.8 for intramedullary screw, P = .05). Subgroup analysis also revealed that overall costs were significantly higher for buried K-wire techniques. Complication rates, time to return to active work, and Disabilities of the Arm, Shoulder, and Hand scores were similar. Conclusions This study identified significantly lower outpatient follow-up costs for uncomplicated intramedullary screw fixation of hand fractures compared with K-wires, along with a trend toward lower overall health care–associated costs. In addition, buried K-wire techniques were also found to carry a significantly higher financial burden. Higher powered prospective studies are required to determine indirect costs.

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Do different surgical techniques in tibia pilon fractures change the results of the midterm?

TURKISH JOURNAL OF MEDICAL SCIENCES ◽

10.3906/sag-2006-212 ◽

2020 ◽

Vol 50 (6) ◽

pp. 1559-1565

Author(s):

Vedat BİÇİCİ ◽

İzzet BİNGÖL

Keyword(s):

Surgical Techniques ◽

Functional Results ◽

Surgical Approaches ◽

Complication Rates ◽

Pilon Fracture ◽

Significant Difference ◽

One Step ◽

Type 3 ◽

Pilon Fractures

Background/aim: Pilon fracture is difficult to treat fractures due to many complications that can develop after surgery. To achieve the best results, different surgical approaches are used.In our study, we aimed to compare the functional results and complication rates of our treatments in patients treated with 3 different surgical tecniques.Materials and methods: 89 pilon fractures of 87 patients treated for pilon fracture were evaluated. Patients were examined in 3 different groups (one step, two step surgery and Ilizarov). Functional results, postoperative complications and ankle AOFAS scores were evaluated.Results: The mean AOFAS score of the all patients was 77.67. There was no significant difference between 3 surgical techniques (P = 0,880). While skin complication was not seen in patients who underwent double-stage surgery and Ilizarov (0%); It was seen in 6 (15.7%) patients who underwent single-stage surgery. Treatment results were found to be better in type 1 and type 2 fractures, while in type 3 fractures (P = 0.004).Conclusion: Despite the different surgical approaches and implants applied, no difference was found between the midterm ankle functional results of the patients. Two-stage surgery and Ilizarov is a safe and effective treatment approach to reduce morbidity and early complications in pilon fractures.

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Surgical Management of Vestibular Schwannoma: Practice Pattern Analysis via NSQIP

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419882044 ◽

2019 ◽

Vol 129 (3) ◽

pp. 230-237

Author(s):

Vijay A. Patel ◽

Mitchell Dunklebarger ◽

Kalins Banerjee ◽

Tom Shokri ◽

Xiang Zhan ◽

...

Keyword(s):

Surgical Management ◽

Vestibular Schwannoma ◽

Surgical Complication ◽

Treatment Strategies ◽

Surgical Approaches ◽

Annual Number ◽

Complication Rates ◽

Entire Study ◽

Acs Nsqip ◽

Significant Difference

Objective: Characterize current perspectives in the surgical management of vestibular schwannoma (VS) to guide otolaryngologists in understanding United States practice patterns. Methods: A retrospective analysis of ACS-NSQIP database was performed to abstract all patients from 2008 to 2016 who underwent VS resection using ICD-9/10 codes 225.1 and D33.3, respectively. The specific surgical approach employed was identified via CPT codes 61520, 61526/61596, and 61591, which represent retrosigmoid (RS), translabyrinthine (TL) and middle cranial fossa (MCF) approaches, respectively. Analyzed outcomes include general surgical complications, total length of stay, and reoperation. Results: A total of 1671 VS cases were identified, 1266 (75.7%) were RS, 292 (17.5%) were TL, and 114 (6.8%) were MCF. The annual number of cases increased over the study period from 15 to 375, which is chiefly attributed to increased institutional participation in ACS-NSQIP. Perioperative variables including BMI ( P < .001), ASA class ( P = .004), ethnicity ( P = .008), operative time ( P < .001), and reoperation ( P < .001) were found to be statistically significant between cohorts. Increased utilization of RS approach was consistent over the entire study period, with significantly more RS performed than either TL or MCF. Finally, a statistically significant difference with respect to general surgical complication rates was not noted between surgical approaches. Conclusions: There is increased employment of RS approach for the operative management of VS, which likely is the result of increased reliance on both stereotactic radiosurgery and observation as alternative treatment strategies.

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Multi-institutional Analysis of Surgical Management and Outcomes of Mandibular Fracture Repair in Adults

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0037-1603460 ◽

2018 ◽

Vol 11 (1) ◽

pp. 041-048 ◽

Cited By ~ 4

Author(s):

Dmitry Zavlin ◽

Kevin T. Jubbal ◽

Anthony Echo ◽

Shayan A. Izaddoost ◽

Jeffrey D. Friedman ◽

...

Keyword(s):

Risk Factors ◽

Surgical Techniques ◽

The United States ◽

Fracture Repair ◽

Surgical Approaches ◽

Facial Trauma ◽

Mandibular Fractures ◽

Complication Rates ◽

Improvement Program ◽

Concomitant Injuries

Mandibular fractures are rare, most commonly occurring in young male patients who present with facial trauma. The etiology, incidence, and presentation vary among previous publications depending on cultural and socioeconomic factors of the region of origin. This multi-institutional study aims to present demographic characteristics, surgical treatment, and clinical outcomes of surgical repair of mandible fractures in the United States. An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) adult databases of the years 2006 through 2014 was performed identifying 940 patients with an International Classification of Diseases, version 9 (ICD-9) diagnosis of either closed or open fracture of the mandible. Preoperative, perioperative, and postoperative details were categorized and evaluated for these two cohorts. Multivariate analysis was performed to detect risk factors related to any complications. Patients were predominantly male (85.7%), young with a mean age of 34.0 ± 14.8 years, and relatively healthy with body mass index of 23.6 ± 8.2 and an American Society of Anesthesiologists (ASA) class of 1 or 2 (84.4%). However, more than half were regular smokers (51.1%). The top five most frequent procedures performed for mandibular repair were exclusively open surgical approaches with internal, external, or interdental fixation in both cohorts. Patients with open fractures were more often admitted as emergencies, treated inpatient, required longer operative times, and presented with more contaminated wounds ( p < 0.05). Overall, medical (1.7%) and surgical complications (3.7%) were low. A high ASA class 3 or above and emergency operations were identified as risk factors for medical adverse events. Despite frequent concomitant injuries after trauma and a diverse array of mandibular injury types, our patient sample demonstrated favorable outcomes and low complication rates. Open surgical techniques were the most common procedures in this study representing the American population.

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Anterior Distal Tibia Plafondplasty for Exposure of the Talar Dome

Foot & Ankle International ◽

10.3113/fai.2012.0231 ◽

2012 ◽

Vol 33 (3) ◽

pp. 231-235 ◽

Cited By ~ 18

Author(s):

Paul G. Peters ◽

Brent G. Parks ◽

Lew C. Schon

Keyword(s):

Soft Tissue ◽

Lower Extremity ◽

Surface Area ◽

Sagittal Plane ◽

Distal Tibia ◽

Osteochondral Lesions ◽

Digital Analysis ◽

Chondrocyte Transplantation ◽

Talar Dome ◽

Accessible Area

Background: It may be possible to avoid malleolar osteotomy for treatment of osteochondral talar lesions with chondrocyte transplantation techniques, where perpendicular approach to the talar surface is not required. We hypothesized that limited anterior distal tibial plafondplasty would allow access to most of the talar surface. We compared talar access with soft tissue exposure versus plafondplasty. Methods: Two soft tissue exposures (anteromedial and anterolateral) and two limited anterior distal tibial plafondplasties (anteromedial and anterolateral) were used on 12 cadaver lower-extremity specimens. Digital analysis was used to assess the accessible area. Results: Percentage of total talar dome surface area access increased significantly between soft tissue exposure and limited plafondplasty medially (22.3 ± 6.3% versus 37.9 ± 4.6%; p < 0.001) and laterally (22.4 ± 7.7% versus 37.9 ± 7.7%; p < 0.001). Percentage sagittal plane access also increased significantly between soft tissue exposure and limited plafondplasty medially 54.4 ± 12.0% versus 81.3 ± 9.7%; p < 0.001) and laterally (53.3 ± 14.5% versus 80.9 ± 12.8%; p < 0.001). Limited exposure to an additional 14.2 ± 5% of the total talar surface area was possible. The posterior 10.6 ± 8% was inaccessible. Conclusions: A soft tissue approach with limited plafondplasty provided adequate exposure for the majority of the medial and lateral talar surface. Only the central posterior 10% of the talus was not accessed by this method. Clinical Relevance: It may be possible to avoid malleolar osteotomy by using limited plafondplasty to access the talar dome for treatment of osteochondral lesions if perpendicular access to the talus is not required.

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A Retrospective Review of Differences in Complication Rates between Dorsal Percutaneous and Mini-Open Surgical Fixation of Scaphoid Fractures

Journal of Wrist Surgery ◽

10.1055/s-0040-1716511 ◽

2020 ◽

Author(s):

Seth D. Dodds ◽

Abdul K. Zalikha ◽

Augustus J. Rush ◽

Natalia Fullerton

Keyword(s):

Smoking Status ◽

Scaphoid Fracture ◽

Major Complication ◽

Fracture Repair ◽

Complication Rates ◽

Level Of Evidence ◽

Scaphoid Fractures ◽

Significant Difference ◽

Surgical Fixation ◽

Mini Open

Abstract Objective We retrospectively reviewed the complications of 80 cases of scaphoid screw fixation in acute fractures and early nonunions comparing dorsal percutaneous and mini-open approaches. Methods We performed a chart review of all patients who underwent surgical fixation of a scaphoid fracture or a nascent nonunion using a dorsal percutaneous or dorsal mini-open technique by a single surgeon. We collected data on patient demographics, including age and smoking status, time to surgery, fracture type, union, and the major and minor complications that occurred in each group. Fisher's exact tests were used to compare the complication rates between the groups. Results We identified 80 patients who underwent surgical fixation. Of these, 44 underwent percutaneous fixation and 36 underwent mini-open fixation. All fractures went on to heal. There was a total of five complications identified. There were no major complications in the percutaneous group, but one major complication in the mini-open group (a delayed union that eventually healed at 6 months). There were two minor complications in each group. There was no statistically significant difference in total, major, or minor complication rates between the groups. Conclusions This study suggests that a dorsal percutaneous surgical technique for scaphoid fracture repair does not affect the complication rate despite prior literature to the contrary. Both techniques analyzed produce excellent rates of union with very low complication rates. Surgeon-specific technique rather than operative approach or exposure may be responsible for previously reported complication rates in the fixation of scaphoid fractures. Level of Evidence This is a level III, therapeutic study.

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Lateral lumbar interbody fusion in revision surgery for restenosis after posterior decompression

Neurosurgical FOCUS ◽

10.3171/2020.6.focus20361 ◽

2020 ◽

Vol 49 (3) ◽

pp. E11 ◽

Cited By ~ 1

Author(s):

Yoshifumi Kudo ◽

Ichiro Okano ◽

Tomoaki Toyone ◽

Akira Matsuoka ◽

Hiroshi Maruyama ◽

...

Keyword(s):

Revision Surgery ◽

Spinal Canal ◽

Interbody Fusion ◽

Decompression Surgery ◽

Complication Rates ◽

Lumbar Interbody Fusion ◽

Posterior Decompression ◽

Lateral Lumbar Interbody Fusion ◽

Significant Difference ◽

Dural Tears

OBJECTIVEThe purpose of this study was to compare the clinical results of revision interbody fusion surgery between lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) with propensity score (PS) adjustments and to investigate the efficacy of indirect decompression with LLIF in previously decompressed segments on the basis of radiological assessment.METHODSA retrospective study of patients who underwent revision surgery for recurrence of neurological symptoms after posterior decompression surgery was performed. Postoperative complications and operative factors were evaluated and compared between LLIF and PLIF/TLIF. Moreover, postoperative improvement in cross-sectional areas (CSAs) in the spinal canal and intervertebral foramen was evaluated in LLIF cases.RESULTSA total of 56 patients (21 and 35 cases of LLIF and PLIF/TLIF, respectively) were included. In the univariate analysis, the LLIF group had significantly more endplate injuries (p = 0.03) and neurological deficits (p = 0.042), whereas the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), surgical site infections (SSIs) (p = 0.02), and estimated blood loss (EBL) (p < 0.001). After PS adjustments, the LLIF group still showed significantly more endplate injuries (p = 0.03), and the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), EBL (p < 0.001), and operating time (p = 0.04). The PLIF/TLIF group showed a trend toward a higher incidence of SSI (p = 0.10). There was no statistically significant difference regarding improvement in the Japanese Orthopaedic Association scores between the 2 surgical procedures (p = 0.77). The CSAs in the spinal canal and foramen were both significantly improved (p < 0.001).CONCLUSIONSLLIF is a safe, effective, and less invasive procedure with acceptable complication rates for revision surgery for previously decompressed segments. Therefore, LLIF can be an alternative to PLIF/TLIF for restenosis after posterior decompression surgery.

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Intracameral Bevacizumab Versus Sub-Tenon’s Mitomycin C as Adjuncts to Trabeculectomy: 3-Year Results of a Prospective Randomized Study

Journal of Clinical Medicine ◽

10.3390/jcm10102054 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2054

Author(s):

Gerasimos Kopsinis ◽

Dimitrios Tsoukanas ◽

Dimitra Kopsini ◽

Theodoros Filippopoulos

Keyword(s):

Mitomycin C ◽

Primary Outcome ◽

Randomized Study ◽

Primary Outcome Measure ◽

Complication Rates ◽

Filtration Surgery ◽

Significant Difference ◽

Exfoliative Glaucoma

Conjunctival wound healing determines success after filtration surgery and the quest for better antifibrotic agents remains active. This study compares intracameral bevacizumab to sub-Tenon’s mitomycin C (MMC) in trabeculectomy. Primary open-angle or exfoliative glaucoma patients were randomized to either bevacizumab (n = 50 eyes) or MMC (n = 50 eyes). The primary outcome measure was complete success, defined as Intraocular Pressure (IOP) > 5 mmHg and ≤ 21 mmHg with a minimum 20% reduction from baseline without medications. Average IOP and glaucoma medications decreased significantly in both groups at all follow-up points compared to baseline (p < 0.001), without significant difference between groups at 3 years (IOP: bevacizumab group from 29 ± 9.4 to 15 ± 3.4 mmHg, MMC group from 28.3 ± 8.7 to 15.4 ± 3.8 mmHg, p = 0.60; Medications: bevacizumab group from 3.5 ± 0.9 to 0.5 ± 1, MMC group from 3.6 ± 0.7 to 0.6 ± 1.1, p = 0.70). Complete success, although similar between groups at 3 years (66% vs. 64%), was significantly higher for bevacizumab at months 6 and 12 (96% vs. 82%, p = 0.03; 88% vs. 72%, p = 0.04, respectively) with fewer patients requiring medications at months 6, 9 and 12 (4% vs. 18%, p = 0.03; 6% vs. 20%, p = 0.04; 8% vs. 24%, p = 0.03, respectively). Complication rates were similar between groups. In conclusion, intracameral bevacizumab appears to provide similar long-term efficacy and safety results as sub-Tenon’s MMC after trabeculectomy.

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Is jumbo biopsy forceps comparable to cold snare for diminutive colorectal polyps? – a meta-analysis

Endoscopy International Open ◽

10.1055/a-1293-6965 ◽

2021 ◽

Vol 09 (01) ◽

pp. E9-E13

Author(s):

Sachin Srinivasan ◽

Peter D. Siersema ◽

Madhav Desai

Keyword(s):

Meta Analysis ◽

Complete Removal ◽

Colorectal Polyps ◽

Comparable Efficacy ◽

Incomplete Resection ◽

Complication Rates ◽

Biopsy Forceps ◽

Significant Difference ◽

Leave One Out ◽

Endoscopic Assessment

Abstract Background and study aims Diminutive colorectal polyps are increasingly being detected and it is not clear whether jumbo biopsy forceps (JBF) has comparable efficacy to that of cold snare polypectomy (CSP) for management of these lesions. Methods An electronic literature search was performed for studies comparing resection rates of JBF and CSP for diminutive polyps (≤ 5 mm). The primary outcome was incomplete resection rate (IRR). Secondary outcomes included failure of tissue retrieval and complication rates (post-polypectomy bleeding, perforation etc.). Leave-one-out analysis was performed to examine the disproportionate role of any of the studies. Meta-analysis outcomes and heterogeneity (I2) were computed using Comprehensive meta-analysis software. Results A total of 4 studies (3 randomized controlled trials and 1 retrospective study) with 407 patients and 569 total polyps (mean size of 3.62 mm) was included for analysis. IRR of JBF was slightly higher than that of CSP (10.2 % vs 7.2 %) but this was not statistically significantly different (Pooled OR 1.76; 95 % CI 0.94–3.28; I2 = 0). Leave-one-out analysis showed no significant difference in the pooled OR comparison either. Two of the 4 studies reported 0 % failure of tissue retrieval for JBF and 1 % and 4.3 % for CSP. There were no complications for either group from the 2 studies that reported this outcome. The quality of the included studies was moderate to high. Conclusions This systematic review with only limited data shows that JBF and CSP are not statistically different in completely removing diminutive polyps, although careful endoscopic assessment is needed to ensure complete removal of all polyp tissue.

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