Endometrial Polyp Recurrence After Hysteroscopic Polypectomy: A Systematic Review and Meta-analysis by Surgical Instrument.

OBJECTIVE: To characterize endometrial polyp recurrence after hysteroscopic removal according to surgical instrument and assess direct comparative evidence without treating instrument-specific single-arm proportions as comparative effects. DATA SOURCES: PubMed, Scopus, Web of Science Core Collection, and Cochrane CENTRAL were searched through July 18, 2026. Trial registries and citations were assessed. The review was prospectively registered (PROSPERO CRD420261335015). METHODS OF STUDY SELECTION: Randomized and nonrandomized studies with at least 10 patients, a histologically confirmed index polyp, hysteroscopic removal, and recurrence assessment at 6 months or later were eligible. Two reviewers independently screened records and assessed full texts; extraction, report linkage, instrument classification, and risk-of-bias judgments were independently verified and finalized by consensus. Cointerventions were analyzed separately or in sensitivity analyses. TABULATION, INTEGRATION, AND RESULTS: Of 1,221 records, 777 were screened and 69 reports were assessed; 38 reports representing 34 studies were included. Strict 12-month single-arm pools were estimable for tissue removal systems (6.3%; 95% CI, 3.3%-11.7%) and electrosurgery (13.5%; 95% CI, 11.6%-15.7%). A strict mechanical/cold pool was not retained after full-text re-verification identified selective sharp curettage in a contributing cold-knife arm. These proportions are descriptive, not comparative effects. Direct comparisons remained sparse and very low certainty. In 2 nonrandomized cohorts, postoperative levonorgestrel-releasing intrauterine systems were associated with lower recurrence (pooled risk ratio, 0.36; 95% CI, 0.23-0.57); certainty was very low. CONCLUSION: Comparative evidence is insufficient to determine whether hysteroscopic instrument choice independently affects recurrence. Case mix, recurrence ascertainment, and follow-up materially limit cross-study interpretation. The observed LNG-IUS association is nonrandomized and does not establish causality. SUMMATION: Comparative evidence is insufficient to determine whether hysteroscopic instrument choice independently affects endometrial polyp recurrence; postoperative LNG-IUS is associated with lower observed recurrence, but the evidence is nonrandomized and very low certainty.