BACKGROUND:EMR traditionally performed by using normal saline solution (NS) plus epinephrine (E) as a submucosal fluid cushion does not maintain the submucosal elevation for a prolonged time. It was hypothesized that 50% dextrose (D(50)) plus E as a hypertonic, inexpensive, and easily available solution might be an ideal alternative for producing and maintaining more-prolonged mucosal elevation. OBJECTIVE: To evaluate D(50)+E versus NS+E during an EMR of sessile rectosigmoid polyps (> 10 mm). DESIGN: A prospective, double-blind, randomized study that compared EMR by using either D(50)+E or NS+E submucosal fluid cushions. SETTING:Four tertiary endoscopic referral centers with 1370 polypectomies in 2006, performed by 5 experienced endoscopists. PATIENTS: Patients treated for sessile rectosigmoid polyps (> 10 mm). INTERVENTIONS:Polypectomy with D(50)+E or NS+E submucosal fluid cushions. MAIN OUTCOME MEASUREMENTS: The duration of submucosal elevation, volume of solution, number of required injections to maintain the elevation, and observations for complications. RESULTS:Ninety-two sessile rectosigmoid polyps were removed. Injected solution volumes and the number of injections to maintain submucosal elevation were lower in the D(50)+E group than in the NS+E group (P = .033 and P = .028, respectively). Submucosal elevation had a longer duration in the D(50)+E group (P = .043). This difference mainly included large (> or = 20 mm) and giant (> 40 mm) polyps. There were 6 and 1 cases of postpolypectomy syndrome in the D(50)+E and NS+E groups, respectively (P = .01). LIMITATIONS: May be limited by inexperienced endoscopist's lack of injection and polypectomy skills. CONCLUSIONS:D(50)+E is superior to NS+E for an EMR, particularly in large and giant sessile polyps, but the risk of thermal tissue injury should be considered.
RCT Entities:
BACKGROUND: EMR traditionally performed by using normal saline solution (NS) plus epinephrine (E) as a submucosal fluid cushion does not maintain the submucosal elevation for a prolonged time. It was hypothesized that 50% dextrose (D(50)) plus E as a hypertonic, inexpensive, and easily available solution might be an ideal alternative for producing and maintaining more-prolonged mucosal elevation. OBJECTIVE: To evaluate D(50)+E versus NS+E during an EMR of sessile rectosigmoid polyps (> 10 mm). DESIGN: A prospective, double-blind, randomized study that compared EMR by using either D(50)+E or NS+E submucosal fluid cushions. SETTING: Four tertiary endoscopic referral centers with 1370 polypectomies in 2006, performed by 5 experienced endoscopists. PATIENTS: Patients treated for sessile rectosigmoid polyps (> 10 mm). INTERVENTIONS: Polypectomy with D(50)+E or NS+E submucosal fluid cushions. MAIN OUTCOME MEASUREMENTS: The duration of submucosal elevation, volume of solution, number of required injections to maintain the elevation, and observations for complications. RESULTS: Ninety-two sessile rectosigmoid polyps were removed. Injected solution volumes and the number of injections to maintain submucosal elevation were lower in the D(50)+E group than in the NS+E group (P = .033 and P = .028, respectively). Submucosal elevation had a longer duration in the D(50)+E group (P = .043). This difference mainly included large (> or = 20 mm) and giant (> 40 mm) polyps. There were 6 and 1 cases of postpolypectomy syndrome in the D(50)+E and NS+E groups, respectively (P = .01). LIMITATIONS: May be limited by inexperienced endoscopist's lack of injection and polypectomy skills. CONCLUSIONS: D(50)+E is superior to NS+E for an EMR, particularly in large and giant sessile polyps, but the risk of thermal tissue injury should be considered.
Authors: Mike T Wei; Christine Y Louie; Yu Chen; Jennifer Y Pan; Susan Y Quan; Robert Wong; Ryanne Brown; Melissa Clark; Kristin Jensen; Hubert Lau; Shai Friedland Journal: Int J Colorectal Dis Date: 2022-05-04 Impact factor: 2.571