A comparative study of 50% dextrose and normal saline solution on their ability to create submucosal fluid cushions for endoscopic resection of sessile rectosigmoid polyps - 23/08/11
, George Paroutoglou, MD, Grigoris Chatzimavroudis, MD, Christos Zavos, MD, Ioannis Pilpilidis, MD, George Gelas, MD, Dimitris Paikos, MD, Konstantinos Karakousis, MD
Reprint requests: Jannis Kountouras, MD, Second Medical Clinic, Department of Gastroenterology, 8 Fanariou St, Byzantio, 551 33, Thessaloniki, Macedonia, Greece.Thesaloniki, Larissa, Greece
Abstract |
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 (D50) 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 D50+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 D50+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 D50+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 D50+E group than in the NS+E group (P = .033 and P = .028, respectively). Submucosal elevation had a longer duration in the D50+E group (P = .043). This difference mainly included large (≥20 mm) and giant (>40 mm) polyps. There were 6 and 1 cases of postpolypectomy syndrome in the D50+E and NS+E groups, respectively (P = .01).
Limitations |
May be limited by inexperienced endoscopist’s lack of injection and polypectomy skills.
Conclusions |
D50+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.
Le texte complet de cet article est disponible en PDF.Abbreviations : APC, D50, E, HPMC, NS, PPS
Plan
Vol 68 - N° 4
P. 692-698 - octobre 2008 Retour au numéro
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