title: Endoscopic mucosal resection of large sessile colorectal polyps with submucosal injection of hypertonic 50 percent dextrose-epinephrine solution.
abstract: OBJECTIVE
  Before endoscopic mucosal resection of large sessile colorectal polyps, injection of solution into submucosa cushions and isolates the tumor, although there is little information as to which solution with optimal effect should be used. This study investigated the effectiveness of endoscopic mucosal resection by use of a hypertonic dextrose plus epinephrine solution for large sessile colorectal polyps.
  
  
  METHODS
  We removed 59 large sessile colorectal polyps in 59 patients by introducing an endoscopic submucosal hypertonic dextrose plus epinephrine injection technique. Endoscopic evaluations were repeated at 3, 6, and 12 months or longer. If no residual tumor was observed endoscopically and histologically at one year or more, the patient was considered to be "cured." The main outcome measurements were the mean amount of solution injected, mean disappearance time of solution, safety, complications, and recurrence at follow-up.
  
  
  RESULTS
  Of the 59 large sessile colorectal polyps, 23 (39 percent) were resected en bloc and 36 (61 percent) piecemeal. The mean amount of hypertonic dextrose plus epinephrine solution injected was 24.42 +/- 17.52 ml, and its mean disappearance time was 13.61 +/- 5.21 (range, 7-21) minutes. Of the 36 patients treated with piecemeal resection, 18 (50 percent) required additional endoscopic interventions. In patients who entered the follow-up surveillance protocol for one year or longer, the cure rate by en bloc resection was 100 percent (23/23) and that by piecemeal intervention was 96.78 percent (30/31). Four patients (6.8 percent) had local bleeding after endoscopic mucosal resection that was mainly controlled endoscopically.
  
  
  CONCLUSIONS
  Endoscopic mucosal resection after submucosal hypertonic dextrose plus epinephrine solution injection, with an intensive follow-up program, seems to be a safe and effective treatment for large sessile colorectal polyps.
authors.affiliation: Department of Endoscopy and Motility Unit, Central Hospital, Thessaloniki, Macedonia 551 33, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Katsinelos
authors.forename: Jannis
authors.initials: J
authors.lastname: Kountouras
authors.forename: George
authors.initials: G
authors.lastname: Paroutoglou
authors.forename: Christos
authors.initials: C
authors.lastname: Zavos
authors.forename: Christos
authors.initials: C
authors.lastname: Rizos
authors.forename: Athanasios
authors.initials: A
authors.lastname: Beltsis
mesh_terms: D000368:Aged; D003111:Colonic Polyps / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D006982:Hypertonic Solutions / Q000008:administration & dosage*; D007267:Injections; D007413:Intestinal Mucosa / Q000601:surgery*; D007417:Intestinal Polyps / Q000601:surgery*; D008297:Male; D012002:Rectal Diseases / Q000601:surgery*; D012008:Recurrence
chemical_list: D006982:Hypertonic Solutions; D005947:Glucose; D004837:Epinephrine