A novel method of endoscopic mucosal resection assisted by submucosal injection of autologous blood (blood patch EMR).
OBJECTIVE
Endoscopic mucosal resection assisted by submucosal injection of saline is a widely used procedure; however, it has three limitations: 1) it often is difficult to maintain a desirable level of tissue elevation after the injection; 2) the saline has no efficacy in preventing hemorrhage; 3) nothing can protect the site of mucosal defect after endoscopic mucosal resection to prevent perforation. Blood, as a new medium for use in submucosal injection, may remedy these drawbacks. This is the first report of this technique.


METHODS
From May to October 2004, 28 outpatients (8 females; median, 64 years) with 35 colorectal polyps (median, 5 mm in diameter; range, 1-30 mm) were enrolled in this study. Technique of the blood patch endoscopic mucosal resection: after autologous blood was injected into the submucosa under the lesion using a disposable 23-gauge needle, the lifted mucosa with the lesion was removed using a conventional snaring technique. The outcomes were prospectively studied.


RESULTS
Although one lesion was not lifted by the submucosal injection because of the submucosal invasion of carcinoma, 33 of the other 34 lesions (97.1 percent) were successfully completed using the blood patch endoscopic mucosal resection. The clot covered the raw surface after the endoscopic mucosal resection without bleeding. No complications (including hemorrhage and perforation) were observed. The blood patch endoscopic mucosal resection did not disturb pathologic examination.


CONCLUSIONS
Endoscopic mucosal resection assisted by submucosal injection of autologous blood can be performed safely, easily, and economically. Autologous blood is a promising medium for submucosal injection on endoscopic mucosal resection.
Sato
Tomoyuki
T
Department of Surgery, International University Hospital of Health and Welfare, International University of Health and Welfare, Iguchi 537-3, Nasushiobara-shi, Tochigi-ken 329-2763, Japan. tomosato@iuhw.ac.jp
D000368:Aged; D000369:Aged, 80 and over; D001691:Biological Therapy; D001769:Blood; D003111:Colonic Polyps / Q000601:surgery; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D007267:Injections; D007413:Intestinal Mucosa / Q000601:surgery*; D007417:Intestinal Polyps / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000601:surgery*; D013525:Surgical Instruments / Q000706:statistics & numerical data; D016896:Treatment Outcome