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.
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).


METHODS
A prospective, double-blind, randomized study that compared EMR by using either D(50)+E or NS+E submucosal fluid cushions.


METHODS
Four tertiary endoscopic referral centers with 1370 polypectomies in 2006, performed by 5 experienced endoscopists.


METHODS
Patients treated for sessile rectosigmoid polyps (> 10 mm).


METHODS
Polypectomy with D(50)+E or NS+E submucosal fluid cushions.


METHODS
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).


CONCLUSIONS
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.
Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thesaloniki, Greece.
Panagiotis
P
Katsinelos
Jannis
J
Kountouras
George
G
Paroutoglou
Grigoris
G
Chatzimavroudis
Christos
C
Zavos
Ioannis
I
Pilpilidis
George
G
Gelas
Dimitris
D
Paikos
Konstantinos
K
Karakousis
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D004311:Double-Blind Method; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005947:Glucose; D006801:Humans; D007413:Intestinal Mucosa / Q000502:physiology; D007417:Intestinal Polyps / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012002:Rectal Diseases / Q000473:pathology / Q000601:surgery*; D012810:Sigmoid Diseases / Q000473:pathology / Q000601:surgery*; D012965:Sodium Chloride; D012996:Solutions; D016896:Treatment Outcome
D012996:Solutions; D012965:Sodium Chloride; D005947:Glucose