title: Submucosal injection of 0.4% hydroxypropyl methylcellulose facilitates endoscopic mucosal resection of early gastrointestinal tumors.
abstract: OBJECTIVE
  Submucosal injection of a viscoelastic solution prolongs submucosal lift, thus, facilitating endoscopic mucosal resection. Our objective was to assess the safety and clinical effectiveness of 0.4% hydroxypropyl methylcellulose (HPMC) as a submucosal injectant for endoscopic mucosal resection.
  
  
  METHODS
  A prospective, open-label, multicenter, phase 2 study was conducted at 2 academic institutions in Brazil. Eligible participants included patients with early gastrointestinal tumors larger than 10 mm. Outcomes evaluated included complete resection rates, volume of HPMC injected, duration of the submucosal cushion as assessed visually, histology of the resected leisons, and complication rates.
  
  
  RESULTS
  Over a 12-month period, 36 eligible patients with superficial neoplastic lesions (stomach 14, colon 11, rectum 5, esophagus 3, duodenum 3) were prospectively enrolled in the study. The mean size of the resected specimen was 20.4 mm (10 to 60 mm). The mean volume of 0.4% HPMC injected was 10.7 mL (range 4 to 35 mL). The mean duration of the submucosal fluid cushion was 27 minutes (range 9 to 70 min). Complete resection was successfully completed in 89%. Five patients (14%) developed immediate bleeding requiring endoclip and APC application. Esophageal perforation occurred in 1 patient requiring surgical intervention. There were no local or systemic adverse events related to HPMC use over the follow-up period (mean 2.2 mo).
  
  
  CONCLUSIONS
  HPMC solution (0.4%) provides an effective submucosal fluid cushion and is safe for endoscopic resection of early gastrointestinal neoplastic lesions.
authors.affiliation: Alfa Institute of Gastroenterology, Federal University of Minas Gerais, Belo Horizonte, Brazil. arantesvitor@hotmail.com
authors.forename: Vitor
authors.initials: V
authors.lastname: Arantes
authors.forename: Walton
authors.initials: W
authors.lastname: Albuquerque
authors.forename: Edgard
authors.initials: E
authors.lastname: Benfica
authors.forename: Dezimar Luis
authors.initials: DL
authors.lastname: Duarte
authors.forename: David
authors.initials: D
authors.lastname: Lima
authors.forename: Sueli
authors.initials: S
authors.lastname: Vilela
authors.forename: Geraldo
authors.initials: G
authors.lastname: Lima
authors.forename: Paulo
authors.initials: P
authors.lastname: Sakai
authors.forename: Fauze Maluf
authors.initials: FM
authors.lastname: Filho
authors.forename: Everson
authors.initials: E
authors.lastname: Artifon
authors.forename: Bhawna
authors.initials: B
authors.lastname: Halwan
authors.forename: Atul
authors.initials: A
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004939:Esophageal Perforation / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery; D005770:Gastrointestinal Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D065347:Hypromellose Derivatives; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery; D008297:Male; D008747:Methylcellulose / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D065347:Hypromellose Derivatives; D008747:Methylcellulose