title: Endoscopic mucosal resection with 0.13% hyaluronic acid solution for colorectal polyps less than 20 mm: a randomized controlled trial.
abstract: OBJECTIVE
  Adequate mucosal elevation by submucosal injection is important for definitive en bloc resection and prevention of perforation during endoscopic mucosal resection (EMR). The objective of this study is to determine the efficacy of 0.13% hyaluronic acid (HA) solution for high and sustained mucosal elevation during colorectal EMR.
  
  
  METHODS
  The study was a prospective randomized controlled trial; a total of 196 patients with colon polyps of < 20 mm diameter were enrolled and randomized in a 1:1 ratio to undergo EMR using either 0.13% HA or normal saline (NS). The primary outcome of the study was histopathologically confirmed complete resection. The secondary outcomes such as maintenance of high mucosal elevation and development of complications were also evaluated. Moreover, the relationship between complete resection and the experience of the endoscopist (veteran vs less experienced) was analyzed.
  
  
  RESULTS
  Compete resection was achieved in 74 of 93 polyps (79.5%) in the 0.13% HA group and 63 of 96 polyps (65.6%) in the NS group (P < 0.05). High mucosal elevation was maintained in 83.9% of procedures in the 0.13% HA group and 54.1% in the NS group (P < 0.01). The frequency of complete resection achieved by less-experienced endoscopists was higher in the 0.13% HA group (79.3%) than in the NS group (62.1%; P < 0.05).
  
  
  CONCLUSIONS
  Endoscopic mucosal resection using 0.13% HA to colon polyps of less than 20 mm diameter is more effective than NS for complete resection and maintenance of mucosal elevation.
authors.affiliation: Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan. naohisa@koto.kpu-m.ac.jp
authors.forename: Naohisa
authors.initials: N
authors.lastname: Yoshida
authors.forename: Yuji
authors.initials: Y
authors.lastname: Naito
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Inada
authors.forename: Munehiro
authors.initials: M
authors.lastname: Kugai
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kamada
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Katada
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Uchiyama
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Takagi
authors.forename: Osamu
authors.initials: O
authors.lastname: Handa
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Konishi
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Yagi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kokura
authors.forename: Naoki
authors.initials: N
authors.lastname: Wakabayashi
authors.forename: Akio
authors.initials: A
authors.lastname: Yanagisawa
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Yoshikawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D007267:Injections; D007413:Intestinal Mucosa / Q000601:surgery*; D007564:Japan; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D012002:Rectal Diseases / Q000473:pathology / Q000601:surgery*; D012965:Sodium Chloride / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D012965:Sodium Chloride; D006820:Hyaluronic Acid