Solutions for submucosal injection in endoscopic resection: a systematic review and meta-analysis

Alexandre Oliveira Ferreira; Joana Moleiro; Joana Torres; Mario Dinis-Ribeiro

doi:10.1055/s-0034-1393079

Endoscopy International Open, Table of Contents

Endosc Int Open 2016; 04(01): E1-E16
DOI: 10.1055/s-0034-1393079

Original article

Solutions for submucosal injection in endoscopic resection: a systematic review and meta-analysis

Authors

Alexandre Oliveira Ferreira^*

¹Department of Gastroenterology, Hospital Beatriz Ângelo, Lisboa, Portugal
Joana Moleiro^*

²Department of Gastroenterology, Instituto Português do Oncologia de Lisboa, Lisboa, Portugal
Joana Torres

¹Department of Gastroenterology, Hospital Beatriz Ângelo, Lisboa, Portugal
Mario Dinis-Ribeiro

³Department of Gastroenterology, Instituto Português do Oncologia do Porto, Porto, Portugal

⁴CIDES/CINTESIS, Faculty of Medicine – University of Porto, Porto, Portugal

Abstract

Background and aims: Submucosal injection is standard practice in endoscopic mucosal resection of gastrointestinal lesions. Several solutions are used. Our aim was to systematically review their efficacy and safety.

Patients and methods: We performed a systematic review and meta-analysis using a random effects model of randomized controlled trials (RCTs) from MEDLINE. Studies in animal models were qualitatively assessed for efficacy and safety.

Results: In total, 54 studies were qualitatively assessed. Eleven RCTs were analyzed, two of which were on endoscopic submucosal dissection (ESD). The quantitative synthesis included nine RCTs on endoscopic mucosal resection (EMR), comprising 792 subjects and 793 lesions. Mean lesion size was 20.9 mm (range 8.5 – 46 mm). A total of 209 lesions were randomized to sodium hyaluronate (SH) vs normal saline (NS), 72 to 50 % dextrose (D50) vs NS, 82 to D50 vs SH, 43 to succinylated gelatin, 25 to hydroxyethyl starch and 36 to fibrinogen. In total, 385 were randomized to NS as controls. NS and SH are the best studied solutions and seem to be equally effective in achieving complete resection (OR 1.09; 95 %CI 0.82, 1.45). No solution was proven to be superior in complete resection rate, post-polypectomy bleeding or coagulation syndrome/perforation incidence. Many solutions have been tested in animal studies and most seem more effective for mucosal elevation than NS.

Conclusions: There are several solutions in clinical use and many more under research, but most are poorly studied. SH seems to be clinically equivalent to NS. There are no significant differences in post-polypectomy complications. Larger RCTs are needed to determine any small differences that may exist between solutions.

Full Text

References

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