EMR using dextrose solution versus sodium hyaluronate for colorectal Paris type I and 0-II lesions: a randomized endoscopist-blinded study

Background and aims: Loss of mucosal ‘lift’ prior to submucosal dissection or endoscopic mucosal resection (EMR) increases the risk of complications. We conducted a randomized controlled trial comparing dextrose solution with sodium hyaluronic acid (SHA) for the en bloc resection of Paris type I/0-II and lateral spreading lesions of the colorectum.

Patients and methods: Patients with Paris type I/0-II or lateral spreading tumor lesions of < 30 mm were randomized in a 1 : 1 ratio to undergo EMR using either dextrose solution or SHA. The primary study outcome was complete resection. Secondary outcomes were endoscopic complications (i. e. perforation or bleeding) and polyp recurrence rates.

Results: A total of 174 patients were randomized. R0 resection was achieved in 59 of the 82 lesions (72 %) in the dextrose group and 56 of the 81 lesions (69 %) in the SHA group (P > 0.1), with no significant difference in median lesion diameter (P > 0.1). The median number of post resection surveillance colonoscopies was 3 (range 2 - 7) in the dextrose group and 4 (range 2 - 6) in the SHA group (P = NS). The median post index EMR resection follow-up period was 20 months (range 4 - 26) in the DS group and 18 months (range 3 - 22) in the SHA group (P = NS). Recurrence rates were 1/82 (1.21 %) in the dextrose group and 1/81 (1.23 %) in the SHA group (P = NS).

Conclusions: EMR using dextrose solution is as effective as SHA in terms of resection completion, recurrence rates, and complications.

References

• 1 Hurlstone D P, Fujii T. Practical uses of chromoendoscopy and magnification at colonoscopy.  Gastrointest Endosc Clin N Am. 2005;  15 687-702
• 2 Hurlstone D P, Cross S S, Adam I. et al . An evaluation of colorectal endoscopic mucosal resection using high-magnification chromoscopic colonoscopy: a prospective study of 1000 colonoscopies.  Endoscopy. 2004;  36 491-498
• 3 Hurlstone D P, Sanders D S, Cross S S. et al . Colonoscopic resection of lateral spreading tumours: a prospective analysis of endoscopic mucosal resection.  Gut. 2004;  53 1334-1339
• 4 Kudo S, Kashida H, Tamura T. et al . Colonoscopic diagnosis and management of nonpolypoid early colorectal cancer.  World J Surg. 2000;  24 1081-1090
• 5 Kudo S, Kashida H, Nakajima T. et al . Endoscopic diagnosis and treatment of early colorectal cancer.  World J Surg. 1997;  21 694-701
• 6 Hurlstone D P, Brown S, Cross S S, Shorthouse A J, Sanders D S. High magnification chromoscopic colonoscopy or high frequency 20 MHz mini probe endoscopic ultrasound staging for early colorectal neoplasia: a comparative prospective analysis.  Gut. 2005;  54 1585-1589
• 7 Uraoka T, Fujii T, Saito Y. et al . Effectiveness of glycerol as a submucosal injection for EMR.  Gastrointest Endosc. 2005;  61 736-740
• 8 Conio M, Rajan E, Sorbi D. et al . Comparative performance in the porcine esophagus of different solutions used for submucosal injection.  Gastrointest Endosc. 2002;  56 513-516
• 9 Yamamoto H, Kawata H, Sunada K. et al . Success rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate.  Gastrointest Endosc. 2002;  56 507-512
• 10 Varadarajulu S, Tamhane A, Slaughter R L. Evaluation of dextrose 50 % as a medium for injection-assisted polypectomy.  Endoscopy. 2006;  38 907-912
• 11 Paris Workshop Participants . The Paris endoscopic classification of superficial neoplastic lesions: Esophagus, stomach and colon.  Gastrointest Endosc. 2002;  58 S3-43
• 12 Karita M, Tada M, Okita K, Kodama T. Endoscopic therapy for early colon cancer: the strip biopsy resection technique.  Gastrointest Endosc. 1991;  37 128-132
• 13 Schlemper R J, Riddell R H, Kato Y. et al . The Vienna classification of gastrointestinal neoplasia.  Gut. 2000;  47 251-255
• 14 Higaki S, Hashimoto S, Harada K. et al . Long-term follow-up of large flat colorectal tumors resected endoscopically.  Endoscopy. 2003;  35 845-849
• 15 Katsinelos P, Kountouras J, Paroutoglou G. et al . Endoscopic mucosal resection of large sessile colorectal polyps with submucosal injection of hypertonic 50 percent dextrose-epinephrine solution.  Dis Colon Rectum. 2006;  49 1384-1392