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).

DESIGN

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

SETTING

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

PATIENTS

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

INTERVENTIONS

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

MAIN OUTCOME MEASUREMENTS

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).

LIMITATIONS

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.