Purpose
Before endoscopic mucosal resection of large sessile colorectal polyps, injection of solution into submucosa cushions and isolates the tumor, although there is little information as to which solution with optimal effect should be used. This study investigated the effectiveness of endoscopic mucosal resection by use of a hypertonic dextrose plus epinephrine solution for large sessile colorectal polyps.
Methods
We removed 59 large sessile colorectal polyps in 59 patients by introducing an endoscopic submucosal hypertonic dextrose plus epinephrine injection technique. Endoscopic evaluations were repeated at 3, 6, and 12 months or longer. If no residual tumor was observed endoscopically and histologically at one year or more, the patient was considered to be “cured.” The main outcome measurements were the mean amount of solution injected, mean disappearance time of solution, safety, complications, and recurrence at follow-up.
Results
Of the 59 large sessile colorectal polyps, 23 (39 percent) were resected en bloc and 36 (61 percent) piecemeal. The mean amount of hypertonic dextrose plus epinephrine solution injected was 24.42 ± 17.52 ml, and its mean disappearance time was 13.61 ± 5.21 (range, 7–21) minutes. Of the 36 patients treated with piecemeal resection, 18 (50 percent) required additional endoscopic interventions. In patients who entered the follow-up surveillance protocol for one year or longer, the cure rate by en bloc resection was 100 percent (23/23) and that by piecemeal intervention was 96.78 percent (30/31). Four patients (6.8 percent) had local bleeding after endoscopic mucosal resection that was mainly controlled endoscopically.
Conclusions
Endoscopic mucosal resection after submucosal hypertonic dextrose plus epinephrine solution injection, with an intensive follow-up program, seems to be a safe and effective treatment for large sessile colorectal polyps.
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References
T Ponchon (2001) ArticleTitleEndoscopic mucosal resection J Clin Gastroenterol 32 6–10 Occurrence Handle11154174 Occurrence Handle1:STN:280:DC%2BD3M3kt1Knsw%3D%3D Occurrence Handle10.1097/00004836-200101000-00004
H Yamamoto H Kawata K Sunada et al. (2003) ArticleTitleSuccessful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood Endoscopy 35 690–694 Occurrence Handle12929067 Occurrence Handle1:STN:280:DC%2BD3szptVGhsA%3D%3D Occurrence Handle10.1055/s-2003-41516
RM Walsh FW Ackroyd PC Shellito (1992) ArticleTitleEndoscopic resection of large sessile colorectal polyps Gastrointest Endosc 38 303–309 Occurrence Handle1607080 Occurrence Handle1:STN:280:By2B1MbhvFE%3D
SJ Winawer AG Zauber MN Ho et al. (1993) ArticleTitlePrevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup N Engl J Med 329 1977–1981 Occurrence Handle8247072 Occurrence Handle1:STN:280:ByuD28jisFw%3D Occurrence Handle10.1056/NEJM199312303292701
M Conio A Repici JF Demarquay S Blanchi R Dumas R Filiberti (2004) ArticleTitleEMR of large sessile colorectal polyps Gastrointest Endosc 60 234–241 Occurrence Handle15278051 Occurrence Handle10.1016/S0016-5107(04)01567-6
H Iishi M Tatsuta S Kitamura H Narahara K Iseki S Ishiguro (1997) ArticleTitleEndoscopic resection of large sessile colorectal polyps using a submucosal saline injection technique Hepatogastroenterology 44 698–702 Occurrence Handle9222674 Occurrence Handle1:STN:280:ByiA28rosVM%3D
RM Soetikno T Gotoda Y Nakanishi N Soehendra (2003) ArticleTitleEndoscopic mucosal resection Gastrointest Endosc 57 567–579 Occurrence Handle12665775 Occurrence Handle10.1067/mge.2003.130
M Mukai I Ito S Mukoyama et al. (2003) ArticleTitleEndoscopic mucosal resection of superficially spreading colonic neoplasms larger than 5 cm in the right colon after injection of dilute sodium hyaluronate: report of two cases Endoscopy 35 973–974 Occurrence Handle14606024 Occurrence Handle1:STN:280:DC%2BD3srislWisg%3D%3D Occurrence Handle10.1055/s-2003-43471
H Makuuchi Y Kise H Shimada O Chino H Tanaka (1999) ArticleTitleEndoscopic mucosal resection for early gastric cancer Semin Surg Oncol 17 108–116 Occurrence Handle10449682 Occurrence Handle1:STN:280:DyaK1MzotVKnsw%3D%3D Occurrence Handle10.1002/(SICI)1098-2388(199909)17:2<108::AID-SSU5>3.0.CO;2-8
H Iishi M Tatsuta K Iseki et al. (2000) ArticleTitleEndoscopic piecemeal resection with submucosal saline injection of large sessile colorectal polyps Gastrointest Endosc 51 697–700 Occurrence Handle10840302 Occurrence Handle1:STN:280:DC%2BD3cvht1aksQ%3D%3D Occurrence Handle10.1067/mge.2000.104652
M Conio E Rajan D Sorbi et al. (2002) ArticleTitleComparative performance in the porcine esophagus of different solutions used for submucosal injection Gastrointest Endosc 56 513–516 Occurrence Handle12297766 Occurrence Handle10.1016/S0016-5107(02)70435-5
NA Ahmad ML Kochman WB Long EE Furth GG Ginsberg (2002) ArticleTitleEfficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of 101 cases Gastrointest Endosc 55 390–396 Occurrence Handle11868015 Occurrence Handle10.1067/mge.2002.121881
U Bergmann HG Beger (2003) ArticleTitleEndoscopic mucosal resection for advanced non-polypoid colorectal adenoma and early stage carcinoma Surg Endosc 17 475–479 Occurrence Handle12415335 Occurrence Handle1:STN:280:DC%2BD3s7gs1eitg%3D%3D Occurrence Handle10.1007/s00464-002-8931-6
O Pech A May L Gossner T Rabenstein C Ell (2004) ArticleTitleManagement of pre-malignant and malignant lesions by endoscopic resection Best Pract Res Clin Gastroenterol 18 61–76 Occurrence Handle15123085 Occurrence Handle10.1016/S1521-6918(03)00104-5
JR Jass LH Sobin (1989) Histological typing of intestinal tumours. WHO international histological classification of tumours EditionNumber2nd ed. Springer-Verlag Berlin
RJ Schlemper RH Riddell Y Kato et al. (2000) ArticleTitleThe Vienna classification of gastrointestinal epithelial neoplasia Gut 47 251–255 Occurrence Handle10896917 Occurrence Handle1:STN:280:DC%2BD3cvgsVWjsA%3D%3D Occurrence Handle10.1136/gut.47.2.251
BJ Rembacken T Gotoda T Fujii AT Axon (2001) ArticleTitleEndoscopic mucosal resection Endoscopy 33 709–718 Occurrence Handle11490390 Occurrence Handle1:STN:280:DC%2BD3MvktlCgtw%3D%3D Occurrence Handle10.1055/s-2001-16224
RW Yeh G Triadafilopoulos (2005) ArticleTitleSubmucosal injection: safety cushion at what cost? Gastrointest Endosc 62 943–945 Occurrence Handle16301041 Occurrence Handle10.1016/j.gie.2005.07.041
N Harada S Hamada H Kubo et al. (2001) ArticleTitlePreoperative evaluation of submucosal invasive colorectal cancer using a 15-MHz ultrasound miniprobe Endoscopy 33 237–240 Occurrence Handle11293756 Occurrence Handle1:STN:280:DC%2BD3Mvit1Cgsg%3D%3D Occurrence Handle10.1055/s-2001-12798
H Kato S Haga S Endo et al. (2001) ArticleTitleLifting of lesions during endoscopic mucosal resection (EMR) of early colorectal cancer: implications for the assessment of resectability Endoscopy 33 568–573 Occurrence Handle11473326 Occurrence Handle1:STN:280:DC%2BD38%2FisFKmtw%3D%3D Occurrence Handle10.1055/s-2001-15308
R Lambert (1998) ArticleTitleEndoscopic treatment of esophagogastric tumors Endoscopy 30 80–93 Occurrence Handle9592649 Occurrence Handle1:STN:280:DyaK1c3lsFSjsA%3D%3D Occurrence Handle10.1055/s-2007-1001234
T Ponchon (1997) ArticleTitleMucosectomic endoscopique Acta Endoscopica 27 1–5
H Inoue M Tani K Nagai et al. (1999) ArticleTitleTreatment of esophageal and gastric tumors Endoscopy 31 47–55 Occurrence Handle10082409 Occurrence Handle1:STN:280:DyaK1M7otVCntA%3D%3D Occurrence Handle10.1055/s-1999-13647
KY Chang CS Wu PC Chen (1996) ArticleTitleProspective, randomized trial of hypertonic glucose water and sodium tetradecyl sulfate for gastric variceal bleeding in patients with advanced liver cirrhosis Endoscopy 28 481–486 Occurrence Handle8886633 Occurrence Handle1:STN:280:ByiD2c7js1Y%3D
MJ Seo SJ Oh SI Kim et al. (2001) ArticleTitleHigh glucose dialysis solutions increase synthesis of vascular endothelial growth factors by peritoneal vascular endothelial cells Perit Dial Int 21 IssueIDSuppl 3 S35–S40 Occurrence Handle11887852
H Li SM Hergert SC Schafer et al. (2005) ArticleTitleMidostaurin upregulates eNOS gene expression and preserves eNOS function in the microcirculation of the mouse Nitric Oxide 12 231–236 Occurrence Handle15890550 Occurrence Handle1:CAS:528:DC%2BD2MXks1ars70%3D Occurrence Handle10.1016/j.niox.2005.04.001
LA Powell KM Warpeha W Xu B Walker ER Trimble (2004) ArticleTitleHigh glucose decreases intracellular glutathione concentrations and upregulates inducible nitric oxide synthase gene expression in intestinal epithelial cells J Mol Endocrinol 33 797–803 Occurrence Handle15591036 Occurrence Handle1:CAS:528:DC%2BD2MXis1artA%3D%3D Occurrence Handle10.1677/jme.1.01671
A Kobayashi T Osaka S Inoue S Kimura (2001) ArticleTitleThermogenesis induced by intravenous infusion of hypertonic solutions in the rat J Physiol 535 601–610 Occurrence Handle11533148 Occurrence Handle1:CAS:528:DC%2BD3MXmvFGisLg%3D Occurrence Handle10.1111/j.1469-7793.2001.00601.x
KM Reavis EY Chang JG Hunter BA Jobe (2005) ArticleTitleUtilization of the delay phenomenon improves blood flow and reduces collagen deposition in esophagogastric anastomoses Ann Surg 241 736–745 Occurrence Handle15849509 Occurrence Handle10.1097/01.sla.0000160704.50657.32
J Glaser R Gonzalez VM Perreau CW Cotman HS Keirstead (2004) ArticleTitleNeutralization of the chemokine CXCL10 enhances tissue sparing and angiogenesis following spinal cord injury J Neurosci Res 77 701–708 Occurrence Handle15352216 Occurrence Handle1:CAS:528:DC%2BD2cXnsVKmt7o%3D Occurrence Handle10.1002/jnr.20204
M Fujishiro N Yahagi K Kashimura et al. (2005) ArticleTitleTissue damage of different submucosal injection solutions for EMR Gastrointest Endosc 62 933–942 Occurrence Handle16301040 Occurrence Handle10.1016/j.gie.2005.07.052
DE Fleischer GQ Wang S Dawsey et al. (1996) ArticleTitleTissue bandligation followed by snare resection (band andsnare): a new technique for tissue acquisition in the esophagus Gastrointest Endosc 44 68–72 Occurrence Handle8836721 Occurrence Handle1:STN:280:BymH3sznsVU%3D Occurrence Handle10.1016/S0016-5107(96)70233-X
Y Matsui M Inomata K Izumi K Sonoda N Shiraishi S Kitano (2004) ArticleTitleHyaluronic acid stimulates tumor-cell proliferation at wound sites Gastrointest Endosc 60 539–543 Occurrence Handle15472675 Occurrence Handle10.1016/S0016-5107(04)01890-5
AB Feitoza CJ Gostout LJ Burgart et al. (2003) ArticleTitleHydroxypropyl methylcellulose: a better submucosal fluid cushion for endoscopic mucosal resection Gastrointest Endosc 57 41–47 Occurrence Handle12518129 Occurrence Handle10.1016/S0016-5107(03)70115-1
SH Lee WY Cho HJ Kim et al. (2004) ArticleTitleA new method of EMR: submucosal injection of a fibrinogen mixture Gastrointest Endosc 59 220–224 Occurrence Handle14745395 Occurrence Handle10.1016/S0016-5107(03)02689-0
S Higaki S Hashimoto K Harada et al. (2003) ArticleTitleLong-term follow-up of large flat colorectal tumors resected endoscopically Endoscopy 35 845–849 Occurrence Handle14551863 Occurrence Handle1:STN:280:DC%2BD3svnsVGnug%3D%3D Occurrence Handle10.1055/s-2003-42622
M Kunihiro S Tanaka K Haruma et al. (2000) ArticleTitleElectrocautery snare resection stimulates cellular proliferation of residual colorectal tumor: an increasing gene expression related to tumor growth Dis Colon Rectum 43 1107–1115 Occurrence Handle10950009 Occurrence Handle1:STN:280:DC%2BD3cvitVSgtQ%3D%3D Occurrence Handle10.1007/BF02236558
SY Tung CS Wu MC Wu MY Su (2001) ArticleTitleEndoscopic treatment of colorectal polyps and early cancer Dig Dis Sci 46 1152–1156 Occurrence Handle11414286 Occurrence Handle1:STN:280:DC%2BD3MzltFarug%3D%3D Occurrence Handle10.1023/A:1010682322370
JC Brooker BP Saunders SG Shah CJ Thapar N Suzuki CB Williams (2002) ArticleTitleTreatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations Gastrointest Endosc 55 371–375 Occurrence Handle11868011 Occurrence Handle10.1067/mge.2002.121597
KF Binmoeller S Bohnacker H Selfert F Thonke H Valdeyar N Soehendra (1996) ArticleTitleEndoscopic snare excision of “giant” colorectal polyps Gastrointest Endosc 43 183–188 Occurrence Handle8857131 Occurrence Handle1:STN:280:ByiD3M%2FgslQ%3D Occurrence Handle10.1016/S0016-5107(96)70313-9
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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 49, 1384–1392 (2006). https://doi.org/10.1007/s10350-006-0611-5
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DOI: https://doi.org/10.1007/s10350-006-0611-5