Fasoulas Kostas, Lazaraki Georgia, Chatzimavroudis Grigoris, Paroutoglou George, Katsinelos Taxiarchis, Dimou Eleni, Geros Christos, Zavos Christos, Kountouras Jannis, Katsinelos Panagiotis
Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Surg Laparosc Endosc Percutan Tech. 2012 Jun;22(3):272-8. doi: 10.1097/SLE.0b013e318251553c.
Normal saline (NS) plus epinephrine (E) is the traditionally used solution as submucosal fluid cushion for a safe and effective endoscopic mucosal resection (EMR) of sessile colorectal polyps. It was hypothesized that hydroxyethyl starch (HES), an inexpensive and easily available solution might be an ideal solution for prolonged elevation of submucosal cushion for an easy and safe EMR of giant colorectal lateral spreading tumors (LSTs).
During a 6-year period, patients suffering from colorectal LSTs with a diameter of ≥ 30 mm were randomized to undergo EMR by using either HES+E (group A) or NS+E (group B) for submucosal fluid cushion. All patients who had undergone a colonoscopy set the diagnosis of LSTs. The LSTs were examined with standard white light and narrow-band imaging to accurately delinate their margins before resection. The initial volume of injected solution, the additional amount to maintain the submucosal cushion, the duration of submucosal elevation and post-EMR-related complications were recorded. After EMR, patients had a standard follow-up at 3, 6, and 12 months and further if it was necessary using total colonoscopy.
Forty-nine patients suffering from giant LSTs were included in the study. No difference between the 2 groups was observed in patients' characteristics, size of LSTs, and the initial volume of injected solution. However, the additional amount of solution to maintain submucosal elevation was lower in group A (median, 4 mL; range, 2 to 25) than in group B (median, 6 mL; range, 3 to 8; P=0.001). Moreover, submucosal elevation had a statistically longer duration in group A (median, 18.5 min; range, 14.5 to 28.4) than in group B (median, 20.15 min, range, 9.6 to 13.4; P<0.001), and there was a statistical difference on total procedure time in favor of group A [group A, 20.15 min (12 to 32.5) vs. group B, 22.8 min (18 to 34.5)]. One case of macroperforation, 2 cases of postpolypectomy syndrome, and 1 case of EMR-related bleeding were observed in the HES+E group, whereas 6 cases of EMR-related bleeding were observed in the NS+E group. During a median follow-up of 32 and 34 months, for HES+E and NS+E groups, respectively, 5 and 7 recurrences were observed, which were all treated endoscopically.
HES+E injection produces a more prolonged submucosal elevation and lowers total procedure time than NS+E; however, the safety of EMR is not influenced.
生理盐水（NS）加肾上腺素（E）是传统上用于为无蒂结直肠息肉进行安全有效的内镜黏膜切除术（EMR）提供黏膜下液垫的溶液。有假设认为，羟乙基淀粉（HES）这种价格低廉且容易获得的溶液，可能是用于延长黏膜下垫隆起时间以轻松安全地切除巨大结直肠侧向发育肿瘤（LST）的理想溶液。
在6年期间，将患有直径≥30mm的结直肠LST的患者随机分为两组，分别使用HES + E（A组）或NS + E（B组）作为黏膜下液垫进行EMR。所有接受结肠镜检查的患者均确诊为LST。在切除前，使用标准白光和窄带成像检查LST，以准确勾勒其边界。记录注入溶液的初始体积、维持黏膜下垫所需的额外量、黏膜下隆起的持续时间以及EMR术后相关并发症。EMR术后，患者在3、6和12个月进行标准随访，必要时使用全结肠镜检查进一步随访。
本研究纳入了49例患有巨大LST的患者。两组在患者特征、LST大小和注入溶液的初始体积方面未观察到差异。然而，A组维持黏膜下隆起所需的额外溶液量（中位数为4mL；范围为2至25mL）低于B组（中位数为6mL；范围为3至8mL；P = 0.001）。此外，A组黏膜下隆起的持续时间在统计学上长于B组（中位数为18.5分钟；范围为14.5至28.4分钟）（中位数为20.15分钟，范围为9.6至13.4分钟；P < 0.001），并且在总手术时间上A组有统计学差异（A组为20.15分钟（12至32.5分钟），B组为22.8分钟（18至34.5分钟））。HES + E组观察到1例大穿孔、2例息肉切除术后综合征和1例EMR相关出血，而NS + E组观察到6例EMR相关出血。在分别对HES + E组和NS + E组进行中位数为32个月和34个月的随访期间，分别观察到5例和7例复发，均通过内镜治疗。
与NS + E相比，注射HES + E可使黏膜下隆起持续时间更长，并缩短总手术时间；然而，EMR的安全性不受影响。
