Clinical efficacy of EMR with submucosal injection of a fibrinogen mixture: a prospective randomized trial

Lee, Suck-Ho; Park, Jeong Hoon; Park, Do Hyun; Chung, Il‐Kwun; Kim, Hongsoo; Park, Sang‐Heum; Kim, Sun‐Joo; Cho, Hyun-Deuk

doi:10.1016/j.gie.2006.07.032

Cited by 55 publications

(43 citation statements)

References 15 publications

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“…Other agents such as fibrinogen mixtures, poloxamers, and photocrosslinkable chitosan have been reported for EMR with great enthusiasm. Compared with SH, fibrinogen mixtures and poloxamer solutions are significantly less expensive but remain substantially more expensive than NS [25]. A study that included EMR of 35 early gastric neoplasms showed that, after an initial injection of fibrinogen mixture, additional submucosal injection was not required for any lesion.…”

Section: Descriptive Analysismentioning

confidence: 99%

“…During follow-up, recurrence was noted in only one patient in whom the lesion had been resected piecemeal [52]. Later, the clinical efficacy of the fibrinogen mixture was evaluated in a RCT, comparing it with NS in EMR of early gastric neoplasms [25]. This study did not show differences between the two groups in the rates of en bloc resection and recurrence rate, but mean procedure time was significantly shorter in the fibrinogen group and additional submucosal injection to maintain elevation of the lesion was less frequently required in the fibrinogen group (P < 0.05).…”

Section: Descriptive Analysismentioning

confidence: 99%

“…The nine EMR studies were all two-arm RCTs; eight of them used NS as the control group and only one used SH as the control [19]. Three trials evaluated SH solutions [20 -22], three trials evaluated D50 [19,23,24], and the others evaluated fibrinogen [25], hydroxyethyl starch (HES) [26], and succinylated gelatin (SG) [27]. The three studies that were excluded from the meta-analysis did not report the outcome of interest [28 -30].…”

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confidence: 99%

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2016

Endosc Int Open

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Section: Descriptive Analysismentioning

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Section: Descriptive Analysismentioning

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2016

Endosc Int Open

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“…These include normal saline with or without diluted epinephrine, hypertonic saline, dextrose solution, sodium hyaluronate, fibrinogen combination, glycerol, and fructose solutions all of those may be mixture with methylene blue depend on the preference of the endoscopist. [5][6][7][8] Conio, et al compared the solutions and showed that the disappearing time of normal saline is approximately 3 minutes with or without epinephrine, while the disappearing times of 50% dextrose and 10% glycerol and hyaluronic acid solutions were 4.7, 4.2 and 22 minutes respectively.…”

Section: 2mentioning

confidence: 99%

Endoscopy: From Diagnosis to Therapeutics

Benson

Mizrahi²

2015

Gastro Open J

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Two decades ago, gastroenterologists used endoscopy for the diagnosis of Gastrointestinal (GI) lesions, thereby helping surgeons to localize lesion that necessitated resection and treatment with surgery. Today, the gastroenterology field has advanced beyond the diagnostic era and now, a large number of GI lesions can be treated via endoluminal procedures performed by the gastroenterologist with no need for surgical intervention.In recent years, the improvement of endoscopic imaging and tools, such as snares, clips and needles which can be delivered through the endoscope channel, have helped to change the field of gastroenterology. This allowed for the development and advancement of Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD). The pioneers of EMR and ESD were from Japan and the first articles describing these techniques were published in the 1990s. 1,2Two classification systems are used for describing GI lesions to be considered for EMR and ESD. One system is the Japanese classification 3 and the second is the Paris system, which was proposed in 2002. 4 The Japanese classification was originally developed for early gastric cancer management, but it can be applied to lesions throughout the GI tract. Once lesions are classified, EMR can be performed in different GI locations, including the esophagus, stomach, colon and rectum. When lesions are more complex and beyond the mucosa, ESD can be performed with careful dissection.Endoscopic ultrasound (EUS) may be useful in deciding whether to perform EMR or ESD. EUS can aid in determining the penetration of the tumor to layers beyond the mucosa when the lesion is localized in proximal parts of the colon. If the lesion cannot be reached by a regular EUS endoscope special high frequency mini-probes may be used through the colonoscope working channel.Two methods are used in performing EMR. The first method is 'suck and cut' and the second method is 'lift and cut'. Both usually begin with a submucosal injection prior to resection of the lesion the suc and cut method may be used also without submucosal injection especially when being performed in the esophagus. The injection is used to expand the submucosa, separating the deeper muscolaris propria from the more superficial mucosa and submucosa layers. Several solutions may be used as the injectate. These include normal saline with or without diluted epinephrine, hypertonic saline, dextrose solution, sodium hyaluronate, fibrinogen combination, glycerol, and fructose solutions all of those may be mixture with methylene blue depend on the preference of the endoscopist.5-8 Conio, et al. compared the solutions and showed that the disappearing time of normal saline is approximately 3 minutes with or without epinephrine, while the disappearing times of 50% dextrose and 10% glycerol and hyaluronic acid solutions were 4.7, 4.2 and 22 minutes respectively. 9After injection, one of the two resection methods can be applied. The 'suck and cut'

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“…It has proved higher durability and effectiveness than NS 0.9 % (73,75). Fibrinogen has also been used in human studies (76). There are many other solutions such as hypertonic (3 %) NaCl, dextrose (20, 30, 50 %) and hydroxypropyl methylcellulose (HPMC) (artificial tears) that have been used in an experimental setting.…”

Section: Injection Substancesmentioning

confidence: 99%