Effect of submucosal injection of normal saline and glycerol fructose on endoscopic polypectomy in patients with colorectal polyps

Abstract

Effect of submucosal injection of normal saline and glycerol fructose on endoscopic polypectomy in patients with colorectal polyps was investigated. A total of 275 patients with colorectal polyps were enrolled in this study and underwent endoscopic gastrointestinal polypectomy in Qingdao Chengyang People's Hospital from March 2013 to December 2016. Among them, 150 patients who underwent submucosal injection of glycerol fructose were set as the experimental group, and 125 patients who underwent submucosal injection of normal saline were set as the control group. The surgery conditions, complications and recurrence rates were compared between the two groups. The time of processing polyps and the total surgery time in the experimental group were shorter than those in the control group (P<0.05). The number of repeated injections in the experimental group was less than that in the control group, and the difference was statistically significant (P<0.05). The amount of fluid and propofol injected in patients of the experimental group was significantly lower than that of the control group, and the difference was statistically significant (P<0.05). The en bloc resection rate (EBRR) and complete resection rate (CRR) in the experimental group were 68.0 and 48.0%, respectively. EBRR and CRR in the control group were 49.6 and 27.2%, respectively. EBRR and CRR in the experimental group were significantly higher than those in the control group (P<0.05). After follow-up of the patients for 3 months, there was no significant difference in the recurrence rate between the two groups (P>0.05). The results indicated that endoscopic colorectal polypectomy with glycerol fructose as a submucosal injection can shorten the time of surgery, reduce the number of repeated injections, reduce the amount of fluid and propofol, and also improve EBRR and CRR.

Hypertonic solution as an optimal submucosal injection solution for endoscopic resection of gastrointestinal mucosal lesions: Systematic review and network meta‐analysis

“…After removing duplicated and irrelevant records, 134 records were included for full‐length article retrieval, and in which 121 records were removed for different reasons (Table S4). Thirteen RCTs (26 arms of treatment) were included in the final network meta‐analysis with 1637 patients (1639 lesions), and 61.6% of patients were male 24–36 . Three trials including 417 patients compared the efficacy and safety of HS with NS (222 in the HS group vs. 195 in the NS group), while nine trials compared NS with VS among 1057 patients (532 in the NS group vs. 525 in the VS group), and one trial with 163 patients compared HS with VS (82 in the HS group vs. 81 in the VS group).…”

“…The superiority of HS was recognized in previous studies but possible tissue damage remains a concern. 24,27,28,36 Unfortunately, quantitative analysis of tissue damage was deficient owing to the insufficient data of included studies. In a previous study, Fujishiro et al observed tissue damage only in 20% and 50% dextrose water, whereas no tissue damage after injection of Glyceol or 15% dextrose water, which indicated tissue damage was related to concentration or some specific type of solutions.…”

“…Glyceol, for instance, demonstrated excellent efficacy and safety due to a seven times higher osmotic pressure than the extracellular fluid. 36,41 Hence, considering the hypertonicity, Glyceol could be confined to the submucosa without penetrating into deeper muscular layers if injected into the submucosa carefully, thus providing the duration for the endoscopist to securely remove the mucosal lesion. 24,28 The VS also showed superiority over NS due to its high viscosity, whereas high cost may hamper utilization.…”

“…In the subgroup of the colorectal lesions, [27][28][29][30][31][32][34][35][36] HS was preferable to NS according to the network meta-analysis (RR 1.40; 95% CI 1.10-1.90), but not significant in pairwise analysis (RR 1.40; 95% CI 0.95-2.20). In the EMR subgroup, 24,25,27,28,[30][31][32]35,36 HS showed higher en bloc resection rates compared with NS (pairwise RR 1.50; 95% CI 1.10-4.90; network RR 1.40; 95% CI 1.20-1.70) and VS (VS vs. HS in network meta-analysis: RR 0.75; 95% CI 0.61-0.91). In addition, VS performed better than NS only in the subgroup of lesions >10 mm [24][25][26][27][29][30][31]33,35 (RR 1.31; 95% CI 1.01-1.80) (Fig.…”

“…Thirteen RCTs (26 arms of treatment) were included in the final network meta-analysis with 1637 patients (1639 lesions), and 61.6% of patients were male. [24][25][26][27][28][29][30][31][32][33][34][35][36] Three trials including 417 patients compared the efficacy and safety of HS with NS (222 in the HS group vs. 195 in the NS group), while nine trials compared NS with VS among 1057 patients (532 in the NS group vs. 525 in the VS group), and one trial with 163 patients compared HS with VS (82 in the HS group vs. 81 in the VS group). The baseline characteristics and number of events of included patients were provided in Tables 1 and S5, respectively.…”