Hydroxy-propyl-methyl-cellulose is a safe and effective lifting agent for endoscopic mucosal resection of large colorectal polyps

Abstract

Injection of HPMC for EMR resulted safe and effective, allowing en bloc resection in the majority of cases with a limited number of complications. Continued progress in the field will include more outcomes research and techniques simplification.

Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis

“…27 Only the sessile polyps of this study were evaluated. 28 Separate analysis was only available for the sessile lesions that were removed by piecemeal resection. 29 Also included subpedunculated lesions.…”

Submucosal Injection of 0.4% Hydroxypropyl Methylcellulose Facilitates Endoscopic Mucosal Resection of Early Gastrointestinal Tumors

“…The safety and effectiveness of EMR after submucosal injection of HPMC has been tested in 2 recent studies. 21,22 In both reports, HPMC proved to be safe for use during EMR with no tissue damage or adverse reactions. In addition, prolonged lifting of the lesions was observed after HPMC submucosal injection ranging from 15 to 20 minutes up to 45 minutes.…”

“…In addition, prolonged lifting of the lesions was observed after HPMC submucosal injection ranging from 15 to 20 minutes up to 45 minutes. 21,22 A comparison of submucosal injection of HPMC versus saline solution in a historical cohort failed to show differences in rates of complete resection, although a significant difference in the volume of fluid injection and in the length of the procedure was noted favoring HPMC. 22 In 1 study that compared the characteristics and the duration of mucosal elevation of various submucosal injection solutions, including 0.3% HPMC, 0.9% NaCl, 20% Mannitol, 0.1% SH, 0.3% HPMC, and 2% fibrinogen, there were no differences in the duration of the elevations.…”

“…20 The use of HPMC for EMR in humans has been reported in 2 recent studies. 21,22 Bacani et al 21 used HPMC mixed with saline solution, epinephrine, and Indigo Carmine for submucosal fluid injection before EMR in 88 patients and found it to be comparable to saline solution. Arezzo et al 22 prospectively evaluated the effectiveness of 0.8% HPMC submucosal injection for resection of colorectal lesions larger than 2 cm in 27 patients.…”

Endoscopic mucosal resection

“…35 HPMC has also been demonstrated to be effective in mucosal lifting for EMR. 29,30,36 HPMC preparations are available in the United States as ophthalmic lubricants and are typically viscous solutions and must be diluted to 0.3% to 0.8% to facilitate injection. The use of succinylated gelatin as a submucosal injection solution for colonic EMR has been demonstrated to facilitate removal of large colonic lesions (>20 mm) in fewer pieces for piecemeal EMR in a randomized, double-blind trial compared with normal saline solution.…”