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Solutions for submucosal injection in endoscopic resection: a systematic review and meta-analysis

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      Background and aims: Submucosal injection is standard practice in endoscopic mucosal resection of gastrointestinal lesions. Several solutions are used. Our aim was to systematically review their efficacy and safety.

      Patients and methods: We performed a systematic review and meta-analysis using a random effects model of randomized controlled trials (RCTs) from MEDLINE. Studies in animal models were qualitatively assessed for efficacy and safety.

      Results: In total, 54 studies were qualitatively assessed. Eleven RCTs were analyzed, two of which were on endoscopic submucosal dissection (ESD). The quantitative synthesis included nine RCTs on endoscopic mucosal resection (EMR), comprising 792 subjects and 793 lesions. Mean lesion size was 20.9 mm (range 8.5 – 46 mm). A total of 209 lesions were randomized to sodium hyaluronate (SH) vs normal saline (NS), 72 to 50 % dextrose (D50) vs NS, 82 to D50 vs SH, 43 to succinylated gelatin, 25 to hydroxyethyl starch and 36 to fibrinogen. In total, 385 were randomized to NS as controls. NS and SH are the best studied solutions and seem to be equally effective in achieving complete resection (OR 1.09; 95 %CI 0.82, 1.45). No solution was proven to be superior in complete resection rate, post-polypectomy bleeding or coagulation syndrome/perforation incidence. Many solutions have been tested in animal studies and most seem more effective for mucosal elevation than NS.

      Conclusions: There are several solutions in clinical use and many more under research, but most are poorly studied. SH seems to be clinically equivalent to NS. There are no significant differences in post-polypectomy complications. Larger RCTs are needed to determine any small differences that may exist between solutions.

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      Most cited references 58

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            Author and article information

            [1 ]Department of Gastroenterology, Hospital Beatriz Ângelo, Lisboa, Portugal
            [2 ]Department of Gastroenterology, Instituto Português do Oncologia de Lisboa, Lisboa, Portugal
            [3 ]Department of Gastroenterology, Instituto Português do Oncologia do Porto, Porto, Portugal
            [4 ]CIDES/CINTESIS, Faculty of Medicine – University of Porto, Porto, Portugal
            Author notes
            Corresponding author Alexandre Oliveira Ferreira, MD Hospital Beatriz Ângelo Department of Gastroenterology Avenida Carlos Teixeira 32674-514 LouresPortugal+351-21-9847209 alex.gastrohep@
            Endosc Int Open
            Endosc Int Open
            Endoscopy International Open
            © Georg Thieme Verlag KG (Stuttgart · New York )
            January 2016
            06 October 2015
            : 4
            : 1
            : E1-E16
            4713187 10.1055/s-0034-1393079
            © Thieme Medical Publishers


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