Effects of epinephrine–saline submucosal injection of different concentrations on endoscopic submucosal dissection

Abstract

Objective To evalute and compare the efficacy and safety of epinephrine–saline submucosal injection of different concentrations on endoscopic submucosal dissection (ESD), and to discuss the best concentration of submucosal injection. Methods A total of 128 patients who underwent ESD were randomly assigned to submucosal normal saline injection group (group A, n=32), 0.001% epinephrine–saline injection group(group B, n=32), 0.002% epinephrine–saline injection group(group C, n=32), and 0.004% epinephrine–saline injection group (group D, n=32). The incidence of bleeding during and after ESD were counted, the blood preasure and heart rate of preoperative and intraoperative, the amount of submucosal injection, the time of operation were observed. Results ESD was successfully performed on all patients. There were no difference in highest blood preasure and fastest heart rate between preoperative and intraoperative results of each group. No perforation or intraoperative acute massive bleeding occurred. Intraoperative acute minimal bleeding during ESD occurred in 9 patients in group A and 3 in group B, 2 in group C and 2 in group D (P<0.05), but there were no differences among group B, C and D. The amount of submucosal injection of group A was(39.5±10.8)ml, which was more than that of group B(29.4±9.4)ml, group C(27.3±8.2)ml and group D(20.4±11.8)ml with significant difference. There were no differences among group B, C and D, but there was less in group D than group B. The operation time of group A was(82.3±24.78 minutes), which was longer than that of group B(60.7±25.35minutes), group C (54.7±31.72minutes) and group D(59.2±28.49 minutes), but there was no difference among B, C and D group. Conclusion Epinephrine–saline submucosal injection assiting ESD is safe and effective and reduces the operation time and bleeding than normal saline. The increase of the epinephrine–saline concentrations has not been found to be more beneficial. Key words: Endoscopic submucosal dissection; Injections; Epinephrine; Bleeding