Abstract
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are minimally invasive and efficient techniques for the removal of gastrointestinal (GI) mucosal polyps. In both techniques, submucosal injection solutions are necessary for complete effectiveness and safety during the intervention to be obtained. The main objective of this study was to evaluate the efficacy and safety of a new sterile submucosal injection solution for EMR/ESD used within a clinical protocol in patients with intestinal polyps. We carried out a prospective study between 2016 and 2017 with patients who attended the Endoscopy Consultation—Digestive Department of Primary Hospital. Patients were selected for EMR/ESD after the application of clinical protocols. Thirty-six patients were selected (≥ 66 years with comorbidities and risk factors). Lesions were located mainly in the colon. Our solution presented an intestinal lift ≥ 60 min in EMR/ESD and a high expansion of tissue, optimum viscosity, and subsequent complete resorption. The genes S100A9 and TP53 presented an expression increase in the distal regions. TP53 and PCNA were the only genes whose expression was increased in polyp specimens vs. the surrounding tissue at the mRNA level. In EMR/ESD, our solution presented a prolonged effect at the intestinal level during all times of the intervention. Thus, our solution seems be an effective and safe alternative in cases of flat lesions in both techniques.
Highlights
Nowadays, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are the two most used techniques to remove gastrointestinal (GI) mucosal polyps
EMR enables a complete removal of suspect premalignant lesions with an efficacy greater than 90% [3]
The main objective of this study was to evaluate the efficacy and safety of a new solution for EMR and ESD used within a clinical protocol in patients with intestinal polyps
Summary
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are the two most used techniques to remove gastrointestinal (GI) mucosal polyps. In bigger lesions, which are resected in a piecemeal fashion (pEMR), ESD is more useful [4] This technique allows in bloc resection of superficial lesions, providing better histopathological diagnosis and decreasing the local recurrence rates [5,6,7]. In both techniques, submucosal injection solutions are used to delimit the area to be excised and to separate the lesion from the muscularis propria. Submucosal injection solutions are used to delimit the area to be excised and to separate the lesion from the muscularis propria This allows complete resection of the lesion, and avoids perforation risks, bleeding, and injury to the GI wall, favoring the rapid recovery of the patient [8,9]. The use of submucosal injection solutions is essential to ensure the effectiveness and safety of the intervention
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