Necessity of adding epinephrine to submucosal injection during endoscopic submucosal dissection

Abstract

Objective To investigate the necessity of adding epinephrine to submucosal injection during endoscopic submucosal dissection(ESD). Methods Patients with early cancer and precancerous lesions of digestive system were prospectively enrolled and underwent ESD when the lesion was 2 cm or more in diameter from December 2013 to January 2014. Patients were randomly divided into two groups, the experimental group(n=54)used saline and indigo carmine for submucosal injection, while the control group(n=47)used a mixed solution including saline, indigo carmine and epinephrine for submucosal injection. Several procedure-related indices and delayed complications were compared between groups. Results All the tumors in both groups were removed en bloc, and all resected lesions showed both lateral and deep tumor-free margins. The mean operation time was 39.4±22.0 min in the experimental group, and 41.5±18.7 in the control group. There were no statistical differences between two groups in the en bloc resection rate, complete resection rate, and mean operation time(all P>0.05). There were no intraoperative or delayed perforations in either group. In the experimental group, mild intraoperative bleeding occurred in 39 cases and moderate in 15 cases. In the control group, mild intraoperative bleeding occurred in 34 cases, moderate in 12 cases, and severe in 1 case. Delayed bleeding occurred in 1 case 3 days after ESD in the experimental group, while none happened in the control group. There were no statistical differences between two groups in intraoperative bleeding or delayed bleeding(P>0.05). Conclusion The therapeutic effect and complication rate are comparable regardless of addition of epinephrine to submucosal injection during ESD. Key words: Intestinal perforation; Epinephrine; Endoscopic submucosal dissection; Submucosal injection