Endoscopic mucosal resection with an over-the-counter hyaluronate preparation

BackgroundHyaluronic acid (HA) provides a long-lasting and distinct mucosal elevation for EMR, but expense and inconvenience have limited its adoption.ObjectiveTo evaluate the safety and efficacy of an over-the-counter 0.15% HA preparation for EMR.DesignRetrospective study.SettingVeterans Administration Hospital and university hospital.Patients30 patients with a total of 32 colonic lesions and 1 duodenal lesion.InterventionEMR by using HA.Main Outcome MeasurementsEn bloc resection rate and complications.ResultsEMR was successful in all cases. En bloc resection was achieved in 26 of the 28 lesions up to 25 mm in diameter. Two lesions, both with fibrosis from prior attempted resection, had trace residual tissue necessitating cauterization with argon plasma. Five lesions measuring 30 mm to 60 mm all required piecemeal resection. There was one complication, a postpolypectomy bleed.LimitationsSmall number of patients and retrospective design.ConclusionsEMR may be performed safely and effectively by using an inexpensive, over-the-counter 0.15% HA preparation. Further studies are needed to verify the results of this study and to compare the safety and efficacy of this HA preparation with saline solution.