A comparative study of 50% dextrose and normal saline solution on their ability to create submucosal fluid cushions for endoscopic resection of sessile rectosigmoid polyps

BackgroundEMR traditionally performed by using normal saline solution (NS) plus epinephrine (E) as a submucosal fluid cushion does not maintain the submucosal elevation for a prolonged time. It was hypothesized that 50% dextrose (D50) plus E as a hypertonic, inexpensive, and easily available solution might be an ideal alternative for producing and maintaining more-prolonged mucosal elevation.ObjectiveTo evaluate D50+E versus NS+E during an EMR of sessile rectosigmoid polyps (>10 mm).DesignA prospective, double-blind, randomized study that compared EMR by using either D50+E or NS+E submucosal fluid cushions.SettingFour tertiary endoscopic referral centers with 1370 polypectomies in 2006, performed by 5 experienced endoscopists.PatientsPatients treated for sessile rectosigmoid polyps (>10 mm).InterventionsPolypectomy with D50+E or NS+E submucosal fluid cushions.Main Outcome MeasurementsThe duration of submucosal elevation, volume of solution, number of required injections to maintain the elevation, and observations for complications.ResultsNinety-two sessile rectosigmoid polyps were removed. Injected solution volumes and the number of injections to maintain submucosal elevation were lower in the D50+E group than in the NS+E group (P = .033 and P = .028, respectively). Submucosal elevation had a longer duration in the D50+E group (P = .043). This difference mainly included large (≥20 mm) and giant (>40 mm) polyps. There were 6 and 1 cases of postpolypectomy syndrome in the D50+E and NS+E groups, respectively (P = .01).LimitationsMay be limited by inexperienced endoscopist's lack of injection and polypectomy skills.ConclusionsD50+E is superior to NS+E for an EMR, particularly in large and giant sessile polyps, but the risk of thermal tissue injury should be considered.