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

Background: EMR 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 (D-50) plus E as a hypertonic, inexpensive, and inexpensive, and easily available solution might be an ideal alternative for producing and maintaining more-prolonged mucosal elevation. Objective: To evaluate D-50+E versus NS+E during an EMR of sessile rectosigmoid polyps (>10 mm). Design: A prospective, double-blind, randomized study that compared EMR by using either D-50+E or NS+E submucosal fluid cushions. Setting: Four tertiary endoscopic referral centers with 1370 polypectomies in 2006, performed by 5 experienced endoscopists. Patients: Patients treated for sessile rectosigmoid polyps (>10 mm). Interventions: Polypectomy with D-50+E or NS+E submucosal fluid cushions. Main Outcome Measurements: The duration of submucosal elevation, volume of solution, number of required injections to maintain the elevation, and observations for complications. Results: Ninety-two sessile rectosigmoid polyps were removed. Injected solution volumes and the number of injections to maintain submucosal elevation were lower in the D-50+E group than in the NS+E group (P = .033 and P + .28, respectively). Submucosal elevation had a longer duration in the D-50+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 D-50+E and NS+E groups, respectively (P = .01). Limitations: May be limited by inexperienced endoscopist's lack of injection and polypectomy skills. Conclusions: D-50+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.