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The Comparison Between Low- and High-Concentration Injection Solution Ability for Colorectal Endoscopic Submucosal
Naohisa Yoshida1, Ryohei Hirose1,2, Yoshikazu Inagaki3
1Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Low-concentration injection solution (LCS) was found to be noninferior and significantly faster than high-concentration injection solution (HCS) for colorectal endoscopic submucosal dissection (ESD) procedures. This study highlights LCS as an effective alternative for submucosal elevation in ESD.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Oncology
Background:
- Submucosal elevation is crucial for endoscopic submucosal dissection (ESD).
- Viscous solutions, categorized as low-concentration (LCS) or high-concentration (HCS) injection solutions, are utilized for this purpose.
- The comparative efficacy of LCS and HCS in colorectal ESD remains an area of investigation.
Purpose of the Study:
- To analyze the differences between low-concentration injection solution (LCS) and high-concentration injection solution (HCS) in colorectal endoscopic submucosal dissection (ESD).
- To evaluate the noninferiority of LCS compared to HCS regarding ESD procedure time.
Main Methods:
- A prospective, randomized controlled trial involving six Japanese institutions.
- Patients with early neoplastic lesions (≥20 mm) were randomized into HCS (0.6% sodium alginate) or LCS (0.3% sodium alginate) groups.
- The primary endpoint was the noninferiority of LCS compared to HCS in terms of ESD procedure time.
Main Results:
- The LCS group (79 cases) demonstrated noninferiority and a significantly shorter mean ESD procedure time (61.9 min) compared to the HCS group (82 cases, 76.9 min).
- No significant differences were observed in en bloc resection rates, perioperative perforation, or delayed bleeding between the groups.
- Subgroup analysis revealed significantly shorter ESD procedure times for LCS in lesions ≥40 mm and among expert endoscopists.
Conclusions:
- Low-concentration injection solution (LCS) is noninferior to high-concentration injection solution (HCS) for colorectal ESD.
- LCS significantly reduces the procedure time for colorectal ESD, offering a more efficient alternative.
- The findings support the use of LCS for improved efficiency in colorectal ESD procedures.
