Skip to main content

Advertisement

SpringerLink
Log in

Multicenter study of endoscopic mucosal resection using 0.13 % hyaluronic acid solution of colorectal polyps less than 20 mm in size

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Endoscopic mucosal resection (EMR) of colorectal polyps should be curative and safe. This study aimed to determine the efficacy and safety of colorectal EMR using 0.13 % hyaluronic acid (HA) solution.

Methods

This was a single-armed multicenter prospective open trial conducted at 11 Japanese institutions. Lesion characteristics and various measures of clinical outcome, including en bloc resection, histopathologically complete resection, and postoperative bleeding were analyzed for 624 consecutive patients who underwent EMR of colorectal polyps at ≤20 mm in size from August 2010 to September 2011.

Results

En bloc and complete resection were achieved in 93.3 and 78.3 % of 624 lesions. The median EMR procedure time was 2.1 ± 1.5 min. The rates of postoperative bleeding and perforation were 1.1 and 0 %. The rate of en bloc resection was higher for polyps at 5–10 mm than for polyps at 11–20 mm (95.1 vs. 85.1 %; P < 0.001) and was higher for protruding polyps than for superficial polyps (94.5 vs. 87.1 %; P < 0.05). The rate of en bloc resection was also higher for polyps in the left-side colon than for those in the right-side colon or rectum (96.7 vs. 91.6 vs. 90.8 %; P < 0.05). Multivariate analysis showed that polyp at 11–20 mm in size and location not on the left-side colon was significantly independent risk factors for failure of en bloc resection.

Conclusion

EMR using 0.13 % HA of colorectal polyps less than 20 mm in size had high rates of en bloc and complete resection and few complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bosman FT, Carneiro F, Fausto N et al (2010) WHO classification of tumours of the digestive system, 4th edn. WHO Press, Lyon

    Google Scholar 

  2. Fujishiro M, Yahagi N, Kashimura K et al (2004) Comparison of various submucosal injection solutions for maintaining mucosal elevation during endoscopic mucosal resection. Endoscopy 36:579–583

    Article  PubMed  CAS  Google Scholar 

  3. Hirasaki S, Kozu T, Yamamoto H et al (2009) Usefulness and safety of 0.4 % sodium hyaluronate solution as a submucosal fluid "cushion" for endoscopic resection of colorectal mucosal neoplasms: a prospective multi-center open-label trial. BMC Gastroenterol 9:1

    Article  PubMed  Google Scholar 

  4. Hurlstone DP, Fu KI, Brown SR et al (2008) EMR using dextrose solution versus sodium hyaluronate for colorectal Paris type I and 0-II lesions: a randomized endoscopist-blinded study. Endoscopy 40:110–114

    Article  PubMed  CAS  Google Scholar 

  5. Hyun JJ, Chun HR, Chun HJ et al (2006) Comparison of the characteristics of submucosal injection solutions used in endoscopic mucosal resection. Scand J Gastroenterol 41:488–492, 2006

    Article  PubMed  CAS  Google Scholar 

  6. Isomoto H, Nishiyama H, Yamaguchi N et al (2009) Clinicopathological factors associated with clinical outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy 41:679–683

    Article  PubMed  CAS  Google Scholar 

  7. Japanese Society for Cancer of the Colon and Rectum, editor (2009) Japanese classification of colorectal carcinoma. 2nd English ed. Kanehara & Co., Ltd., Tokyo

  8. Lee SH, Cho WY, Kim HJ et al (2004) A new method of EMR: submucosal injection of a fibrinogen mixture. Gastrointest Endosc 59:220–224

    Article  PubMed  Google Scholar 

  9. Moss A, Bourke MJ, Kwan V et al (2010) Succinylated gelatin substantially increases en bloc resection size in colonic EMR: a randomized, blinded trial in a porcine model. Gastrointest Endosc 71:589–595

    Article  PubMed  Google Scholar 

  10. Oka S, Tanaka S, Kanao H et al (2010) Current status in the occurrence of postoperative bleeding, perforation and residual/local recurrence during colonoscopic treatment in Japan. Dig Endosc 22:376–380

    Article  PubMed  Google Scholar 

  11. Puli SR, Kakugawa Y, Gotoda T et al (2009) Meta-analysis and systemic review of colorectal endoscopic mucosal resection. World J Gastroenterol 15:4273–4277

    Article  PubMed  Google Scholar 

  12. Saito Y, Uraoka T, Yamaguchi Y et al (2010) A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 72:1217–1225

    Article  PubMed  Google Scholar 

  13. Tanaka S, Haruma K, Oka S et al (2001) Clinicopathological features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm. Gastrointest Endosc 54:62–66

    Article  PubMed  CAS  Google Scholar 

  14. Uraoka T, Fujii T, Saito Y et al (2005) Effectiveness of glycerol as a submucosal injection for EMR. Gastrointest Endosc 61:736–740

    Article  PubMed  Google Scholar 

  15. Varadarajulu S, Tamhane A, Slaughter RL (2006) Evaluation of dextrose 50 % as a medium for injection-assisted polypectomy. Endoscopy 38:907–912

    Article  PubMed  CAS  Google Scholar 

  16. Walsh RM, Ackroyd FW, Shellito PC (1992) Endoscopic resection of large sessile colorectal polyps. Gastrointest Endosc 38:303–309

    Article  PubMed  CAS  Google Scholar 

  17. Yamamoto H, Yube T, Isoda N et al (1999) A novel method of endoscopic mucosal resection using sodium hyaluronate. Gastrointest Endosc 50:251–256

    Article  PubMed  CAS  Google Scholar 

  18. Yoshida N, Wakabayashi N, Kanemasa K et al (2009) Endoscopic submucosal dissection for colorectal tumors: technical difficulties and rate of perforation. Endoscopy 41:758–761

    Article  PubMed  CAS  Google Scholar 

  19. Yoshida N, Naito Y, Yagi N et al (2010) Safe procedure in endoscopic submucosal dissection for colorectal tumors focused on preventing complications. World J Gastroenterol 16:1688–1695

    Article  PubMed  Google Scholar 

  20. Yoshida N, Naito Y, Kugai M et al (2011) Efficacy of hyaluronic acid in endoscopic mucosal resection for colorectal tumors. J Gastroenterol Hepatol 26:286–291

    Article  PubMed  Google Scholar 

  21. Yoshida N, Naito Y, Inada Y et al (2012) Efficacy of endoscopic mucosal resection with 0.13 % hyaluronic acid solution for colorectal polyps: a randomized controlled trial. J Gastroenterol Hepatol 27:1377–1383

    Article  PubMed  Google Scholar 

  22. Yoshida N, Naito Y, Yagi N et al (2012) Importance of histological evaluation in endoscopic resection of early colorectal cancer. World Journal of Gastrointestinal Pathophysiology 3:51–59

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Dr. Eiko Imamoto, Dr. Kengo Takimoto, Dr. Kazuyuki Toyoda, and all doctors helping the current study in Kyoto Prefectural University of Medicine and other ten participating institutions.

Financial support

None

Potential competing interests

None

Author information

Authors and Affiliations

  1. Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Naohisa Yoshida, Yuji Naito, Yutaka Inada, Munehiro Kugai, Nobuaki Yagi & Toshikazu Yoshikawa

  2. Department of Gastroenterology, Kyoto Yosanoumi Hospital, Kyoto, Japan

    Ken Inoue

  3. Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto, Japan

    Takashi Okuda

  4. Department of Gastroenterology, Ayabe City Hospital, Kyoto, Japan

    Daisuke Hasegawa

  5. Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan

    Kazuyuki Kanemasa

  6. Department of Gastroenterology, Nishijin Hospital, Kyoto, Japan

    Kassai Kyoichi

  7. Department of Gastroenterology, Takeda General Hospital, Kyoto, Japan

    Kiichi Matsuyama

  8. Department of Gastroenterology, Social Insurance Kyoto Hospital, Kyoto, Japan

    Takashi Ando

  9. Department of Gastroenterology, Gakken City Hospital, Kyoto, Japan

    Toshiki Takemura

  10. Department of Gastroenterology, Osaka General Hospital of West Railway Company, Osaka, Japan

    Seiji Shimizu

  11. Department of Gastroenterology, Otsu City Hospital, Shiga, Japan

    Naoki Wakabayashi

  12. Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan

    Akio Yanagisawa

Authors
  1. Naohisa Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yuji Naito
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yutaka Inada
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Munehiro Kugai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nobuaki Yagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ken Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takashi Okuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daisuke Hasegawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kazuyuki Kanemasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kassai Kyoichi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kiichi Matsuyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Takashi Ando
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Toshiki Takemura
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Seiji Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Naoki Wakabayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Akio Yanagisawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Toshikazu Yoshikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Naohisa Yoshida.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yoshida, N., Naito, Y., Inada, Y. et al. Multicenter study of endoscopic mucosal resection using 0.13 % hyaluronic acid solution of colorectal polyps less than 20 mm in size. Int J Colorectal Dis 28, 985–991 (2013). https://doi.org/10.1007/s00384-012-1631-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-012-1631-3

Keywords

Search

Navigation