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Submucosal Injection Solutions for Colon Polypectomy

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Colon Polypectomy

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Abstract

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are usually performed through the injection of a fluid agent into the submucosal space in order to render polypectomy easier and safer (“inject-and-cut” technique).

Normal saline (NS) solution is most commonly used in clinical practice because of its low cost and ease of use, but it often requires repeated injections due to its rapid absorption into the surrounding tissue, thus increasing the risk of piecemeal resection and theoretically hampering the overall efficacy of the procedure.

This aspect pushed the endoscopy community to test various submucosal injection solutions such as hyaluronic acid (HA), glycerol, dextrose water (DW), fibrinogen mixture (FM), polidocanol, and hydroxypropyl methylcellulose (HPMC).

Many of these substances are able to create a longer-lasting submucosal cushion and potentially to allow lengthier procedures and increase the rate of en bloc resection even for large lesions.

However, despite the promising results of the preliminary reports, their efficacy in preventing the main complication after polypectomy, namely, postpolypectomy bleeding (PPB), is still a matter of debate.

An ideal submucosal injection solution should be inexpensive, readily available, nontoxic, and easy to prepare and inject and should provide a long-lasting submucosal cushion. It should also provide a sufficiently high submucosal elevation to facilitate en bloc resection and reduce the risk of perforation.

Unfortunately, none of the substances tested so far seem to fulfill all these features.

The aim of this chapter is to provide an updated overview on this important topic and to address recent advances in this field. The physical characteristics of various submucosal injection solutions are also described.

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  1. Gastroenterology Unit, Department of Medical Sciences, University of Foggia, AOU Ospedali Riuniti, Viale Pinto, 1, 71100, Foggia, Italy

    Antonio Facciorusso & Nicola Muscatiello

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  1. Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy

    Antonio Facciorusso

  2. Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy

    Nicola Muscatiello

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Facciorusso, A., Muscatiello, N. (2018). Submucosal Injection Solutions for Colon Polypectomy. In: Facciorusso, A., Muscatiello, N. (eds) Colon Polypectomy. Springer, Cham. https://doi.org/10.1007/978-3-319-59457-6_7

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