Endoscopic mucosal resection using sodium hyaluronate

I~ackground: Circumferential mucosal incision around a lesion before snaring is one of the effective ways to make an outcome of endoscopic mucosal ~'esection (EMR) reliable.However, mucosal incision with a needle knife is considered to be difficult with a considerable risk of perforation even with ~ubmucosal injection of normal saline.We have been using sodium hyaluronate instead of normal saline for submucosal injection, which makes the mucosal incision with a needle knife easier and safer.Clinical outcome of EMR using sodium hyaluronate is evaluated.Patients and Methods: Between June 1998 and November 2000, EMR with circumferencial mucosal incision assisted by submucosal injection of sodium hyaluronate was performed on 118 early neoplastic lesions of stomach, colon and rectum (52 gastric lesions and 66 colorectal lesions).For those lesions, the size of the resected mucosa, the rates of successful en bloc resection, complications and residual lesions at follow-up were all assessed.Results: The size of the resected mucosa measured 28.4 mm (15 -62 mm) in average for 52 gastric lesions, and 26.8 mm (11 -65 mm) for 66 colorectal lesions.The rates of successful en bloc resections were 31135 ~88.6 %) for gastric mucosal resections smaller than 30 mm and 7/17 (41.2 %) for those larger or equal to 30 mm.The rates were 37/43 (86.0 %) for colorectal mucosal resections smaller than 30 mm and 8/23 (34.8 %) for those larger or equal to 30 mm.Follow-up endoscopy after three months revealed no residual lesions in the gastric cases (0/38, 0%) and only one residual lesion in colorectal cases (1/49, 2%).In the follow-up after one year, one recurrent lesion was found in 15 gastric cases (6.7 %) and another recurrent lesion in 26 colorectal cases (3.8%).All residual and recurrent lesions were found after piecemeal resections, and they were treated endoscopically.There were 2 major complications of perforation in colon cases.The both perforations occurred during snaring, and they were treated by laparoscopic closure and endoscopic clipping.Conclusions: EMR using sodium hyaluronate is a reliable method that has high success rates of en bloc resections for the resections up to 30 mm.There were no complications in mucosal incision with a needle knife by using sodium hyaluronate for submucosal injection.Snaring of a large mucosa carries a risk of perforation.Therefore, some methods other than snaring, such as submucosal incision with a needle knife, would be a better choice for en bloc mucosal resections larger than 30 mm.