Unsuspected efficacy of starch-based polysaccharide vs crystalloid-oil emulsion for lifting in colonic endoscopic resections.

Abstract

Background: In endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), submucosal lifting agents such as crystalloid-oil emulsion solution (COES) are used for improved effect. Starch-based polysaccharide solution (SPS), which in powder form acts as effective hemostatic agent, are now available as an alternative lifting agent.

Aim: To compare SPS to COES outcomes as lifting agents in colonic EMR and ESD.

Methods: This is a retrospective study of patients who underwent colonic EMR or ESD and received submucosal injection of either SPS or COES at a single academic center from March 2021 to November 2023. A total of 79 patients were included in the COES group and 99 patients in the SPS group from chart review. Intraprocedural bleeding was defined as bleeding during a procedure requiring hemostatic intervention. Adverse events included were perforation or post-procedure gastrointestinal bleed within the first 30-day period. Data were analyzed using t-test and χ ² test.

Results: Successful resection was achieved in all 178 patients. Average lesion size in SPS group was 2.6 cm vs 2.4 cm in COES group. Average procedure time was 22 minutes shorter in the SPS group (P < 0.05). Intraprocedural bleeding was 24.1% more frequent in COES group (P < 0.01). The 30-day adverse events were 9.37% more frequent in the COES group (P < 0.01). En bloc resection was achieved 22.2% more frequently in patients receiving SPS submucosal injection (P < 0.01).

Conclusion: SPS colonic submucosal injection appears to be beneficial over COES, as it is associated with lower intraprocedural bleeding, less adverse events, shorter procedures, and more frequent en bloc resections.