Endoscopy International Open (Jul 2020)

Usefulness of epinephrine-added injection solution to reduce procedure time for gastric endoscopic submucosal dissection

  • Shuntaro Inoue,
  • Noriya Uedo,
  • Takahiro Tabuchi,
  • Kentaro Nakagawa,
  • Masayasu Ohmori,
  • Hiroyoshi Iwagami,
  • Kenshi Matsuno,
  • Taro Iwatsubo,
  • Hiroko Nakahira,
  • Noriko Matsuura,
  • Satoki Shichijo,
  • Akira Maekawa,
  • Takashi Kanesaka,
  • Yoji Takeuchi,
  • Koji Higashino,
  • Ryu Ishihara

DOI
https://doi.org/10.1055/a-1192-4202
Journal volume & issue
Vol. 08, no. 08
pp. E1044 – E1051

Abstract

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Background and study aims Epinephrine-added submucosal injection solution is used to facilitate hemostasis of non-variceal upper gastrointestinal bleeding and to prevent delayed bleeding of large pedunculated colorectal lesions. However, its benefit in gastric endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is unclear. The effectiveness of epinephrine-added injection solution for outcomes of gastric ESD was examined using propensity score matching analysis. Patients and methods A total of 1,599 patients with solitary EGC (83 with non-epinephrine-added solution and 1,516 with epinephrine-added solution) between 2011 and 2018 were enrolled. Propensity scores were calculated to balance the distribution of baseline characteristics: age, sex, tumor location, specimen size, presence of ulcer scar, tumor depth, histological tumor type, and operators’ experience, and 1:3 matching was performed. En bloc resection rate, mean procedure time, delayed bleeding rate, and perforation rate were compared between the non-epinephrine (n = 79) and epinephrine (n = 237) groups. Results Mean procedure time was significantly shorter in the epinephrine group than in the non-epinephrine group (60 vs. 78 min, P < 0.001). No significant difference was found in the rate of en bloc resection (both 99 %), incidence of delayed bleeding (both 6 %), or perforation (0 vs. 0.8 %) between the two groups. In multiple linear regression analysis, use of epinephrine-added solution was independently associated with short procedure time (P < 0.001) after adjustment for other covariates. Conclusion The results suggest that epinephrine-added injection solution is useful for reduction of gastric ESD procedure time, warranting validation in a randomized controlled trial.