The safety and efficacy in humans of endoscopic mucosal resection with hydroxypropyl methylcellulose as compared with normal saline

Abstract

Background and study aims: Endoscopic mucosal resection (EMR) is a therapeutic modality that utilizes fluid to form a submucosal fluid cushion (SFC) for the treatment of early gastrointestinal neoplasia. The goal of this study was to determine the safety and efficacy in humans of EMR with hydroxypropyl methylcellulose (HPMC) as compared with historical controls of EMR performed with normal saline.

Patients and methods: A retrospective cohort study presented data on EMR performed in 89 lesions in 88 patients was compared with 22 control EMRs performed with normal saline. Indications for EMR included known or suspected cancerous or precancerous lesions of the gastrointestinal tract. Efficacy of EMR was based on rates of complete excision and tumor recurrence.

Results: EMR was performed in 89 lesions with HPMC-EMR used in 67 lesions and compared with 22 historical control lesions treated with saline EMR by the same five endoscopists. Lesion size and location were similar in both HPMC and saline groups. Complications were observed in six patients [5/67 (8%) HPMC and 1/22 (5%) saline, p > 0.2]. Long-term follow-up with repeat endoscopy was available on 43 lesions and identified 35/43 to be completely excised [20/25 (80%) HPMC-EMR and 15/18 (83%) saline EMR, p > 0.2]. Size of the lesion was not associated with success.

Conclusion: Both HPMC and normal saline are effective agents for creating a submucosal cushion for EMR. Larger randomized studies are needed to determine statistically significant differences in efficacy.