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Use of Saline in Colorectal Endoscopic Mucosal Resection: A Safety Analysis

By: Joshua Swore
Posted: Wednesday, February 12, 2020

A Japanese retrospective study published in BMC Gastroenterology has confirmed the safe use of epinephrine/saline and hypertonic saline with colonic endoscopic mucosal resection in patients taking antithrombotic agents. Although endoscopic mucosal resection is an increasingly common procedure in this patient population, a study investigating the safety of using submucosal saline had yet to be done. The study, which was conducted by Daisuke Yamaguchi, MD, PhD, of Ureshino Medical Center, Japan, and colleagues, demonstrated the safety of both saline solutions.

A total of 204 patients taking the antithrombotic agents aspirin, warfarin, or clopidogrel were enrolled in the study. All patients underwent colonic endoscopic mucosal resection with either epinephrine/saline (n = 102) or 10% hypertonic saline (n = 102) from April 2012 to March 2018 at Ureshino Medical Center. Groups were sex- and age-matched; the median age of patients in both groups was 73.7 years, and 84 patients in both groups were men (82.4%).

The researchers found no significant differences between the use of hypertonic saline and epinephrine/saline, with similar en bloc resection rates of 95.0% in those who received epinephrine/saline and 97.5% in those given hypertonic saline. In addition, there was no significant difference in adverse effects for both groups. The incidence of immediate bleeding was 7.5% and 2.5%, respectively, and the post–endoscopic mucosal resection bleeding incidence was 8.8% and 3.8%, respectively. No perforations or cerebrovascular events were reported, and the mortality rate was 0% in both groups.

Lastly, the authors investigated the risk factors associated with immediate and post-resection bleeding. They found that polyp size greater than 10 mm alone increased the risk of immediate bleeding (odds ratio = 12.1; 95% confidence interval = 2–74; P = .).

Disclosure: The study authors reported no conflicts of interest.



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