Application of sodium hyaluronate to endoscopic submucosal dissection

Objective To evaluate effects and safety of mixed solution of sodium hyaluronate, normal saline and indicarmine during endoscopic submucosal dissection (ESD). Methods A total of 233 patients with gastric, esophageal and colonic lesions diagnosed by endoscopy in the digestive endoscopy center of the First Affiliated Hospital of Soochow University between September 2015 and November 2016 were randomly divided into the experimental group (173 patients) and the control group (50 patients). The experimental group was injected with sodium hyaluronate 100 mg+ normal saline 60 mL+ 0.2% indicarmine 4 mL, and the control group with normal saline 70 mL+ 0.2% indicarmine 4 mL. The solutions were used for multi-point injection in submucosa outside markers of lesions, respectively, and ESD was performed until lesions were effectively lifted up. The location and size of lesions, operation time, dose of injection and the incidence of complications were compared between the two groups. Results The diameter of resected specimen was 1.9±1.3 cm in the experimental group, slightly less than that in the control group (2.0±1.8 cm, P>0.05). The operation time from lesion mark to the end of ESD in the experimental group was 59.5±26.7 min, significantly less than that in the control group (68.6±29.0 min, P<0.05). The dose of injection in the experimental group (55.5±31.8 mL) was obviously lower than that in the control group (66.7±35.1 mL, P<0.05). The rate of delayed bleeding in the experimental group was 1.16% (2/173), which was significantly lower than that in the control group [12.00%(6/50), P<0.05]. No delayed perforation occurred in the experimental group, while 3 cases (6.00%) occurred in the control group (P<0.05). Conclusion ESD shows better effects and high safety after the submucosal injection of mixed solution of sodium hyaluronate, normal saline and indicarmine. Key words: Endoscopic submucosal dissection; Submucosal injection; Sodium hyaluronate; Efficacy