医学
粘膜切除术
透明质酸钠
病变
外科
不利影响
生理盐水
切除术
内科学
作者
Hironori Yamamoto,Naohisa Yahagi,Tsuneo Oyama,Takuji Gotoda,Toshihiko Doi,Hirokazu Shoji,Tadakazu Shimoda,Kentaro Sugano,Hisao Tajiri,T Takekoshi,Daizo Saito
标识
DOI:10.1016/j.gie.2007.07.039
摘要
Sodium hyaluronate (SH) solution has been used for submucosal injection in endoscopic resection to create a long-lasting submucosal fluid "cushion."Our purpose was to assess the usefulness and safety of 0.4% SH solution in endoscopic resection.A prospective multicenter randomized controlled trial.Six referral hospitals in Japan.One hundred forty patients with 5- to 20-mm gastric intramucosal neoplastic lesions.Patients were randomized into 0.4% SH and control groups. Endoscopic resection was performed with 0.4% SH or normal saline solution for submucosal injection.The usefulness of 0.4% SH solution was assessed by en bloc complete resection and the formation and maintenance of mucosal lesion-lifting during endoscopic resection.(1) steepness of mucosal lesion lifting, (2) complications, (3) time required for mucosal resection, (4) volume of submucosal injection solution, and (5) ease of mucosal resection. Safety was assessed by analyzing adverse events during the study period.The usefulness rate was significantly higher for the 0.4% SH group (88.4%, 61/69) than for the control group (58.6%, 41/70). As secondary outcome measures, significant intergroup differences (P < .001) were noted for (1) steepness of mucosal lesion lifting, (2) volume of submucosal injection solution, and (3) ease of mucosal resection. No serious adverse events were encountered in either group.Lack of blinding. Safety was not a powered outcome measure.Using 0.4% SH as a submucosal injection solution in endoscopic resection enabled the formation and maintenance of sufficient mucosal lesion lifting for gastric intramucosal lesions, reducing the need for additional injections and simplifying mucosal resection. Use of 0.4% SH thus simplifies the complicated procedures involved in endoscopic resection.
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