The use of diluted epinephrine during gastric endoscopic submucosal dissection: an international randomized controlled trial.
Hon Chi Yip, Noriya Uedo, Hiroyoshi Iwagami et al.
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In 30 seconds
This international, multicentre, blinded randomised controlled trial compared submucosal injection solution with or without diluted epinephrine during endoscopic submucosal dissection (ESD) for gastric mucosal neoplasia. Of 800 enrolled patients, 774 were included in the modified intention-to-treat analysis. Mean procedure time was shorter with epinephrine than with control solution: 60 (46) versus 68 (45) minutes (P = .018). Epinephrine was also associated with fewer intraprocedural hemorrhages requiring hemostatic forceps, while postprocedural adverse events did not differ significantly between groups.
Key findings
- Mean procedure time was 60 (46) minutes with epinephrine versus 68 (45) minutes with control solution (P = .018).
- Mean intraprocedural hemorrhage count requiring hemostatic forceps was 1.8 with epinephrine versus 3.0 with control (P < .001).
- Postprocedural adverse events did not differ significantly between groups.
Why it matters
Intraprocedural bleeding can prolong gastric ESD. In this multicentre randomised trial, adding diluted epinephrine to the injection solution reduced procedure time and the need for hemostatic forceps, without a significant difference in postprocedural adverse events. These results provide comparative evidence about an injection-solution modification intended to limit bleeding during gastric ESD.