Epinephrine in the submucosal injectate of no benefit for colorectal Endoscopic mucosal resection: study

Endoscopic mucosal resection (EMR) is an outpatient procedure that lets physicians remove tumours just beneath the gastrointestinal (GI) wall without surgery. Using an endoscope — a flexible, tube-like instrument — our gastroenterologists (physicians who specialize in treating the GI tract) can see inside the body with a high degree of detail. At the same time, they can remove growths such as upper GI or colon polyps that might otherwise require surgery.

EMR is the first-line therapy for colorectal laterally spreading lesions. Some colonoscopists include epinephrine in the submucosal injectate, which we observed increased post-procedure discomfort. Our aim was to determine whether the inclusion of epinephrine in the submucosal injectate increases postprocedure pain after EMR.

Researchers performed a randomized, controlled, double-blind trial comparing epinephrine in submucosal injectate versus injectate alone for abdominal pain at 30 and 60 minutes after EMR.

The Results of the study are:

The mean polyp diameter in both arms was >40 mm. There were no differences in procedure times or amounts of fluid injected. Mean pain was higher on a visual analog scale in the epinephrine group at 30 minutes (47 vs 14, P = .022) and at 60 minutes (44 vs 13, P = .035). Recovery room stay was longer in the epinephrine group (68 vs 53 minutes, P = .034).

Thus, the researchers concluded that epinephrine in the submucosal injectate for EMR increases postprocedural pain, which could cause diagnostic confusion and prolong observation time in the recovery area.

Reference:

Impact of including epinephrine in the submucosal injectate for colorectal EMR on postprocedural pain: a randomized controlled trial by Douglas K. Rex, et al. published in the Gastrointestinal Endoscopy.

https://www.giejournal.org/article/S0016-5107(21)01874-5/fulltext#