Epinephrine boosts efficiency in gastric ESD

Epinephrine, known for its vasoconstrictive properties, is commonly used for managing haemorrhage. A recent international study explored the efficacy of an epinephrine-enhanced solution in the endoscopic submucosal dissection (ESD) of early gastric cancer treatment. The objective was to determine whether epinephrine could optimise ESD procedures by shortening operational times and reducing intra-operative bleeding.

Haemorrhage is an important adverse event of gastric ESD, potentially obscuring the view of the surgeon during the procedure. Some operators use epinephrine during gastric ESD due to its vasoconstrictive effects. However, no evidence is available to support the use of this substance for this purpose. Dr Hon Chi Yip (The Chinese University of Hong Kong, China) presented the findings of a double-blind, multicentre, randomised-controlled trial that evaluated the efficacy of epinephrine during gastric ESD [1].

The study involved 774 adults diagnosed with gastric mucosal neoplasia, excluding those with multiple lesions or on certain anticoagulants. Participants were divided into 2 groups: 1 received an epinephrine-added solution, and the control group did not. The study’s primary outcome was the duration of the procedure, from the initial mucosal incision to the completion of resection, and secondary outcomes included intra-operative haemorrhage and post-procedure adverse events.

The epinephrine-enhanced solution significantly reduced the procedure time (59.96 minutes in the epinephrine arm vs 68.06 minutes in the control arm; P=0.018) and the number of intra-operative bleeding episodes (mean 1.76 in the epinephrine arm vs 3.02 in the control arm; P<0.001). “The addition of epinephrin significantly shortened the procedural time by about 10% and reduced the need for intraoperative haemostasis,” said Dr Yip.

The study advocates for the routine inclusion of epinephrine in the injection solutions used in gastric ESD procedures, representing an advancement in the field.

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   1. Yip HC, et al. Epinephrine added solution significantly reduced procedural time during gastric endoscopic submucosal dissection (ESD) – results from an international double blinded multi-centre randomized controlled trial. LB11, UEG Week 2023, 14–17 October, Copenhagen, Denmark.

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Posted on 7 December 202321 May 2024