Unsuspected efficacy of starch-based polysaccharide vs crystalloid-oil emulsion for lifting in colonic endoscopic resections

doi:10.4253/wjge.v17.i9.109396

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World Journal of Gastrointestinal Endoscopy

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1948-5190

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World J Gastrointest Endosc. Sep 16, 2025; 17(9): 109396
Published online Sep 16, 2025. doi: 10.4253/wjge.v17.i9.109396

Unsuspected efficacy of starch-based polysaccharide vs crystalloid-oil emulsion for lifting in colonic endoscopic resections

Sartajdeep Kahlon, Amer Alsamman, Jiten Desai, Shiro Urayama

Sartajdeep Kahlon, Amer Alsamman, Jiten Desai, Shiro Urayama, Division of Gastroenterology and Hepatology, Department of Internal Medicine, UC Davis Medical Center, Sacramento, CA 95817, United States

Author contributions: Kahlon S, Alsamman A, and Desai J were responsible for data collection and analysis; Kahlon S and Urayama S were responsible for conception and design; Kahlon S, Alsamman A, Desai J, and Urayama S were responsible for writing and editing; all authors have read and approved the final manuscript.

Institutional review board statement: This study was reviewed and determined to be exempt by the UC Davis Institutional Review Board (No. 1982596-1) on November 22, 2022, under category Exempt 4(iii), flex.

Informed consent statement: Patient consent was waived by the Institutional Review Board, as the research met the criteria for minimal risk and involved retrospective data collection only, consistent with Health Insurance Portability and Accountability Act regulations.

Conflict-of-interest statement: The authors declare no conflicts of interest relevant to this study.

Data sharing statement: The data supporting the findings of this study are not publicly available due to privacy and institutional restrictions. Reasonable requests for access to de-identified data may be considered by the corresponding author, in compliance with institutional and Institutional Review Board guidelines.

Corresponding author: Shiro Urayama, MD, Professor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, UC Davis Medical Center, 4150 V Street Suite 3500, Sacramento, CA 95817, United States. surayama@ucdavis.edu

Received: May 12, 2025
Revised: May 30, 2025
Accepted: August 20, 2025
Published online: September 16, 2025
Processing time: 125 Days and 12 Hours

Abstract

BACKGROUND

In endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), submucosal lifting agents such as crystalloid-oil emulsion solution (COES) are used for improved effect. Starch-based polysaccharide solution (SPS), which in powder form acts as effective hemostatic agent, are now available as an alternative lifting agent.

AIM

To compare SPS to COES outcomes as lifting agents in colonic EMR and ESD.

METHODS

This is a retrospective study of patients who underwent colonic EMR or ESD and received submucosal injection of either SPS or COES at a single academic center from March 2021 to November 2023. A total of 79 patients were included in the COES group and 99 patients in the SPS group from chart review. Intraprocedural bleeding was defined as bleeding during a procedure requiring hemostatic intervention. Adverse events included were perforation or post-procedure gastrointestinal bleed within the first 30-day period. Data were analyzed using t-test and χ² test.

RESULTS

Successful resection was achieved in all 178 patients. Average lesion size in SPS group was 2.6 cm vs 2.4 cm in COES group. Average procedure time was 22 minutes shorter in the SPS group (P < 0.05). Intraprocedural bleeding was 24.1% more frequent in COES group (P < 0.01). The 30-day adverse events were 9.37% more frequent in the COES group (P < 0.01). En bloc resection was achieved 22.2% more frequently in patients receiving SPS submucosal injection (P < 0.01).

CONCLUSION

SPS colonic submucosal injection appears to be beneficial over COES, as it is associated with lower intraprocedural bleeding, less adverse events, shorter procedures, and more frequent en bloc resections.

Keywords: Submucosal injections; Endoscopic mucosal resection; Endoscopic submucosal dissection; Therapeutic colonoscopy; Complex polypectomy

Core Tip: This retrospective study compares starch-based polysaccharide solution (SPS) and crystalloid-oil emulsion solution (COES) as submucosal lifting agents in colonic endoscopic mucosal resection and endoscopic submucosal dissection. SPS use was associated with shorter procedure times, significantly less intraprocedural bleeding, fewer adverse events, and higher en bloc resection rates compared to COES. These findings support the potential dual role of SPS as both an effective lifting and hemostatic agent.