Efficacy and Safety of Sodium Alginate as an Injection Solution in Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: The increasing incidence of gastrointestinal (GI) tumors, such as colorectal and esophageal cancers, highlights the need for effective treatment methods. Endoscopic submucosal dissection (ESD) has emerged as a preferred technique due to its low local recurrence rates. This study evaluates the safety and efficacy of sodium alginate as a submucosal injection solution in ESD. Methods: A systematic search of Embase, Scopus, Web of Science, Medline, and Cochrane databases up to April 17, 2034, identified randomized controlled trials (RCTs) and observational studies on sodium alginate for ESD in GI adenomas and early-stage neoplastic lesions. Data extraction and analysis were independently conducted by 2 reviewers, with consensus resolving discrepancies. Statistical analyses were performed with Comprehensive Meta-analysis software. Results: Five studies involving 255 patients were included in this analysis. Overall en-bloc resection rates for sodium alginate were 97% [95% CI (93%-99%); I2:0%]. En-bloc resection subgroup analysis revealed 97% [95% CI (93%-99%); I2:0%] for 0.6% sodium alginate and 95% [95% CI (70%-99%); I2: 0%] for 0.4% sodium alginate. Delayed bleeding rates for sodium alginate were 5% [95% CI (1%-20%); I2: 65.2%]; however, after subgroup analysis delayed bleeding was 2% [95% CI (1%-6%); I2: 0%] for 0.6% sodium alginate and 22% [95% CI (8%-49%); I2:0%] for 0.4% sodium alginate. Perforation rates for 0.6% sodium alginate were 1% [95% CI (0%-5%); I2: 0%]. Procedure times were 60.86 minutes [95% CI (45.06-76.67); I2: 85.31%] for sodium alginate, 45.77 minutes [95% CI (32.94-58.59); I2:80.71% ] for 0.6% sodium alginate, 85.38 minutes [95% CI (61.29-109.47); I2:24.90%] for 0.4% sodium alginate. Conclusion: This study demonstrates that sodium alginate is an effective and safe submucosal injection solution for ESD, offering several advantages over traditional solutions. Sodium alginate provides higher en-bloc resection rates and lower adverse event rates, along with a reliable submucosal cushion that enhances mucosal elevation and stability during ESD. Its properties, including excellent water retention and viscoelasticity, contribute to better mucosal elevation. Injectable sodium alginate hydrogels (ISAHs) also exhibit self-healing abilities and antioxidant activity. Additionally, sodium alginate is cost-effective and has a proven safety profile. These findings suggest sodium alginate, especially at a 0.6% concentration, is a viable and effective alternative for ESD procedures. (Figure Presented).

Volume

119

Issue

10

First Page

S1104

Last Page

S1105

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