methylcellulose and Rectal-Diseases

Endoscopic mucosal resection (EMR) is today the treatment of choice for flat and sessile colorectal lesion, the only concern being completeness of resection. One of the major issues is the choice of the infiltrating substance to enable a long-lasting cushion under the lesion. The aim of this study was to prospectively evaluate safety and efficacy of hydroxy-propyl-methyl-cellulose (HPMC) injection for this purpose.. All flat and sessile lesions of the colon and rectum larger than 20 mm and considered suitable for EMR were included. In all cases 0.8% HPMC solution was injected through a 23G needle, in quantity according to the endoscopist's indication. Primary endpoints of the study were: (1) ability to perform en bloc resection of the lesions by using this new injection means, (2) complete resection rate, and (3) early and late complication rate.. We resected 27 flat, sessile, or laterally spreading lesions up to 60 mm (28 mm average). Mean dose of HPMC injected was 10.2 ml (range 8-40 ml). Median procedure time was 32 min (range 15-105 min). En bloc resection was achieved in up to 21 cases (78%). Histologically detected complete tumour removal was achieved in 23 lesions, whereas lateral margins could not be properly evaluated in 4 cases due to coagulation artefacts. No perforation was observed. Procedural spurting bleeding was managed by epinephrine injection in one case and clip application in the remaining. Two case of local recurrence of adenomatous tissue were observed at 3 and 12 months, and treated by EMR. No complication related to the use of HPMC was observed.. Injection of HPMC for EMR resulted safe and effective, allowing en bloc resection in the majority of cases with a limited number of complications. Continued progress in the field will include more outcomes research and techniques simplification.

Topics: Aged; Aged, 80 and over; Colonic Polyps; Colonoscopy; Dissection; Female; Humans; Hypromellose Derivatives; Intestinal Polyps; Male; Methylcellulose; Middle Aged; Pharmaceutical Solutions; Rectal Diseases; Treatment Outcome

Assessment of 3 different rectal contrast agents (water, methylcellulose, ultrasound gel) for their suitability for colorectal imaging in multislice CT (MS-CT).. 115 patients with colorectal diseases underwent MS-CT with varying, rectal contrast agents in a prospective study. Images were assessed by 2 independent CT-experienced radiologists. 6 criterias were evaluated, using a 5-point scale.. Methylcellulose (MC) proved to be significantly superior to ultrasound gel (US). Especially, differentiation of healthy and diseased bowel and bowel wall and lumen were aided, which was proven by quantitative analysis of attenuation values. Rectal distension is greater using MC or US than for water. More proximal parts of the colon could be better distended with water. The interobserver correlation was good (kappa 0.76).. Rectal filling with MC significantly improves diagnostic confidence in colorectal examinations. Ease of administration and lack of problems suggest its use as a clinical routine tool.

Topics: Adult; Aged; Aged, 80 and over; Colitis, Ulcerative; Colonic Diseases; Colorectal Neoplasms; Contrast Media; Crohn Disease; Female; Gels; Humans; Male; Methylcellulose; Middle Aged; Observer Variation; Prospective Studies; Radiography, Abdominal; Rectal Diseases; Tomography, X-Ray Computed; Water