Impact of including epinephrine in the submucosal injectate for colorectal EMR on post-procedural pain: A randomized controlled trial

Background and aims: Endoscopic mucosal resection (EMR) is first-line therapy for colorectal laterally spreading lesions. Some colonoscopists include epinephrine in the submucosal injectate, which the authors observed increased post-procedure discomfort. The aim of their study was to determine whether inclusion of epinephrine in the submucosal injectate increases post-procedure pain after EMR.
Methods: They 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.
Results: 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 = 0.022) and at 60 minutes (44 vs. 13, p = 0.035). Recovery room stay was longer in the epinephrine group (68 vs. 53 minutes, p = 0.034).

Conclusions: Epinephrine in the submucosal injectate for endoscopic mucosal resection increases post-procedural pain, which could cause diagnostic confusion and prolong observation time in the recovery area.

D.K. Rex, M.D., Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indiana University Hospital, Indianapolis, IN, USA

DOI: DOI: 10.1016/j.gie.2021.11.043

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