Safety and Efficacy of Na Alginate and Mesna in Endoscopic Submucosal Dissection: A Systematic Review and Meta-analysis

American Society for Inclusion, Diversity, and Equity in Healthcare (ASIDE) 2025-04-22

Background: Sodium hyaluronate, commonly used in ESD, has drawbacks such as high cost and potential tumorigenesis. Sodium alginate (Na alginate) and Mesna offer promising alternative solutions with their viscoelastic and mucolytic properties. In this review we aimed to evaluate the safety and efficacy of Na alginate and Mesna solutions in ESD. Methods: A systematic search was conducted across multiple databases. Inclusion criteria were randomized controlled trials and observational studies assessing Na alginate and Mesna in ESD. Primary outcome included en-bloc resection rates. Secondary outcomes included adverse events such as perforation and delayed bleeding, and procedural time. Results: Eight studies involving 255 patients were included in this analysis. Overall en-bloc resection rate for sodium alginate was 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. Moreover, En-bloc resection rate for Mesna was 98% [95%CI: 92%-100%); I2: 0%]. 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 rate for 0.6% sodium alginate was 1% [95% CI (0%-5%); I2: 0%]. Conclusion: Na alginate (0.6%) and Mesna are effective and safe alternatives to sodium hyaluronate for submucosal injection in ESD. These solutions offer potential cost-effective and safer options for clinical practice, with Na alginate (0.6%) showing particularly low adverse event rates.

Mesna; Endoscopic Submucosal Dissection; Sodium Alginate; Na alginate; Gastroenterology; Surgical Techniques; Pharmacology; Gastrointestinal Oncology; Evidence-Based Medicine; info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion

Open access content. Open access content
Copyright (c) 2025 Hazem Abosheaishaa, Abdallfatah Abdallfatah , Imad Samman Tahhan, Abdelmalek Abdelghany , Iyiad Alabdul Razzak, Mohamed A. M. Amer , Ahmed Y. Azzam, Muhammed Amir Essibayi, Mahmoud Nassar, Omar Abdelhalim , Sherif Andrawes
https://creativecommons.org/licenses/by/4.0

application/pdf
application/pdf
English

ASIDE oai:ojs2.asidejournals.com:article/37
10.71079/ASIDE.GI.04222537
1523205072

AMERICAN SOC FOR INCLUSION DIVERSITY &
From OAIster®, provided by the OCLC Cooperative.

edsoai.on1523205072