Vol. 1 No. 2 (2025), Original Article
Vol. 1 No. 2 (2025)

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

Original Article
Published 2025-04-22
Hazem Abosheaishaa
Internal Medicine Department, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals Queens, New York, NY, USA
https://orcid.org/0000-0002-5581-8702
Abdallfatah Abdallfatah
Internal Medicine Department, October 6 University, Cairo, Egypt image/svg+xml
https://orcid.org/0000-0002-5670-2234
Imad Samman Tahhan
Neurology and Neurosurgery Department, Medical University of South Carolina, Charleston, SC, USA
https://orcid.org/0009-0004-3778-1565
Abdelmalek Abdelghany
Internal Medicine Department, October 6 University, Cairo, Egypt image/svg+xml
https://orcid.org/0009-0002-5399-1795
Iyiad Alabdul Razzak
Internal Medicine Department, Alfaisal University, Riyadh, Saudi Arabia image/svg+xml
https://orcid.org/0009-0001-1489-2850
Mohamed A. M. Amer
Internal Medicine Department, Menoufia University, Menoufia, Egypt image/svg+xml
https://orcid.org/0009-0004-1455-8010
Ahmed Y. Azzam
Visiting Assistant Professor, SNU Medical Big Data Research Center, Seoul National University, Seoul, South Korea. image/svg+xml
https://orcid.org/0000-0002-4256-0159
Muhammed Amir Essibayi
Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, New York, NY, USA. image/svg+xml
https://orcid.org/0000-0001-8325-2382
Mahmoud Nassar
Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA. image/svg+xml
https://orcid.org/0000-0002-5401-9562
Omar Abdelhalim
Internal Medicine Department, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals Queens, New York, NY, USA image/svg+xml
https://orcid.org/0009-0004-7528-9045
Sherif Andrawes
Gastroenterology Department, Zucker School of Medicine at Hofstra/Northwell, Staten Island, New York, NY, USA image/svg+xml
https://orcid.org/0000-0002-7880-5410
ASIDE GI Issue 2
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Keywords

Mesna
Endoscopic Submucosal Dissection
Sodium Alginate
Na alginate

How to Cite

1.
Abosheaishaa H, Abdallfatah A, Samman Tahhan I, et al. Safety and Efficacy of Na Alginate and Mesna in Endoscopic Submucosal Dissection: A Systematic Review and Meta-analysis. ASIDE GI. 2025;1(2):10-15. doi:10.71079/ASIDE.GI.04222537
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Abstract

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.

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