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The safety and efficacy of 2% vitamin C solution spray for relief of mucosal irritation caused by Lugol chromoendoscopy: a multicenter, randomized, double-blind, parallel trial

  • Author Footnotes
    ∗ Drs Jin, J. Wang, and Q. Zhan contributed equally to this work.
    Duochen Jin
    Footnotes
    ∗ Drs Jin, J. Wang, and Q. Zhan contributed equally to this work.
    Affiliations
    Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China

    First Clinical Medical College of Nanjing Medical University, Nanjing, China
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  • Author Footnotes
    ∗ Drs Jin, J. Wang, and Q. Zhan contributed equally to this work.
    Jun Wang
    Footnotes
    ∗ Drs Jin, J. Wang, and Q. Zhan contributed equally to this work.
    Affiliations
    Department of Gastroenterology and Hepatology, Jinhu County People’s Hospital, Huaian, China
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  • Author Footnotes
    ∗ Drs Jin, J. Wang, and Q. Zhan contributed equally to this work.
    Qiang Zhan
    Correspondence
    Reprint requests: Guoxin Zhang, Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, No. 300 of Guangzhou Road, Nanjing 210029, China.
    Footnotes
    ∗ Drs Jin, J. Wang, and Q. Zhan contributed equally to this work.
    Affiliations
    Department of Gastroenterology and Hepatology, Wuxi People’s Hospital Affiliated with Nanjing Medical University, Wuxi, China
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  • Keting Huang
    Affiliations
    Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China

    First Clinical Medical College of Nanjing Medical University, Nanjing, China
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  • Hui Wang
    Affiliations
    Department of Gastroenterology and Hepatology, Wuxi People’s Hospital Affiliated with Nanjing Medical University, Wuxi, China
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  • Guoqiang Zhang
    Affiliations
    Department of Gastroenterology and Hepatology, Wuxi People’s Hospital Affiliated with Nanjing Medical University, Wuxi, China
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  • Yinghong Xu
    Affiliations
    First Clinical Medical College of Nanjing Medical University, Nanjing, China

    Endoscopic Center, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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  • Jian Yao
    Affiliations
    Department of Gastroenterology and Hepatology, Jinhu County People’s Hospital, Huaian, China
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  • Rong Sun
    Affiliations
    Department of Gastroenterology and Hepatology, Jinhu County People’s Hospital, Huaian, China
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  • Qin Huang
    Affiliations
    Department of Pathology and Laboratory Medicine, Veterans Affairs Boston Healthcare System and Harvard Medical School, West Roxbury, Massachusetts, USA
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  • Feng Ye
    Affiliations
    Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China

    First Clinical Medical College of Nanjing Medical University, Nanjing, China
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  • Guoxin Zhang
    Affiliations
    Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China

    First Clinical Medical College of Nanjing Medical University, Nanjing, China
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  • Author Footnotes
    ∗ Drs Jin, J. Wang, and Q. Zhan contributed equally to this work.
Published:November 26, 2019DOI:https://doi.org/10.1016/j.gie.2019.11.028

      Background and Aims

      Lugol chromoendoscopy facilitates endoscopic visualization of esophageal dysplasia and carcinoma. Vitamin C solution (VCS) can theoretically neutralize free iodine, which causes mucosal irritation. The aim was to assess the safety and efficacy of VCS for relieving adverse symptoms caused by Lugol iodine staining.

      Methods

      Two hundred forty eligible patients were randomized to receive 20 mL of normal saline solution (NS), 5% sodium thiosulfate solution (STS), or 2% VCS after spraying 10 mL of 2% Lugol iodine solution on the mid-distal esophagus. The primary endpoints were statistically significant reductions in acute and late adverse symptom severity scores. The secondary endpoint was the discoloration effect on esophageal brown iodine-stained mucosa.

      Results

      Spraying both VCS and STS similarly decreased the severity scores of acute (NS vs VCS = 2.58 vs 1.61, P = .040; VCS vs STS = 1.61 vs 1.89, P > .999) and late (NS vs VCS = 1.70 vs 0.91, P = .002; VCS vs STS = 0.91 vs 1.38; P = .212) adverse symptoms after Lugol chromoendoscopy compared with spraying NS. Compared with STS spray, VCS spray alleviated acute acid regurgitation or heartburn (33% vs 15%, P = .017) and late retrosternal discomfort or pain (21% vs 9%, P = .027). Moreover, compared with spraying NS, spraying VCS quickly discolored the iodine-stained mucosa, with a better decolorization score (2.26 vs 3.56, P = .000), and the effects of fading iodine dye were similar between VCS and STS (3.56 vs 3.59, P = .908).

      Conclusions

      VCS can reduce mucosal irritation symptoms induced by Lugol chromoendoscopy and can be routinely recommended. (Chinese Clinical Trial Registry number: ChiCTR1900022000.)

      Abbreviations:

      HE (hematoxylin and eosin), NS (normal saline solution), STS (sodium thiosulfate solution), VCS (vitamin C solution)
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      Linked Article

      • Spraying vitamin C solution for relief of mucosal irritation caused by Lugol chromoendoscopy
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          We read with great interest the recent study by Jin et al,1 in which they evaluated the safety and efficacy of vitamin C solution (VCS) for relieving adverse symptoms caused by Lugol iodine staining. A previous study verified the feasibility and usefulness of 5% sodium thiosulfate solution (STS).2 This multicenter, randomized, double-blind study initially compared normal saline solution (NS), STS, and 2% VCS after spraying Lugol iodine solution to evaluate the acute and late adverse symptoms and the discoloration effect on esophageal mucosa stained brown by iodine.
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