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Hydroxypropyl methylcellulose: A better submucosal fluid cushion for endoscopic mucosal resection
Arnaldo B Feitoza1, Christopher J Gostout, Lawrence J Burgart
1Developmental Endoscopy Unit, Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA.
Gastrointestinal Endoscopy
|January 9, 2003
Summary
Hydroxypropyl methylcellulose effectively creates durable submucosal fluid cushions for gastrointestinal procedures. This low-cost option offers a viable alternative to existing, more expensive solutions, with minimal tissue reaction observed.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Biomaterials Science
Background:
- Submucosal fluid cushions are essential for endoscopic mucosal resection and polyp removal.
- Current solutions for creating these cushions are either short-lived or expensive.
- Investigating novel, cost-effective materials for submucosal injection is crucial.
Purpose of the Study:
- To evaluate the feasibility and durability of submucosal fluid cushions created with hydroxypropyl methylcellulose (HPMC).
- To assess the histologic response to HPMC injection in the esophageal submucosa.
- To compare HPMC as a low-cost alternative for submucosal injection.
Main Methods:
- Submucosal fluid cushions were created using HPMC in 36 esophageal sites in 12 pigs.
- Two groups were established: Group I (HPMC + tattoo) and Group II (HPMC + suture marker).
- Cushion duration was measured, followed by endoscopic, necropsy, and histologic assessment after 7 days.
Main Results:
- Mean cushion duration was approximately 36-38 minutes in both groups.
- Endoscopic and necropsy evaluations revealed normal mucosa after 1 week.
- Histologic analysis showed minimal alterations in 92% of sites; tattoo sites in Group I had higher inflammatory reactions.
Conclusions:
- Hydroxypropyl methylcellulose provides a long-lasting submucosal fluid cushion with minimal tissue reaction.
- HPMC is a cost-effective option for submucosal fluid cushion creation in GI endoscopy.
- Careful consideration of tattooing methods is advised for subsequent histologic analysis.