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Tissue damage of different submucosal injection solutions for EMR
Mitsuhiro Fujishiro1, Naohisa Yahagi, Koji Kashimura
1Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Japan.
Gastrointestinal Endoscopy
|November 23, 2005
Summary
Hypertonic submucosal injection solutions, except Glyceol, can cause tissue damage during EMR. A combination of hyaluronic acid (HA) and Glyceol is recommended for safe and effective endoscopic mucosal resection.
Area of Science:
- Gastroenterology
- Endoscopic Procedures
- Surgical Materials Science
Background:
- Choosing submucosal injection solutions for Endoscopic Mucosal Resection (EMR) requires balancing tissue damage and lesion-lifting ability.
- Assessing the potential for tissue damage from various submucosal injection solutions is crucial for optimizing EMR outcomes.
Purpose of the Study:
- To evaluate the potential tissue damage caused by different submucosal injection solutions used in Endoscopic Mucosal Resection (EMR).
- To determine tolerable concentrations of dextrose water (DW) that do not cause significant tissue damage.
Main Methods:
- Tested solutions included normal saline (NS), hypertonic saline (3.75% NaCl), various concentrations of dextrose water (5%-50%), Glyceol (10% glycerin), and two hyaluronic acid (HA) solutions.
- Solutions were injected endoscopically into the submucosal layer of minipig stomachs, with observations at 30 minutes and one week post-injection.
Main Results:
- Normal saline, 5% and 10% DW, Glyceol, and both HA solutions showed no apparent tissue damage.
- Hypertonic solutions, including 3.75% NaCl and DW concentrations of 20% or higher, caused significant tissue damage, potentially impacting EMR specimen quality and ulcer healing.
Conclusions:
- Hypertonic solutions, with the exception of Glyceol, are not recommended due to their potential for causing tissue damage.
- A combination of hyaluronic acid (HA) and Glyceol appears to be the most favorable submucosal injection solution, offering a good balance of minimal tissue damage and effective lesion lifting.