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Updated: Jun 21, 2026
A New Ex Vivo Model for the Evaluation of Endoscopic Submucosal Injection Material Performance
Published on: October 19, 2018
Comparative performance of novel solutions for submucosal injection in porcine stomachs: An ex vivo study
Dimitrios Polymeros1, George Kotsalidis, Konstantinos Triantafyllou
1Department of Internal Medicine - Propaedeutic, University of Athens, "Attikon" University General Hospital, Greece. dimpolymeros@yahoo.com
Background:
Submucosal injection of normal saline (NS) is commonly used during endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) but is quickly absorbed. Sodium hyaluronate (SH) produces longer lasting mucosal elevation but is expensive.
Aims:
To evaluate the performance of novel solutions for submucosal injection in comparison with NS and SH.
Methods:
One ml of the following solutions was injected in the submucosa of fresh specimens of porcine stomachs: NaCl 0.9%, SH 0.4%, human albumin 25%, two artificial tears solutions, namely, hydroxypropyl methylcellulose (HPMC) 0.3%/dextran 70.1% and polyvinyl alcohol (PVA) 1.4%, hydroxyethyl starch (HES) 6% and polyethylene glycol (PEG) 50%. The time until the disappearance of the mucosal elevation was recorded in a blind manner.
Results:
The median duration of mucosal elevation was significantly longer with HPMC/dextran, PVA, HES, PEG and SH (29, 26, 38, 31.5, and 41.5min, respectively) compared with NS (12min) (p<0.05 for each comparison). There were no significant time differences between SH and HPMC/dextran, HES and PEG (p>0.05).
Conclusions:
Novel viscous or hypertonic solutions for submucosal injection, perform better than normal saline and equally well as sodium hyaluronate in porcine stomachs in vitro.
