Solutions for submucosal injection: What to choose and how to do it

Area of Science:

• Gastroenterology and Endoscopy
• Surgical Oncology

Background:

• Endoscopic resection techniques have advanced significantly for managing premalignant lesions and early cancers.
• Key techniques include snare polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD).
• Submucosal injection is vital for EMR and ESD, less so for polypectomy, primarily for bleeding prevention in specific cases.

Purpose of the Study:

• To review common endoscopic resection techniques.
• To highlight the critical role of submucosal injection in these procedures.
• To discuss current and future submucosal injection solutions and techniques.

Main Methods:

• Review of established endoscopic resection techniques (snare polypectomy, EMR, ESD).
• Analysis of the function and importance of submucosal injection in each technique.
• Discussion of common submucosal injection solutions, their pros and cons.
• Evaluation of optimal timing and methods for submucosal injection based on lesion characteristics and technique.
• Exploration of novel submucosal injection solutions, techniques, and devices.

Main Results:

• Submucosal injection facilitates lesion lifting, separating it from the muscularis propria.
• This separation minimizes thermal injury, perforation, and bleeding risks.
• Injection improves technical feasibility for en-bloc resection.
• The review details advantages and disadvantages of various injection solutions.
• Guidance is provided on when and how to perform submucosal injections for optimal outcomes.

Conclusions:

• Submucosal injection is integral to successful EMR and ESD, improving safety and efficacy.
• Careful selection and application of injection solutions are key to preventing adverse events.
• Emerging technologies promise further advancements in therapeutic endoscopy.