Safe and Efficient Colonic Endoscopic Submucosal Dissection Using an Injectable Hydrogel.

Area of Science:

• Gastroenterology and minimally invasive surgery
• Biomaterials science and drug delivery

Background:

• Endoscopic submucosal dissection (ESD) for early colon cancer is challenging due to technical difficulty and perforation risk.
• Effective submucosal injection is critical for en bloc resection and safety in colonic ESD.

Purpose of the Study:

• To evaluate a novel injectable thermoreversible hydrogel as a submucosal agent for colonic ESD.
• To assess the hydrogel's efficacy in mucosal elevation, procedure simplification, and safety compared to conventional agents.

Main Methods:

• Synthesis of a triblock copolymer (PLGA-PEG-PLGA) hydrogel.
• In vivo evaluation in minipigs, assessing mucosal elevation, duration, and performance during colonic ESD.
• Comparison with glycerol fructose as a control submucosal agent.

Main Results:

• The hydrogel provided adequate and durable mucosal elevation in the colonic submucosa at body temperature.
• Successful en bloc resection of all colonic lesions was achieved with a single hydrogel injection.
• No major hemorrhage, perforation, or tissue damage was observed; the 15 wt % hydrogel was optimized.

Conclusions:

• The thermoreversible hydrogel is an effective submucosal fluid for colonic ESD, providing durable mucosal lifting.
• It simplifies the procedure, minimizes complications, and enhances the accessibility of colonic ESD.
• The hydrogel's
• autodissection
• capability significantly aids the ESD process.