Use of scopolamine butylbromide to facilitate specimen fixation after endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) is a technique for the en bloc resection of early neoplastic lesions in the gastrointestinal tract. A step that must be carried out after excision is the pinning down of the specimen on a support plate such as a cork board to avoid artifacts because of tissue contraction. After ESD lesion borders usually curl up from contraction, hence this procedure must be carefully performed to prevent damaging the specimen. Recently, Nishizawa T, et al. reported that dropping adrenaline onto the lesion results in edge relaxation, which facilitates fixation. However, the use of other drugs-such as Buscapine-that induce gastrointestinal smooth muscle relaxation, potentially with similar effects, has not been described. Below, two ESD specimens from two different institutions are shown. These specimens correspond to gastric lesions. Buscapine is applied on their surface and the edges become relaxed, thus facilitating stretching and thus fixation. In conclusion, the use of Buscapine may help in the processing of excised lesions by facilitating pinning out and reducing damage risk for specimens.