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Updated: Nov 14, 2025
A New Ex Vivo Model for the Evaluation of Endoscopic Submucosal Injection Material Performance
Published on: October 19, 2018
Differences between two sodium hyaluronate-based submucosal injection materials currently used in Japan based on
Ryohei Hirose1,2, Takuma Yoshida3, Yuji Naito3
1Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan. ryo-hiro@koto.kpu-m.ac.jp.
Two sodium hyaluronate submucosal injection materials (SIMs) for endoscopic submucosal dissection (ESD) were compared. Ksmart (HA-Ks) demonstrated superior viscosity and performance over MucoUp (HA-Mc), with a diluted version matching HA-Mc performance.
Area of Science:
- Gastroenterology
- Endoscopic Procedures
- Biomaterials Science
Background:
- Two 0.4% sodium hyaluronate (HA)-based submucosal injection materials (SIMs), MucoUp (HA-Mc) and Ksmart (HA-Ks), are used in Japan for endoscopic submucosal dissection (ESD).
- Despite having the same concentration, visual observations suggest HA-Ks may possess higher viscosity and better performance than HA-Mc.
- This perception necessitates a detailed examination of the distinct properties and performance characteristics of these two SIMs.
Purpose of the Study:
- To investigate and elucidate the differences in physical properties and performance between HA-Mc and HA-Ks.
- To determine the impact of viscosity on the efficacy of submucosal injection materials during ESD procedures.
- To provide a comparative analysis to guide endoscopists in selecting optimal SIMs for ESD.
Main Methods:
- Comparative analysis of viscosity and weight-average molecular weight between HA-Mc and HA-Ks.
- Evaluation of submucosal elevation height (SEH) for both materials and a diluted version of HA-Ks (HA-Ks-80%).
- Measurement of endoscopic submucosal dissection (ESD) procedure time and total injection volume for each SIM.
Main Results:
- HA-Ks exhibited significantly higher viscosity and greater weight-average molecular weight compared to HA-Mc.
- HA-Ks demonstrated a significantly greater submucosal elevation height (SEH) than HA-Mc; HA-Ks-80% showed comparable SEH to HA-Mc.
- ESD procedure time and total injection volume were significantly reduced with HA-Ks compared to HA-Mc, but not significantly different for HA-Ks-80% versus HA-Mc.
Conclusions:
- HA-Ks possesses higher viscosity and superior submucosal injection material performance compared to HA-Mc, despite similar concentrations.
- The viscosity of SIMs is a critical factor influencing their performance in ESD, affecting elevation height, procedure time, and injection volume.
- HA-Ks-80% offers comparable performance to HA-Mc, suggesting that viscosity modulation can tailor SIM effectiveness for specific endoscopic applications.
