Design and validation of performance-oriented injectable chitosan thermosensitive hydrogels for endoscopic submucosal...

Area of Science:

• Biomaterials Science
• Gastroenterology
• Surgical Innovation

Background:

• Endoscopic submucosal dissection (ESD) is a complex endoscopic procedure.
• Improving operator convenience and patient outcomes in ESD remains a challenge.
• Limited research exists on biomaterials to enhance ESD performance.

Purpose of the Study:

• To develop and evaluate novel thermosensitive hydrogels for ESD.
• To compare the efficacy of these hydrogels against conventional agents (normal saline and glycerin fructose).
• To assess the impact of hydrogels on operative convenience, procedure time, and wound healing.

Main Methods:

• Preparation and characterization of two thermosensitive hydrogels: lactobionic acid-modified chitosan/chitosan/β-glycerophosphate hydrogel (hydrogel 1) and its lyophilized form (hydrogel 2).
• Evaluation of physicochemical properties including viscosity and viscoelasticity.
• In vivo testing on a large animal model (pigs) involving submucosal injection and ESD in the stomach and esophagus.

Main Results:

• Hydrogels exhibited favorable low-temperature fluidity and superior viscoelastic properties compared to normal saline and glycerin fructose.
• Submucosal injection with hydrogels resulted in a higher, more sustained cushion height.
• ESD procedures using hydrogels were significantly shorter, and postoperative analysis indicated enhanced wound healing.

Conclusions:

• The developed thermosensitive hydrogels effectively facilitate ESD procedures by improving submucosal lifting and operator convenience.
• These hydrogels shorten operation times and promote faster wound healing, potentially reducing complications.
• The distinct properties of the two hydrogels allow for selection based on lesion characteristics, with hydrogel 2 potentially suited for longer procedures, ultimately promoting wider adoption of ESD.