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A New Ex Vivo Model for the Evaluation of Endoscopic Submucosal Injection Material Performance
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Innovative submucosal injection solution for endoscopic resection with phosphorylated pullulan: a preclinical study.

Takuya Satomi1, Yukari Ochi2, Takumi Okihara3

  • 1Department of Gastroenterology and Hepatology, Okayama University, Okayama, Japan.

Gastrointestinal Endoscopy
|January 15, 2024
PubMed
Summary

A new, low-viscosity submucosal injection solution using phosphorylated pullulan (PPL) was developed. This PPL solution is easy to inject and use during endoscopic surgery, improving procedures like EMR and ESD.

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Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Biomaterials

Background:

  • Current submucosal injection solutions for endoscopic surgery have high viscosity, hindering ease of use.
  • Development of improved injection solutions is crucial for enhancing endoscopic surgical procedures.

Purpose of the Study:

  • To develop an extremely low-viscosity, easy-to-use submucosal injection solution.
  • To evaluate the efficacy and practicality of the novel phosphorylated pullulan (PPL) solution in endoscopic surgery.

Main Methods:

  • Phosphorylated pullulan (PPL) solutions were prepared at various concentrations and their viscosities measured.
  • Mucosal elevation capacity was assessed using excised porcine stomachs, comparing PPL to sodium hyaluronate (SH), sodium alginate (SA), and saline.
  • Catheter injectability and performance in live pig endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) were evaluated.

Main Results:

  • PPL solutions exhibited significantly lower viscosity than SH and SA solutions.
  • PPL demonstrated comparable mucosal elevation capacity to SH and superior catheter injectability.
  • In live pig models, PPL facilitated easier snaring, reduced bubble formation during ESD, and tended to shorten procedure times compared to SH.

Conclusions:

  • The developed PPL solution is an innovative and user-friendly option for submucosal injection in endoscopic surgery.
  • PPL offers significant advantages in viscosity, injectability, and procedural efficiency over existing solutions.