Advancements in injection materials for submucosal lifting in endoscopic interventions

Endoscopic submucosal dissection and endoscopic mucosal resection rely on submucosal injection cushions to effectively separate lesions from the muscularis propria, thereby expanding the operative field, improving resection precision, and minimizing procedure-related complications. Although recent advances have yielded cushions with enhanced lift durabilities and biofunctional properties, their widespread clinical adoption remains limited. Key barriers include poor injectability, uncertain long-term biocompatibility, restricted multifunctionality, manufacturing and supply chain constraints, and a lack of robust clinical and reimbursement evidence. This article comprehensively evaluated the current submucosal injection materials and assessed their mechanical performance, biocompatibility, and intraoperative usability. It compares conventional agents with emerging functionalized materials, identifies critical translational hurdles, and proposes actionable strategies to overcome them. These include the implementation of standardized biosafety protocols, early engagement with regulatory agencies, optimization of production processes, and incorporation of clinical and cost-effectiveness analyses. Bridging the gap between laboratory innovation and routine clinical use requires coordinated efforts across biomaterial research, industrial scalability, regulatory science, and health policies.