Comparative performance in the porcine esophagus of different solutions used for submucosal injection.
BACKGROUND
Before endoscopic mucosal resection and polypectomy of sessile lesions, injection of fluid into the submucosa cushions and isolates the tissue and thereby reduces thermal injury and the risk for perforation and hemorrhage. This study investigated the performance of 5 different solutions when used to form submucosal fluid cushions in the porcine esophagus.


METHODS
Five groups of 5 pigs were studied. In each pig, 6 separate submucosal injections of 5 mL of a single test solution were performed within the distal third of the esophagus. The time required for the submucosal bleb to flatten completely was recorded after each injection. The solutions used were as follows: normal saline solution, normal saline plus epinephrine solution, 50% dextrose, 10% glycerine/5% fructose in normal saline solution, and 1% rooster comb hyaluronic acid.


RESULTS
The normal saline solution and normal saline plus epinephrine solutions had the shortest disappearance times (respectively, median 2.4 and 3.0 minutes), which were significantly shorter compared with the other test solutions. The mean disappearance times for 50% dextrose and 10% glycerine were, respectively, 4.7 and 4.2 minutes. The mean disappearance time for hyaluronic acid was 22.1 minutes.


CONCLUSIONS
A solution of hyaluronic acid appears to be ideal for producing a lasting submucosal cushion for prolonged procedures. Dextrose 50% is superior to normal saline solution and may serve as an alternative to hyaluronic acid in terms of availability and cost.
Conio
Massimo
M
Developmental Endoscopy Unit, Center for Endoscopic Research and Development, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Rajan
Elizabeth
E
Sorbi
Darius
D
Norton
Ian
I
Herman
Lori
L
Filiberti
Rosangela
R
Gostout
Christopher J
CJ
D000276:Adjuvants, Immunologic; D000818:Animals; D004837:Epinephrine / Q000008:administration & dosage / Q000494:pharmacology; D004945:Esophagoscopy / Q000379:methods; D004947:Esophagus / Q000187:drug effects* / Q000502:physiology*; D005260:Female; D005950:Glucose Solution, Hypertonic / Q000008:administration & dosage / Q000494:pharmacology; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000494:pharmacology; D007267:Injections; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000494:pharmacology; D009092:Mucous Membrane / Q000187:drug effects / Q000601:surgery; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage / Q000494:pharmacology; D012965:Sodium Chloride / Q000008:administration & dosage / Q000494:pharmacology; D013552:Swine; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000494:pharmacology
D000276:Adjuvants, Immunologic; D005950:Glucose Solution, Hypertonic; D007552:Isotonic Solutions; D012462:Saline Solution, Hypertonic; D014662:Vasoconstrictor Agents; D012965:Sodium Chloride; D006820:Hyaluronic Acid; D004837:Epinephrine