Different mixtures of sodium hyaluronate and their ability to create submucosal fluid cushions for endoscopic mucosal resection.
OBJECTIVE
Sodium hyaluronate (SH) is a promising submucosal injection solution during endoscopic mucosal resection, but its high cost is an obstacle to more widespread use. The aim of this study was to identify an appropriate low-cost SH solution by varying the molecular weight of SH and mixing various solutions with it.


METHODS
The viscoelasticity of various SH solutions was first measured. The concentrations of two 1 % SH preparations with different molecular weights (800 kDa and 1900 kDa) were adjusted to 0.5 %, 0.25 %, and 0.125 %, using 0.9 %/3.75 % normal saline (NS), 5 %/20 % dextrose water (DW), and a glycerin solution (Glyceol): 10 % glycerin with 0.9 % normal saline plus 5 % fructose. The ability of these SH solutions to create submucosal fluid cushions (SFCs) was then investigated in the stomachs of two live minipigs.


RESULTS
The 0.25 % 1900 kDa SH/NS solution and the 0.125 % 1900 kDa SH/20 % DW solution created a similar viscoelasticity to that of the 0.5 % 800 kDa SH/NS solution. The ability of these solutions to create SFCs was also similar. In addition, the 0.125 % 1900 kDa SH/Glyceol solution created similar SFCs, with a synergistic effect of increased viscoelasticity and the hypertonic nature of glycerin.


CONCLUSIONS
A mixture of higher molecular weight sodium hyaluronate with a sugar solution (particularly 20 % dextrose), with or without glycerin, should be regarded as a cost-effective option for creating SFCs instead of the conventional SH solution made with the same amount of a 1 % 800 kDa SH preparation and normal saline.
Fujishiro
M
M
Dept. of Gastroenterology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
Yahagi
N
N
Kashimura
K
K
Mizushima
Y
Y
Oka
M
M
Matsuura
T
T
Enomoto
S
S
Kakushima
N
N
Imagawa
A
A
Kobayashi
K
K
Hashimoto
T
T
Iguchi
M
M
Shimizu
Y
Y
Ichinose
M
M
Omata
M
M
D000818:Animals; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods; D005947:Glucose; D005990:Glycerol; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007267:Injections; D008970:Molecular Weight; D012965:Sodium Chloride; D012996:Solutions / Q000008:administration & dosage; D013552:Swine; D013556:Swine, Miniature; D014783:Viscosity
D012996:Solutions; D012965:Sodium Chloride; D006820:Hyaluronic Acid; D005947:Glucose; D005990:Glycerol