Tissue damage of different submucosal injection solutions for EMR.
BACKGROUND
When choosing submucosal injection solutions for EMR, tissue damage should be considered, as well as the lesion-lifting ability. The objective of the study was to find out the potential tissue damage of submucosal injection solutions.


METHODS
The submucosal injection solutions examined were the following: normal saline solution (NS), 3.75% NaCl, 20% and 50% dextrose water (DW), a glycerin solution (Glyceol; 10% glycerin with 0.9% NaCl plus 5% fructose), and two hyaluronic acid (HA) solutions (0.25% 1900 kDa/NS solution and 0.125% 1900 kDa/ Glyceol solution). Furthermore, DW with different concentrations (5%, 10%, 15%, 30%, 40%) also was examined to find out the tolerable concentration without tissue damage. A total of 2 mL of each solution per stomach were injected by endoscopy into the submucosal layer at the separate sites of 4 living minipigs. Two minipigs were euthanized after 30 minutes of endoscopic observations, and the others were euthanized after additional endoscopic observations a week after injection.


RESULTS
There was no apparent tissue damage in NS, 5% and 10% DW, Glyceol, or two solutions of HA, whereas, hypertonic solutions, except Glyceol and 10% DW, have more or less potency of tissue damage. In 3.75% NaCl and DW with concentrations of >or=20%, considerable tissue damage was observed, which might affect resected EMR specimens and ulcer healing.


CONCLUSIONS
Use of hypertonic solutions except Glyceol is not recommended with respect to tissue damage. A combination of HA and Glyceol is the most favorable submucosal injection solution, considering tissue damage and lesion-lifting ability.
Fujishiro
Mitsuhiro
M
Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Japan.
Yahagi
Naohisa
N
Kashimura
Koji
K
Matsuura
Toyokazu
T
Nakamura
Masanori
M
Kakushima
Naomi
N
Kodashima
Shinya
S
Ono
Satoshi
S
Kobayashi
Katsuya
K
Hashimoto
Takuhei
T
Yamamichi
Nobutake
N
Tateishi
Ayako
A
Shimizu
Yasuhito
Y
Oka
Masashi
M
Ichinose
Masao
M
Omata
Masao
M
D000818:Animals; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy; D005947:Glucose / Q000008:administration & dosage; D005990:Glycerol / Q000008:administration & dosage / Q000009:adverse effects; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000009:adverse effects; D007267:Injections; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage / Q000009:adverse effects; D012965:Sodium Chloride / Q000008:administration & dosage / Q000009:adverse effects; D012996:Solutions / Q000008:administration & dosage / Q000009:adverse effects*; D013552:Swine; D013556:Swine, Miniature
D012462:Saline Solution, Hypertonic; D012996:Solutions; D012965:Sodium Chloride; D006820:Hyaluronic Acid; D005947:Glucose; D005990:Glycerol