title: Comparison of the characteristics of submucosal injection solutions used in endoscopic mucosal resection.
abstract: OBJECTIVE
  Submucosal injection is used to prevent complications, such as perforation, during endoscopic mucosal resection (EMR). Since injection of normal saline produces mucosal elevation of short duration, repeated injection is needed for extensive resection. To overcome this limitation, various submucosal injection solutions have been developed but there are few data comparing their efficacy. This study was therefore conducted to compare the physical and chemical properties and the duration of mucosal elevation of various submucosal injection solutions.
  
  
  METHODS
  A fresh transverse colon specimen acquired from a mongrel was used. Experiments were repeated four times. To compare the efficacy of mucosal elevation, 1 ml of each solution was injected into the submucosa: 0.9% NaCl, 20% mannitol, 0.1% sodium hyaluronate, 0.3% hydroxypropyl methylcellulose (HPMC), and 2% fibrinogen. Physical and chemical properties such as viscosity and osmolarity were compared.
  
  
  RESULTS
  The heights of initial mucosal elevations were 6.52+/-0.26 mm, 6.87+/-0.05 mm, 6.92+/-0.09 mm, 6.90+/-0.08 mm, and 6.90+/-0.08 mm for normal saline, mannitol, sodium hyaluronate, HPMC, and fibrinogen, respectively. Whereas injection of normal saline took about 20 min and mannitol about 30 min for the initial elevation to be reduced to more than half the initial height, it took more than 60 min for all the other agents. A correlation was found between the duration of mucosal elevation and viscosity but not with osmolarity.
  
  
  CONCLUSIONS
  The mucosal elevation lasted longer with sodium hyaluronate, HPMC, and fibrinogen than with mannitol or normal saline, and this seems to be due to the viscosity rather than the osmolarity of each solution.
authors.affiliation: Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, Korea.
authors.forename: Jong Jin
authors.initials: JJ
authors.lastname: Hyun
authors.forename: Hwang Rae
authors.initials: HR
authors.lastname: Chun
authors.forename: Hoon Jai
authors.initials: HJ
authors.lastname: Chun
authors.forename: Yoon Tae
authors.initials: YT
authors.lastname: Jeen
authors.forename: Chang Won
authors.initials: CW
authors.lastname: Baeck
authors.forename: Sang Kyun
authors.initials: SK
authors.lastname: Yu
authors.forename: Yong Sik
authors.initials: YS
authors.lastname: Kim
authors.forename: Hong Sik
authors.initials: HS
authors.lastname: Lee
authors.forename: Soon Ho
authors.initials: SH
authors.lastname: Um
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Lee
authors.forename: Jai Hyun
authors.initials: JH
authors.lastname: Choi
authors.forename: Chang Duck
authors.initials: CD
authors.lastname: Kim
authors.forename: Ho Sang
authors.initials: HS
authors.lastname: Ryu
authors.forename: Jin Hai
authors.initials: JH
authors.lastname: Hyun
mesh_terms: D000818:Animals; D003106:Colon / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D004285:Dogs; D005340:Fibrinogen / Q000494:pharmacology; D006820:Hyaluronic Acid / Q000494:pharmacology; D065347:Hypromellose Derivatives; D066298:In Vitro Techniques; D007267:Injections; D007413:Intestinal Mucosa / Q000187:drug effects / Q000601:surgery*; D008353:Mannitol / Q000494:pharmacology; D008747:Methylcellulose / Q000031:analogs & derivatives / Q000494:pharmacology; D009994:Osmolar Concentration; D011183:Postoperative Complications / Q000517:prevention & control; D012965:Sodium Chloride / Q000494:pharmacology; D012996:Solutions; D014783:Viscosity
chemical_list: D012996:Solutions; D065347:Hypromellose Derivatives; D008353:Mannitol; D012965:Sodium Chloride; D005340:Fibrinogen; D006820:Hyaluronic Acid; D008747:Methylcellulose