Comparison of the characteristics of submucosal injection solutions used in endoscopic mucosal resection.
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.
Hyun
Jong Jin
JJ
Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, Korea.
Chun
Hwang Rae
HR
Chun
Hoon Jai
HJ
Jeen
Yoon Tae
YT
Baeck
Chang Won
CW
Yu
Sang Kyun
SK
Kim
Yong Sik
YS
Lee
Hong Sik
HS
Um
Soon Ho
SH
Lee
Sang Woo
SW
Choi
Jai Hyun
JH
Kim
Chang Duck
CD
Ryu
Ho Sang
HS
Hyun
Jin Hai
JH
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
D012996:Solutions; D065347:Hypromellose Derivatives; D008353:Mannitol; D012965:Sodium Chloride; D005340:Fibrinogen; D006820:Hyaluronic Acid; D008747:Methylcellulose