Comparative performance of novel solutions for submucosal injection in porcine stomachs: An ex vivo study.
BACKGROUND
Submucosal injection of normal saline (NS) is commonly used during endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) but is quickly absorbed. Sodium hyaluronate (SH) produces longer lasting mucosal elevation but is expensive.


OBJECTIVE
To evaluate the performance of novel solutions for submucosal injection in comparison with NS and SH.


METHODS
One ml of the following solutions was injected in the submucosa of fresh specimens of porcine stomachs: NaCl 0.9%, SH 0.4%, human albumin 25%, two artificial tears solutions, namely, hydroxypropyl methylcellulose (HPMC) 0.3%/dextran 70.1% and polyvinyl alcohol (PVA) 1.4%, hydroxyethyl starch (HES) 6% and polyethylene glycol (PEG) 50%. The time until the disappearance of the mucosal elevation was recorded in a blind manner.


RESULTS
The median duration of mucosal elevation was significantly longer with HPMC/dextran, PVA, HES, PEG and SH (29, 26, 38, 31.5, and 41.5min, respectively) compared with NS (12min) (p<0.05 for each comparison). There were no significant time differences between SH and HPMC/dextran, HES and PEG (p>0.05).


CONCLUSIONS
Novel viscous or hypertonic solutions for submucosal injection, perform better than normal saline and equally well as sodium hyaluronate in porcine stomachs in vitro.
Polymeros
Dimitrios
D
Department of Internal Medicine - Propaedeutic, University of Athens, "Attikon" University General Hospital, Greece. dimpolymeros@yahoo.com
Kotsalidis
George
G
Triantafyllou
Konstantinos
K
Karamanolis
George
G
Panagiotides
John G
JG
Ladas
Spiros D
SD
D000818:Animals; D005753:Gastric Mucosa / Q000187:drug effects* / Q000601:surgery; D005773:Gastroscopy / Q000379:methods*; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D006982:Hypertonic Solutions / Q000008:administration & dosage*; D007267:Injections; D012965:Sodium Chloride / Q000008:administration & dosage*; D034421:Sus scrofa; D055675:Viscosupplements / Q000008:administration & dosage*
D006982:Hypertonic Solutions; D055675:Viscosupplements; D012965:Sodium Chloride; D006820:Hyaluronic Acid