Comparative results of gastric submucosal injection with hydroxypropyl methylcellulose, carboxymethylcellulose and normal saline solution in a porcine model.
Endoscopic mucosal resection is an established modality for excision of sessile lesions in the gastrointestinal tract. Submucosal fluid injection creates a cushion and may prevent thermal injury and perforation.



This blind study investigated the performance of three different solutions to create submucosal fluid cushions in porcine stomach.



Three solutions were injected in the stomach of nine pigs BR1: normal saline solution, carboxymethylcellulose 0.5% and hydroxypropyl methylcellulose 0.25%. In each pig, submucosal injections with 6 mL per test-solution were performed. One drop of methylene blue was added to all injections for better visualization. The time for the bleb to disappear was recorded.



The overall median time of visible submucosal cushion was 37 minutes (range 12-60 min) for hydroxypropyl methylcellulose, 31 minutes for carboxymethylcellulose (range 10-43 min) and 19 minutes for normal saline solution (range 8-37 min). There was no statistically significant difference neither between normal saline solution and carboxymethylcellulose (P = 0.146) nor carboxymethylcellulose and hydroxypropyl methylcellulose (P = 0.119) but the median duration of hydroxypropyl methylcellulose was significantly longer than normal saline solution (P = 0.039).



The length of hydroxypropyl methylcellulose submucosal fluid cushion is longer in comparison with normal saline solution. The median time for carboxymethylcellulose was not longer than normal saline solution. Hydroxypropyl methylcellulose, in the concentration of 0.25%, may be a durable alternative for submucosal injection.
Lenz
Luciano
L
Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brazil. luciano.lenz@terra.com.br
Di Sena
Veruska
V
Nakao
Frank S
FS
Andrade
Gustavo Paulo de
GP
Rohr
Maria Rachel da Silveira
MR
Ferrari
Angelo Paulo
AP
D000818:Animals; D002266:Carboxymethylcellulose Sodium / Q000008:administration & dosage*; D004311:Double-Blind Method; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000187:drug effects*; D006801:Humans; D065347:Hypromellose Derivatives; D008747:Methylcellulose / Q000008:administration & dosage / Q000031:analogs & derivatives*; D023421:Models, Animal; D012965:Sodium Chloride / Q000008:administration & dosage*; D013552:Swine; D013997:Time Factors
D065347:Hypromellose Derivatives; D012965:Sodium Chloride; D008747:Methylcellulose; D002266:Carboxymethylcellulose Sodium