title: Endoscopic submucosal dissection with a flexible Maryland dissector: randomized comparison of mesna and saline solution for submucosal injection (with videos).
abstract: BACKGROUND
  Endoscopic submucosal dissection (ESD) is increasingly used for en bloc removal of GI lesions. Current ESD techniques have limitations including long procedure times, technical difficulty, and complications.
  
  
  OBJECTIVE
  To compare mesna with saline solution for ESD.
  
  
  METHODS
  Blinded, randomized, controlled, porcine study in live animals.
  
  
  METHODS
  Animal laboratory.
  
  
  METHODS
  Twelve gastric lesions were marked by using electrocautery. After submucosal injection, a circumferential mucosal incision was created, and ESD was performed by using a flexible Maryland dissector. Half of the ESDs were performed with submucosal injection of mesna.
  
  
  METHODS
  Primary outcome was the time to dissect the submucosal plane. Secondary outcomes were total ESD time, specimen size, and procedure related complications.
  
  
  RESULTS
  The average (± SD) time for dissecting the submucosal plane was 15 minutes (range 10-22 ± 4.8 min) in the group with submucosal mesna injection and 16 minutes (range 8-29 ± 8.3 min) in the control group (P = 1.0). Complete en bloc resection including all of the electrocautery markings was achieved in all cases. Injection of mesna did not provide any benefit over saline solution in terms of overall ESD time (24 ± 7.3 min vs 28 ± 11 min; P = .42). There were no perforations. Four hemorrhages requiring intervention were encountered during the procedures in the control group, compared with no bleeding in the mesna group (P = .09).
  
  
  CONCLUSIONS
  Animal model, limited sample size.
  
  
  CONCLUSIONS
  Submucosal mesna injection did not affect procedure times but was associated with a trend toward a lower incidence of intraprocedural bleeding.
authors.affiliation: Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany. renteln@gmx.net
authors.forename: Daniel
authors.initials: D
authors.lastname: von Renteln
authors.forename: Parambir S
authors.initials: PS
authors.lastname: Dulai
authors.forename: Heiko
authors.initials: H
authors.lastname: Pohl
authors.forename: Melina C
authors.initials: MC
authors.lastname: Vassiliou
authors.forename: Thomas
authors.initials: T
authors.lastname: Rösch
authors.forename: Richard I
authors.initials: RI
authors.lastname: Rothstein
mesh_terms: D000818:Animals; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D020699:Gastroscopes; D005773:Gastroscopy / Q000379:methods*; D007267:Injections; D015080:Mesna / Q000008:administration & dosage*; D023421:Models, Animal; D012965:Sodium Chloride / Q000008:administration & dosage*; D034421:Sus scrofa
chemical_list: D012965:Sodium Chloride; D015080:Mesna