title: High-pressure jet injection of viscous solutions for endoscopic submucosal dissection: a study on ex vivo pig stomachs.
abstract: BACKGROUND
  Long-lasting lifting is a key factor during endoscopic submucosal dissection (ESD) and can be obtained by water-jet injection of saline solution or by injection of viscous macromolecular solutions. Combination of the jet injection and the macromolecular viscous solutions has never been used yet. We assessed the ability of a new water-jet system to inject viscous solutions in direct viewing and in retroflexion. We compared jet injection of saline solution and hyaluronate 0.5 % to perform ESD on ex vivo pig stomachs in order to evaluate the benefits of macromolecular solutions when injected by a jet-injector system.
  
  
  METHODS
  This is a prospective comparative study in pig stomachs. Using the jet injector, four viscous solutions were tested: hydroxyethyl starch, glycerol mix, hyaluronate sodic (0.5 %), and poloxamer mix. Ten ESDs larger than 25 mm (five in direct viewing and five in retroflexion) and one larger than 10 cm were performed with each solution. ESD with hyaluronate jet injection was then compared with ESD with saline jet injection by performing 50 ESDs in each group. A single, minimally-experienced operator conducted all the procedures.
  
  
  RESULTS
  All 145 resections were complete, including all marking points with two perforations. Eleven jet ESDs per solution were conducted without any injection issue. In the second part of the study, when compared with saline, significant benefit of hyaluronate was observed on dissection speed (0.80 vs. 1.08 cm(2)/min, p < 0.001).
  
  
  CONCLUSIONS
  This is the first report on a jet-injector system allowing injection of macromolecular viscous solutions even with retroflexed endoscope. Jet injection of macromolecular solutions can speed up dissection in comparison with saline, and should now be tested on humans.
authors.affiliation: Endoscopy Unit, Digestive Disease Department, H Pavillon - Edouard Herriot Hospital, 69437, Lyon Cedex, France, mathieupioche@free.fr.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Pioche
authors.forename: Mihai
authors.initials: M
authors.lastname: Ciocirlan
authors.forename: Vincent
authors.initials: V
authors.lastname: Lépilliez
authors.forename: Damien
authors.initials: D
authors.lastname: Salmon
authors.forename: Laetitia
authors.initials: L
authors.lastname: Mais
authors.forename: Olivier
authors.initials: O
authors.lastname: Guillaud
authors.forename: Valérie
authors.initials: V
authors.lastname: Hervieu
authors.forename: Marco
authors.initials: M
authors.lastname: Petronio
authors.forename: Isabelle
authors.initials: I
authors.lastname: Lienhart
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Adriano
authors.forename: Cyril
authors.initials: C
authors.lastname: Lafon
authors.forename: Thierry
authors.initials: T
authors.lastname: Ponchon
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004210:Dissection / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005753:Gastric Mucosa / Q000601:surgery*; D007277:Injections, Jet / Q000379:methods; D011312:Pressure; D011446:Prospective Studies; D013552:Swine; D055675:Viscosupplements / Q000008:administration & dosage*
chemical_list: D055675:Viscosupplements