alexa Tissue damage of different submucosal injection solutions for EMR.


Journal of Gastrointestinal & Digestive System

Author(s): Fujishiro M, Yahagi N, Kashimura K, Matsuura T, Nakamura M,

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Abstract BACKGROUND: When choosing submucosal injection solutions for EMR, tissue damage should be considered, as well as the lesion-lifting ability. The objective of the study was to find out the potential tissue damage of submucosal injection solutions. METHODS: The submucosal injection solutions examined were the following: normal saline solution (NS), 3.75\% NaCl, 20\% and 50\% dextrose water (DW), a glycerin solution (Glyceol; 10\% glycerin with 0.9\% NaCl plus 5\% fructose), and two hyaluronic acid (HA) solutions (0.25\% 1900 kDa/NS solution and 0.125\% 1900 kDa/ Glyceol solution). Furthermore, DW with different concentrations (5\%, 10\%, 15\%, 30\%, 40\%) also was examined to find out the tolerable concentration without tissue damage. A total of 2 mL of each solution per stomach were injected by endoscopy into the submucosal layer at the separate sites of 4 living minipigs. Two minipigs were euthanized after 30 minutes of endoscopic observations, and the others were euthanized after additional endoscopic observations a week after injection. RESULTS: There was no apparent tissue damage in NS, 5\% and 10\% DW, Glyceol, or two solutions of HA, whereas, hypertonic solutions, except Glyceol and 10\% DW, have more or less potency of tissue damage. In 3.75\% NaCl and DW with concentrations of >or=20\%, considerable tissue damage was observed, which might affect resected EMR specimens and ulcer healing. CONCLUSIONS: Use of hypertonic solutions except Glyceol is not recommended with respect to tissue damage. A combination of HA and Glyceol is the most favorable submucosal injection solution, considering tissue damage and lesion-lifting ability. This article was published in Gastrointest Endosc and referenced in Journal of Gastrointestinal & Digestive System

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