Comparative results of gastric submucosal injection with hydroxypropyl methylcellulose, carboxymethylcellulose and normal saline solution in a porcine model

Abstract

-Context -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. Objectives -This blind study investigated the performance of three different solutions to create submucosal fluid cushions in porcine stomach. Methods -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. Results -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). Conclusions -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.

Endoscopically Injectable Shear‐Thinning Hydrogels Facilitating Polyp Removal

“…Additionally, injection solutions showing significantly prolonged duration can be associated with administration challenges. For example, carboxymethylcellulose solutions can require a special 18 gauge submucosal injection needle catheter to minimize injection resistance because of its high viscosity . Moreover, hyaluronic acid potentially stimulates the growth of residual tumor tissues .…”

Safety and efficacy of underwater versus conventional endoscopic mucosal resection for colorectal polyps: Systematic review and meta-analysis of RCTs

“…One of the concerns with U-EMR technique is possibly a higher risk of perforation or deep muscle injury, as reported in a few cases. Contrary to C-EMR, in U-EMR, a submucosal lifting agent separating the muscle layer from the mucosal layer is not employed 35 48 . In our analysis, the pooled rates of perforations were comparable between the two techniques.…”

Nanodrugs systems for therapy and diagnosis of esophageal cancer

“…In contrast, hyaluronic acid (nano-)hydrogel has many advantages such as maintaining a favorable submucosal fluid cushion and excellent safety, making it the preferred choice for submucosal injection during ESD ( Jung and Park, 2013 ). Similarly, hydroxyethyl cellulose, a synthetic product, can trigger antigen-antibody reactions ( Lenz et al, 2010 ), while fibrinogen mixture carries the risk of viral transmission, including hepatitis ( Uraoka et al, 2009 ). Recent advancements in submucosal injection media have introduced novel options.…”