Comparative study of electrical and rheological properties of different solutions used in endoscopic mucosal resection

Abstract

Background and Aim The study of electrical and rheological properties of solutions to carry out endoscopic resection procedures could determinate the best candidate. An ex vivo study with porcine stomachs was conducted to analyze electrical resistivity (R) and rheological properties (temperature, viscosity, height and lasting of the cushion) of different substances used in these techniques. Methods Tested solutions were: 0.9% saline (S), platelet‐rich plasma (PRP), Gliceol (GC), hyaluronic acid 2% (HA), Pluronic‐F127 20% (PL), saline with 10% glucose (GS), Gelaspan (GP), Covergel‐BiBio (TB) and PRP with TB (PRP+TB). Measurements of electrical and rheological properties were done at 0, 15, 30, 45 and 60 min after submucosal injection. Results Solutions showed a wide variability of transepithelial R after submucosal injection. Substances able to maintain the highest R 60 min postinjection were TB (7 × 104 Ω), HA (7 × 104 Ω) and PL (7 × 104 Ω). Protective solutions against deep thermal injury (Tª lower than 60°C) were PL (47.6°C), TB (55°C) and HA (56.63°C). Shortest time to carry out resections were observed with GC (17.66″), PRP (20.3″) and GS (23.45″). Solutions with less cushion decrease (<25%) after 60 min were TB (11.74%), PL (18.63%) and PRP (22.12%). Conclusions Covergel‐BiBio, PL and HA were the best solutions with long‐term protective effects (transepithelial R, lower thermal injury and less cushion decrease). Solutions with quicker resection time were GC, PRP and GS.

Novel submucosal injection solution 0.6% sodium alginate: Bench to market for endoscopic submucosal dissection optimization

“…Various injection solutions are widely used to facilitate en bloc resection or to reduce the risks of adverse events associated with ESD, in particular, perforation. [3][4][5] Although no consensus for an ideal solution in ESD exists, it should maintain a long-lasting mucosal cushion, be non-toxic and have no influence on the histological evaluation, be inexpensive, be readily available and easily given with optimum injectability. [3][4][5] Sodium hyaluronate (SH) and glycerol solutions are most commonly used to carry out ESD in Japan.…”

“…In fact, procedural safety increases with greater tissue elevation, and efficiency increases with longer‐lasting submucosal cushion. Various injection solutions are widely used to facilitate en bloc resection or to reduce the risks of adverse events associated with ESD, in particular, perforation …”

“…Although no consensus for an ideal solution in ESD exists, it should maintain a long‐lasting mucosal cushion, be non‐toxic and have no influence on the histological evaluation, be inexpensive, be readily available and easily given with optimum injectability . Sodium hyaluronate (SH) and glycerol solutions are most commonly used to carry out ESD in Japan.…”

“…Several factors contribute to dissipation of the submucosal cushion. Respiratory movement, peristalsis, and blood flow may promote more rapid distribution . As the connective tissue is divided during ESD, additional fluid is lost directly and by evaporation as a result of heat generated by the electrocautery.…”

“…With respect to muscular damage due to electrification, the electric circuit that forms between the electrode and the tissue can be affected by many variables, influencing the outcome of the procedure. Rheological properties, viscosity, and osmolality of the injection materials should be experimentally explored ex vivo and hopefully in vivo in addition to electrical assessments to further support their safety …”