Comparison of Various Submucosal Injection Solutions for Maintaining Mucosal Elevation During Endoscopic Mucosal Resection

Abstract

SH solutions were the most suitable ones for producing and maintaining long-term mucosal elevation, while the superiority of hypertonic solutions over normal saline was not clearly demonstrated.

Argon Plasma Coagulation with Submucosal Saline Injection for Gastric Adenoma on Outpatient Basis

“…Submucosa saline injection is a routine procedure of EMR for elevation of mucosa layer and prevention of damage of proper muscle. Furthermore, it can predict depth of invasion and submucosa fibrosis with mucosa lifting sign [22]. Submucosa saline injection before APC produces an insulating submucosa fluid cushion, protects deep layer from thermal injury, prevents the risk of perforation, and enables APC-SSI to be performed on an OPD basis without hospital admission.…”

“…Considering its less progressive nature, frequent recurrence of the lesion, the complication risk and medical expense of EMR, and hospital admission for more invasive procedure, new feasible treatment methods are required for gastric adenoma with LGD. Submucosa saline injection has been the routine procedure of EMR for lifting mucosa and prevention of bleeding and perforation [19][20][21][22]. Submucosa saline injection prior to APC (APC-SSI) forms an insulating fluid cushion in the submucosa layer, thereby preventing the risk of perforation [9].…”

Endoscopic submucosal dissection: Sociedad Española de Endoscopia Digestiva (SEED) clinical guideline

“…layer, separating the mucosa from the muscularis propria (62,63). Normal saline (NS) 0.9 % maintains the cushion for a short time and usually makes it necessary to perform repeated injections during the dissection phase.…”

“…Addition of epinephrine and/or colorants such as methylene blue or indigo carmine can facilitate resection by means of reducing the risk of bleeding and improving the identification of the submucosal layer. In order to prevent the short duration of submucosal injection effect, different substances with higher viscosity have been used (62)(63)(64)(65)(66)(67)(68)(69)(70). Hyaluronic acid (HA), is one of the most commonly used substances in Japan but its high cost and in vitro tumor cells stimulatory effect, limit its use in other countries (63-67,71-74).…”

Noninvasive treatment of pneumoperitoneum after gastric mucosectomy microperforation

“…Endoscopic mucosectomy resection (EMR) was carried out [1 -3] after identifying and marking the lesion with circumferential electrocoagulation. Following infiltration of hydroxyethyl starch in sodium chloride (Voluven, Fresenius Kabi Italia S. p. A., Verona, Italy) and epinephrine (1 : 20 000, 20 mL) the mucosa was lifted from the submucosa [4]. The lesion was removed by piecemeal technique, using a diathermic snare.…”