Crosslinkable poloxamer in-situ gel as a submucosal cushion for endoscopic submucosal dissection

Abstract

Background: Hypertonic saline solution is used for endoscopic submucosal dissection (ESD) as a submucosal fluid cushion (SFC). However, the application of SFC is limited by challenges including a short effect duration as well as increased risk of perforation and bleeding.Methods: An in-situ gel crosslinked acrylate/thiol Poloxamer 407 (PA-PSH) can be used as a novel SFC for ESD to avoid perforation, and the feasibility and safety of the PA-PSH for ESD was evaluated in vitro and in vivo .Results: PA-PSH thermal injection led to a longer-lasting elevation with clearer margins as compared with glycerol, with a high mucosal elevation induced by thiol-ene reaction in physiological conditions between acrylate Poloxamer 407 (PA) and thiol-capped Poloxamer 407 (PSH). Precise ESD along the margins of the elevated mucosa was achieved without obvious adverse effects such as bleeding, perforation and tissue damage.Conclusion: The PA-PSH in-situ gel provides an excellent submucosal injection system, which has great potential to improve the ESD technique.