Different Mixtures of Sodium Hyaluronate and Their Ability to Create Submucosal Fluid Cushions for Endoscopic Mucosal Resection

Fujishiro, M.; Yahagi, Naoki; Kashimura, Koji; Mizushima, Yasuhiro; Oka, Masashi; Matsuura, Toyokazu; Enomoto, Shotaro; Kakushima, Naomi; Imagawa, Atsushi; Kobayashi, Katsuya; Hashimoto, Takuhei; Iguchi, Mikitaka; Shimizu, Yasuhito; Ichinose, Masakazu; Omata, Masao

doi:10.1055/s-2004-814524

Cited by 123 publications

(82 citation statements)

References 9 publications

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“…It was reported that a hyaluronic acid solution makes a better long-lasting submucosal cushion without tissue damage than other available solutions [7,[20][21][22][23] . As a further improvement of hyaluronic acid solution, usefulness of a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar has also been reported [24,25] . ESD is characterized by three steps: injecting fluid into the submucosa to elevate the lesion from the muscle layer, circumferential cutting of the surrounding mucosa of the lesion, and subsequent dissection of the connective tissue of the submucosa beneath the lesion.…”

Section: Development Of Esdmentioning

confidence: 99%

Endoscopic submucosal dissection for gastrointestinal neoplasms

Kakushima¹,

Fujishiro²

2008

WJG

159

131

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Endoscopic submucosal dissection (ESD) is an advanced technique of therapeutic endoscopy for superficial gastrointestinal neoplasms. Three steps characterize it: injecting fluid into the submucosa to elevate the lesion, cutting the surrounding mucosa of the lesion, and dissecting the submucosa beneath the lesion. The ESD technique has rapidly permeated in Japan for treatment of early gastric cancer, due to its excellent results of enbloc resection compared to endoscopic mucosal resection (EMR). Although there is still room for improvement to lessen its technical difficulty, ESD has recently been applied to esophageal and colorectal neoplasms. Favorable short-term results have been reported, but the application of ESD should be well considered by three aspects: (1) the possibility of nodal metastases of the lesion, (2) technical difficulty such as location, ulceration and operator's skill, and (3) organ characteristics.

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Section: Development Of Esdmentioning

confidence: 99%

Endoscopic submucosal dissection for gastrointestinal neoplasms

Kakushima¹,

Fujishiro²

2008

WJG

159

131

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“…Besides that, SH is a synthetic product that could potentially cause antigenic reactions (4) . HPMC has been identified as an economical alternative to SH, being similarly effective at a dramatically lower cost, with no storage requirement, no need for reconstitution before use and minimal tissue reaction (3) .…”

Section: Recently Various Emr Devices Have Been V 47 -No2 -Abr/jumentioning

confidence: 99%

“…One of the major complications of EMR is perforation (15,16) . The most effective method of preventing perforation is to create an adequate submucosal fluid cushion (SFC) between the lesion and the muscle layer by submucosal injection (4) . A SFC lifts the mucosa around the target lesion facilitating resection techniques and protecting from deeper tissue injury.…”

Section: Introductionmentioning

confidence: 99%

“…Although the duration of mucosal elevation has improved, the ideal solution has not been founded yet (8) . SH is reported to create longer lasting SFCs (4,5,6,25) . However, it is expensive, needs specific storage requirements and has to be manipulated before There are no identifiable conflicts of interested (financial or otherwise) related to products mentioned in this article.…”

Section: Introductionmentioning

confidence: 99%

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

Lenz

Sena

Nakao

et al. 2010

Arq. Gastroenterol.

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-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.

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“…It was reported that a hyaluronic acid solution makes a better long-lasting submucosal cushion without tissue damage than other available solutions [29][30][31][32][33] . As a further improvement of hyaluronic acid solution, usefulness of a mixture of high-molecularweight hyaluronic acid, glycerin, and sugar has also been reported [34,35] . A representative case of ESD procedure using a flex-knife and a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar is shown in Figure 2 [36] .…”

Section: Cosal Dissectionmentioning

confidence: 99%

Endoscopic submucosal dissection for stomach neoplasms

Fujishiro¹

2006

WJG

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Recent advances in techniques of therapeutic endoscopy for stomach neoplasms are rapidly achieved. One of the major topics in this field is endoscopic submucosal dissection (ESD). ESD is a new endoscopic technique using cutting devices to remove the tumor by the following three steps: injecting fluid into the submucosa to elevate the tumor from the muscle layer, pre-cutting the surrounding mucosa of the tumor, and dissecting the connective tissue of the submucosa beneath the tumor. So the tumors are resectable in an en bloc fashion, regardless of the size, shape, coexisting ulcer, and location. Indication for ESD is strictly confined by two aspects: the possibility of nodal metastases and technical difficulty, which depends on the operators. Although long-term outcome data are still lacking, short-term outcomes of ESD are extremely favourable and laparotomy with gastrectomy is replaced with ESD in some parts of therapeutic strategy for early gastric cancer.

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Different Mixtures of Sodium Hyaluronate and Their Ability to Create Submucosal Fluid Cushions for Endoscopic Mucosal Resection

Cited by 123 publications

References 9 publications

Endoscopic submucosal dissection for gastrointestinal neoplasms

Endoscopic submucosal dissection for gastrointestinal neoplasms

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

Endoscopic submucosal dissection for stomach neoplasms

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