Evaluation of Eleview® Bioadhesive Properties and Cushion-Forming Ability

Abstract

Submucosal injection is generally required for both endoscopic-mucosal resection (EMR) and submucosal dissection (ESD). SIC-8000 (Eleview®) is a new liquid composition in the form of a microemulsion for submucosal injection, approved by the Food and Drug Administration (FDA) 510(k) and Conformité Européene (CE) marked, containing a biocompatible polymer as a cushioning agent. The aim of this study was to evaluate Eleview®’s performance in terms of bioadhesive properties and cushion-forming ability. The bioadhesion was evaluated by measuring the interaction between Eleview® and the extracellular matrix (the main component of the submucosal layer) using the texture analyzer. To better comprehend the mechanism of action of Eleview® after submucosal injection, force of detachment and adhesion work were measured for the following formulations: Eleview®, Eleview® without poloxamer (functional polymer), poloxamer solution alone, normal saline, and MucoUp® (competing product on the Japanese market). The results obtained show the interaction between Eleview® and the extracellular matrix, highlighting the stronger bioadhesive properties of Eleview® compared with Eleview® without poloxamer, poloxamer solution alone, as well as normal saline and MucoUp®. The ability of Eleview® to form a consistent and long-lasting cushion in situ, once injected into the submucosal layer, was tested ex vivo on a porcine stomach. The results obtained show a better permanence in situ for the product compared with normal saline injection and to MucoUp® (t-test, p < 0.05).

Hetastarch induced volume changes of starving adenoma and suggested mechanism of action

“…(2) more importantly, the described behaviour of the polyps after the submucosal injection of both Eleview and EverLift lack (a) the elevation of the other submerged polyps in the proximity of injection and (b) volume changes of the polyp itself. Interestingly in the paper comparing the Eleview vs HES contrasting composition authors did not notice the volume change of polyps themselves, focusing rather on bolus volume dynamics 5 . While the elevation time of Eleview is excellent, the differences in volume changes lead us to believe, that the EMR solution activity based on HES is on first sight similar but acts on different mechanism.…”

“…The physiological solution with the addition of methylene blue or sodium salt of indigotindisulfonate was applied as a visual tool to stain the neoplasm 4 . Only very recently, the ready-made injection solutions Eleview and EverLift were introduced on some markets 5 .…”

Research trends on endoscopic mucosal resection: A bibliometric analysis from 1991 to 2021

“…A recent comparative trial found that eleview injections significantly increased the height and duration of mucosal lift compared with saline injections, creating a buffer layer for polyp removal surgery and improving the success rate of surgery. Therefore, eleview is expected to be an effective alternative to saline injection ( 40 ). The keyword “cold snare polypectomy” exploded in 2017, and the use of cold snares to ligate tumors or polyps is becoming a popular research topic.…”

Endoscopic submucosal dissection: How to be more efficient?

“…Much research has been done on viscous solutions and there are now several high-viscosity products available, such as hyaluronic acid 10 or poloxamers, which offer interesting properties of variable viscosity according to temperature 11 12 13 . These products are efficient but expensive.…”