Hydroxypropyl methylcellulose: A better submucosal fluid cushion for endoscopic mucosal resection

Feitoza, Arnaldo B.; Gostout, Christopher J.; Burgart, Lawrence J.; Burkert, Alexander; Herman, Lori J.; Rajan, Elizabeth

doi:10.1067/mge.2003.25

Cited by 127 publications

(59 citation statements)

References 30 publications

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“…These include normal saline with or without diluted epinephrine, hypertonic saline, dextrose solution, sodium hyaluronate, fibrinogen combination, glycerol, and fructose solutions all of those may be mixture with methylene blue depend on the preference of the endoscopist. [5][6][7][8] Conio, et al compared the solutions and showed that the disappearing time of normal saline is approximately 3 minutes with or without epinephrine, while the disappearing times of 50% dextrose and 10% glycerol and hyaluronic acid solutions were 4.7, 4.2 and 22 minutes respectively.…”

Section: 2mentioning

confidence: 99%

Endoscopy: From Diagnosis to Therapeutics

Benson

Mizrahi²

2015

Gastro Open J

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Two decades ago, gastroenterologists used endoscopy for the diagnosis of Gastrointestinal (GI) lesions, thereby helping surgeons to localize lesion that necessitated resection and treatment with surgery. Today, the gastroenterology field has advanced beyond the diagnostic era and now, a large number of GI lesions can be treated via endoluminal procedures performed by the gastroenterologist with no need for surgical intervention.In recent years, the improvement of endoscopic imaging and tools, such as snares, clips and needles which can be delivered through the endoscope channel, have helped to change the field of gastroenterology. This allowed for the development and advancement of Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD). The pioneers of EMR and ESD were from Japan and the first articles describing these techniques were published in the 1990s. 1,2Two classification systems are used for describing GI lesions to be considered for EMR and ESD. One system is the Japanese classification 3 and the second is the Paris system, which was proposed in 2002. 4 The Japanese classification was originally developed for early gastric cancer management, but it can be applied to lesions throughout the GI tract. Once lesions are classified, EMR can be performed in different GI locations, including the esophagus, stomach, colon and rectum. When lesions are more complex and beyond the mucosa, ESD can be performed with careful dissection.Endoscopic ultrasound (EUS) may be useful in deciding whether to perform EMR or ESD. EUS can aid in determining the penetration of the tumor to layers beyond the mucosa when the lesion is localized in proximal parts of the colon. If the lesion cannot be reached by a regular EUS endoscope special high frequency mini-probes may be used through the colonoscope working channel.Two methods are used in performing EMR. The first method is 'suck and cut' and the second method is 'lift and cut'. Both usually begin with a submucosal injection prior to resection of the lesion the suc and cut method may be used also without submucosal injection especially when being performed in the esophagus. The injection is used to expand the submucosa, separating the deeper muscolaris propria from the more superficial mucosa and submucosa layers. Several solutions may be used as the injectate. These include normal saline with or without diluted epinephrine, hypertonic saline, dextrose solution, sodium hyaluronate, fibrinogen combination, glycerol, and fructose solutions all of those may be mixture with methylene blue depend on the preference of the endoscopist.5-8 Conio, et al. compared the solutions and showed that the disappearing time of normal saline is approximately 3 minutes with or without epinephrine, while the disappearing times of 50% dextrose and 10% glycerol and hyaluronic acid solutions were 4.7, 4.2 and 22 minutes respectively. 9After injection, one of the two resection methods can be applied. The 'suck and cut'

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Section: 2mentioning

confidence: 99%

Endoscopy: From Diagnosis to Therapeutics

Benson

Mizrahi²

2015

Gastro Open J

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“…HPMC is cellulose derivate with viscoelastic characteristics. We used HPMC in lower concentration (0.25%) than were used in previous studies (3,8) . CMC has high viscosity and is used as eye drops and in ophthalmologic practice.…”

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

confidence: 99%

“…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) . HPMC is cellulose derivate with viscoelastic characteristics.…”

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

confidence: 99%

“…A long-lasting SFC is necessary in lengthy procedures or in piecemeal resection of large sessile polyps. Many solutions have been tested for submucosal injection during EMR (2,3,7,13,19,21,23,24,25,26) . Recently, solutions with high viscosity, such as sodium hyaluronate (SH), hydroxypropyl methylcellulose (HPMC) and fibrinogen have been used.…”

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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“…SFC solution is commonly composed of distilled water, physiological saline, glycerin, hyaluronic acid, and other additives. [12][13][14][15] The SFC can lift the lesion from the submucosal layer and thus protect nontarget tissues from bleeding and perforation.…”

Section: Introductionmentioning

confidence: 99%

Analysis of opto-thermal interaction of porcine stomach tissue with 808-nm laser for endoscopic submucosal dissection

Kim

Hossain

Lee

et al. 2015

J. Innov. Opt. Health Sci.

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In endoscopic submucosal dissection (ESD), the narrow gastrointestinal space can cause di±culty in surgical interventions. Tissue ablation apparatuses with high-power CO 2 lasers or Nd:YAG lasers have been developed to facilitate endoscopic surgical procedures. We studied the interaction of 808-nm laser light with a porcine stomach tissue, with the aim of developing a therapeutic medical device that can remove lesions at the gastrointestinal wall by irradiating a near-infrared laser light incorporated in an endoscopic system. The perforation depths at the porcine¯llet and the stomach tissues linearly increased in the range of 2-8 mm in proportion to the laser energy density of 63.7-382 kJ/cm 2 . Despite the distinct structural and compositional di®erence, the variation of the perforation depth between the stomach and the¯llet was not found at 808-nm wavelength in our measurement. We further studied the laser-tissue interaction by changing the concentration of the methyl blue solution used conventionally as a submucosal°u idic cushion (SFC) in ESD procedures. The temperature of the mucosal layer increased more rapidly at higher concentration of the methyl blue solution, because of enhanced light absorption at the SFC layer. The insertion of the SFC would protect the muscle layer from thermal damage. We con¯rmed that more e®ective laser treatment should be enabled by tuning the opto-thermal properties of the SFC. This study can contribute to the optimization of the driving parameters for laser incision techniques as an alternative to conventional surgical interventions.

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Hydroxypropyl methylcellulose: A better submucosal fluid cushion for endoscopic mucosal resection

Cited by 127 publications

References 30 publications

Endoscopy: From Diagnosis to Therapeutics

Endoscopy: From Diagnosis to Therapeutics

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

Analysis of opto-thermal interaction of porcine stomach tissue with 808-nm laser for endoscopic submucosal dissection

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