An innovative next-generation endoscopic submucosal injection material with a 2-step injection system (with video) - 18/01/21
Abstract |
Background and Aims |
Next-generation submucosal injection materials (SIMs) with higher performance and flexibility than the current SIMs (eg, 0.4% sodium hyaluronate solution [HA]) are expected to improve the outcomes of endoscopic submucosal dissection (ESD) but are difficult to develop. We developed a next-generation SIM by devising a 2-solution-type SIM comprising 2.0% calcium chloride solution (Ca) and 0.4% sodium alginate solution (SA) and evaluated its performance.
Methods |
Viscoelasticity, submucosal elevation height, and injection pressure of HA, SA, and the next-generation SIM were measured. Outcomes of ESDs on pseudo-lesions in ex vivo porcine stomach/colon models were compared.
Results |
The dramatic increase in SA viscoelasticity with the addition of Ca facilitated the formation of highly viscous submucosal cushions that can be controlled by endoscopists. The submucosal elevation height of the next-generation SIM was significantly higher than that of HA or SA with the same injection pressure. The ESD procedure time using the next-generation SIM was significantly shorter than that using HA or SA (14.2 ± 6.1 vs 29.2 ± 9.1 minutes, P = .0004, or 14.2 ± 6.1 vs 29.1 ± 5.9 minutes, P <.0001). Furthermore, the total injection volume for the next-generation SIM was considerably lower than that for HA or SA (7.0 ± 0.9 vs 17.2 ± 3.4 mL, P <.0001, or 7.0 ± 0.9 vs 16.2 ± 2.9 mL, P <.0001).
Conclusions |
We developed an ideal next-generation SIM that achieved high performance and high flexibility in ex vivo models. Our findings warrant further investigations in a patient population.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : Ca, ESD, HA, IP, SA, SEH, SIM, VAS
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| DISCLOSURE: Dr Hirose received a collaboration research fund from Fuso Pharmaceutical Industries and Kao Corporation. Dr Naito received a scholarship fund from EA Pharma and a collaboration research fund from Taiyo Kagaku and has been paid lecture fees by Mylan EPD, Takeda Pharma, Mochida Pharma EA Pharma, Otsuka Pharma, Nippon Kayaku, and Miyarisan Pharma. Dr Dohi received a research fund from Fujifilm. Dr Itoh received personal fees from Gilead Sciences and AbbVie, and received funding from Takeda Pharmaceutical, AbbVie, Merck Sharp & Dohme, Bayer Yakuhin, Bristol-Myers Squibb, and Novo Nordisk. This study was not funded by these funds. Neither the funding agency nor any outside organization participated in the study design or has any conflict of interest. All other authors disclosed no financial relationships relevant to this publication. |
Vol 93 - N° 2
P. 503 - febbraio 2021 Ritorno al numero
Articolo precedente
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- Richard Brill, Constantin Goldann, Jens Walldorf, Helmut Messmann, Eva Brill, Wibke Uller, Patrick Michl, Moritz Wildgruber, Walter A. Wohlgemuth, Jonas Rosendahl
- The journey to develop the ideal submucosal injection solution for endoscopic submucosal dissection
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