OBJECTIVE: Submucosal injection is used to prevent complications, such as perforation, during endoscopic mucosal resection (EMR). Since injection of normal saline produces mucosal elevation of short duration, repeated injection is needed for extensive resection. To overcome this limitation, various submucosal injection solutions have been developed but there are few data comparing their efficacy. This study was therefore conducted to compare the physical and chemical properties and the duration of mucosal elevation of various submucosal injection solutions. MATERIAL AND METHODS: A fresh transverse colon specimen acquired from a mongrel was used. Experiments were repeated four times. To compare the efficacy of mucosal elevation, 1 ml of each solution was injected into the submucosa: 0.9% NaCl, 20% mannitol, 0.1% sodium hyaluronate, 0.3% hydroxypropyl methylcellulose (HPMC), and 2% fibrinogen. Physical and chemical properties such as viscosity and osmolarity were compared. RESULTS: The heights of initial mucosal elevations were 6.52+/-0.26 mm, 6.87+/-0.05 mm, 6.92+/-0.09 mm, 6.90+/-0.08 mm, and 6.90+/-0.08 mm for normal saline, mannitol, sodium hyaluronate, HPMC, and fibrinogen, respectively. Whereas injection of normal saline took about 20 min and mannitol about 30 min for the initial elevation to be reduced to more than half the initial height, it took more than 60 min for all the other agents. A correlation was found between the duration of mucosal elevation and viscosity but not with osmolarity. CONCLUSIONS: The mucosal elevation lasted longer with sodium hyaluronate, HPMC, and fibrinogen than with mannitol or normal saline, and this seems to be due to the viscosity rather than the osmolarity of each solution.
OBJECTIVE: Submucosal injection is used to prevent complications, such as perforation, during endoscopic mucosal resection (EMR). Since injection of normal saline produces mucosal elevation of short duration, repeated injection is needed for extensive resection. To overcome this limitation, various submucosal injection solutions have been developed but there are few data comparing their efficacy. This study was therefore conducted to compare the physical and chemical properties and the duration of mucosal elevation of various submucosal injection solutions. MATERIAL AND METHODS: A fresh transverse colon specimen acquired from a mongrel was used. Experiments were repeated four times. To compare the efficacy of mucosal elevation, 1 ml of each solution was injected into the submucosa: 0.9% NaCl, 20% mannitol, 0.1% sodium hyaluronate, 0.3% hydroxypropyl methylcellulose (HPMC), and 2% fibrinogen. Physical and chemical properties such as viscosity and osmolarity were compared. RESULTS: The heights of initial mucosal elevations were 6.52+/-0.26 mm, 6.87+/-0.05 mm, 6.92+/-0.09 mm, 6.90+/-0.08 mm, and 6.90+/-0.08 mm for normal saline, mannitol, sodium hyaluronate, HPMC, and fibrinogen, respectively. Whereas injection of normal saline took about 20 min and mannitol about 30 min for the initial elevation to be reduced to more than half the initial height, it took more than 60 min for all the other agents. A correlation was found between the duration of mucosal elevation and viscosity but not with osmolarity. CONCLUSIONS: The mucosal elevation lasted longer with sodium hyaluronate, HPMC, and fibrinogen than with mannitol or normal saline, and this seems to be due to the viscosity rather than the osmolarity of each solution.
Authors: Sanghoon Park; Hoon Jai Chun; Chul Young Kim; Ju Young Kim; Jin Su Jang; Yong Dae Kwon; Doo Rang Kim; Bora Keum; Yeon Seok Seo; Yong Sik Kim; Yoon Tae Jeen; Hong Sik Lee; Soon Ho Um; Sang Woo Lee; Jae Hyun Choi; Chang Duck Kim; Ho Sang Ryu; Jong Hyeon Chang; James Jungho Pak Journal: Dig Dis Sci Date: 2008-06 Impact factor: 3.199