BACKGROUND: Long-lasting lifting is a key factor during endoscopic submucosal dissection (ESD) and can be obtained by water-jet injection of saline solution or by injection of viscous macromolecular solutions. Combination of the jet injection and the macromolecular viscous solutions has never been used yet. We assessed the ability of a new water-jet system to inject viscous solutions in direct viewing and in retroflexion. We compared jet injection of saline solution and hyaluronate 0.5 % to perform ESD on ex vivo pig stomachs in order to evaluate the benefits of macromolecular solutions when injected by a jet-injector system. METHODS: This is a prospective comparative study in pig stomachs. Using the jet injector, four viscous solutions were tested: hydroxyethyl starch, glycerol mix, hyaluronate sodic (0.5 %), and poloxamer mix. Ten ESDs larger than 25 mm (five in direct viewing and five in retroflexion) and one larger than 10 cm were performed with each solution. ESD with hyaluronate jet injection was then compared with ESD with saline jet injection by performing 50 ESDs in each group. A single, minimally-experienced operator conducted all the procedures. RESULTS: All 145 resections were complete, including all marking points with two perforations. Eleven jet ESDs per solution were conducted without any injection issue. In the second part of the study, when compared with saline, significant benefit of hyaluronate was observed on dissection speed (0.80 vs. 1.08 cm(2)/min, p < 0.001). CONCLUSION: This is the first report on a jet-injector system allowing injection of macromolecular viscous solutions even with retroflexed endoscope. Jet injection of macromolecular solutions can speed up dissection in comparison with saline, and should now be tested on humans.
BACKGROUND: Long-lasting lifting is a key factor during endoscopic submucosal dissection (ESD) and can be obtained by water-jet injection of saline solution or by injection of viscous macromolecular solutions. Combination of the jet injection and the macromolecular viscous solutions has never been used yet. We assessed the ability of a new water-jet system to inject viscous solutions in direct viewing and in retroflexion. We compared jet injection of saline solution and hyaluronate 0.5 % to perform ESD on ex vivo pig stomachs in order to evaluate the benefits of macromolecular solutions when injected by a jet-injector system. METHODS: This is a prospective comparative study in pig stomachs. Using the jet injector, four viscous solutions were tested: hydroxyethyl starch, glycerol mix, hyaluronate sodic (0.5 %), and poloxamer mix. Ten ESDs larger than 25 mm (five in direct viewing and five in retroflexion) and one larger than 10 cm were performed with each solution. ESD with hyaluronate jet injection was then compared with ESD with saline jet injection by performing 50 ESDs in each group. A single, minimally-experienced operator conducted all the procedures. RESULTS: All 145 resections were complete, including all marking points with two perforations. Eleven jet ESDs per solution were conducted without any injection issue. In the second part of the study, when compared with saline, significant benefit of hyaluronate was observed on dissection speed (0.80 vs. 1.08 cm(2)/min, p < 0.001). CONCLUSION: This is the first report on a jet-injector system allowing injection of macromolecular viscous solutions even with retroflexed endoscope. Jet injection of macromolecular solutions can speed up dissection in comparison with saline, and should now be tested on humans.
Authors: Adolfo Parra-Blanco; María Rosa Arnau; David Nicolás-Pérez; Antonio Z Gimeno-García; Nicolás González; Juan A Díaz-Acosta; Alejandro Jiménez; Enrique Quintero Journal: World J Gastroenterol Date: 2010-06-21 Impact factor: 5.742
Authors: Sebastian Flacke; Alirezah Moinzadeh; John A Libertino; John Merhige; Jean-Marie Vogel; Kathy Lyall; Urmila Khettry; Curtis W Bakal; Peter N Madras Journal: J Vasc Interv Radiol Date: 2010-03-21 Impact factor: 3.464
Authors: Dimitrios Polymeros; George Kotsalidis; Konstantinos Triantafyllou; George Karamanolis; John G Panagiotides; Spiros D Ladas Journal: Dig Liver Dis Date: 2009-07-09 Impact factor: 4.088
Authors: E Vázquez-Sequeiros; D Boixeda de Miquel; J R Foruny Olcina; J A González Martín; M García; D Juzgado Lucas; E Garrido; C González; A Parra Blanco; M R Arnau; A Buenadicha; V Moreira Vicente; C Martín de Argila; J M Milicua Journal: Rev Esp Enferm Dig Date: 2009-08 Impact factor: 2.086
Authors: N Yahagi; H Neuhaus; B Schumacher; A Neugebauer; G F Kaehler; M Schenk; K Fischer; M Fujishiro; M D Enderle Journal: Endoscopy Date: 2009-04-01 Impact factor: 10.093
Authors: Alireza Moinzadeh; Sebastian Flacke; John A Libertino; John Merhige; Jean-Marie Vogel; Katy Lyall; Curtis W Bakal; Peter N Madras Journal: J Urol Date: 2009-08-15 Impact factor: 7.450
Authors: Mihai Ciocîrlan; Mathieu Pioche; Vincent Lepilliez; Nicolas Gonon; Roland Roume; Guillaume Noel; Christian Pinset; Thierry Ponchon Journal: Endoscopy Date: 2013-10-25 Impact factor: 10.093