Comparison of the characteristics of submucosal injection solutions used in endoscopic mucosal resection

Jong Jin Hyun, Rae Chun Hwang, Hoon-Jai Chun, Yoon Tae Jeen, Won Baeck Chang, Kyun Yu Sang, Sik Kim Yong, Hong Sik Lee, Soon-Ho Um, Sang Woo Lee, Hyun Choi Jai, Chang Duck Kim, Sang Ryu Ho, Hai Hyun Jin

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)488-492
Number of pages5
JournalScandinavian Journal of Gastroenterology
Volume41
Issue number4
DOIs
Publication statusPublished - 2006 Mar 1

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Mannitol
Injections
Hyaluronic Acid
Viscosity
Osmolar Concentration
Fibrinogen
Transverse Colon
Endoscopic Mucosal Resection
Hypromellose Derivatives

Keywords

  • Endoscopic mucosal resection
  • Fibrinogen
  • HPMC
  • Mannitol
  • Normal saline
  • Sodium hyaluronate
  • Submucosal injection solution
  • Viscosity

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Comparison of the characteristics of submucosal injection solutions used in endoscopic mucosal resection. / Hyun, Jong Jin; Hwang, Rae Chun; Chun, Hoon-Jai; Jeen, Yoon Tae; Chang, Won Baeck; Sang, Kyun Yu; Yong, Sik Kim; Lee, Hong Sik; Um, Soon-Ho; Lee, Sang Woo; Jai, Hyun Choi; Kim, Chang Duck; Ho, Sang Ryu; Jin, Hai Hyun.

In: Scandinavian Journal of Gastroenterology, Vol. 41, No. 4, 01.03.2006, p. 488-492.

Research output: Contribution to journalArticle

Hyun, Jong Jin ; Hwang, Rae Chun ; Chun, Hoon-Jai ; Jeen, Yoon Tae ; Chang, Won Baeck ; Sang, Kyun Yu ; Yong, Sik Kim ; Lee, Hong Sik ; Um, Soon-Ho ; Lee, Sang Woo ; Jai, Hyun Choi ; Kim, Chang Duck ; Ho, Sang Ryu ; Jin, Hai Hyun. / Comparison of the characteristics of submucosal injection solutions used in endoscopic mucosal resection. In: Scandinavian Journal of Gastroenterology. 2006 ; Vol. 41, No. 4. pp. 488-492.
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abstract = "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.",
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AU - Chun, Hoon-Jai

AU - Jeen, Yoon Tae

AU - Chang, Won Baeck

AU - Sang, Kyun Yu

AU - Yong, Sik Kim

AU - Lee, Hong Sik

AU - Um, Soon-Ho

AU - Lee, Sang Woo

AU - Jai, Hyun Choi

AU - Kim, Chang Duck

AU - Ho, Sang Ryu

AU - Jin, Hai Hyun

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AB - 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.

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