Optimal injection solution for endoscopic submucosal dissection: A randomized controlled trial of Western solutions in a porcine model.

Journal Article (Journal Article)

BACKGROUND AND AIM: When carrying out endoscopic submucosal dissection (ESD), procedural safety increases with greater tissue elevation and efficiency increases with longer-lasting submucosal cushion. Fluids specifically developed for ESD in Asia are not commercially available in the West, leaving endoscopists to use a variety of injectable fluids off-label. To determine the optimal fluid available in the West, we compared commonly used fluids for Western ESD. METHODS: All phases were carried out in an ex vivo porcine stomach model. Phase 1 compared tissue elevation and duration of submucosal cushions produced by various standard volumes of various injectable solutions used for ESD. The two best-performing solutions used off-label were tested head-to-head in ESD in Phase 2. Phase 3 compared the best solution from Phase 2 to Eleview® , currently the only submucosal injection fluid approved in the USA. In Phases 2 and 3, five ESD were carried out with each solution. The solutions were randomized and the endoscopist blinded to the solution. RESULTS: The best-performing solutions in Phase 1 were 0.4% hyaluronic acid, 6% hydroxyethyl starch (HES), and Eleview® . Phase 2 compared 6% HES and hydroxypropyl methylcellulose (HPMC), showing that ESD with 6% HES was easier (P = 0.007), faster (P = 0.041) and required less injection volume (P = 0.003). In Phase 3, resection speed, ease of ESD and total volume per area resected were comparable between 6% HES and Eleview® . CONCLUSIONS: Of the submucosal injection fluids currently available in the West, Eleview® and 6% HES are the best-performing solutions for ESD in a porcine model.

Full Text

Duke Authors

Cited Authors

  • Mehta, N; Strong, AT; Franco, M; Stevens, T; Chahal, P; Jang, S; Lopez, R; Patil, D; Abe, S; Saito, Y; Uraoka, T; Vargo, J; Bhatt, A

Published Date

  • May 2018

Published In

Volume / Issue

  • 30 / 3

Start / End Page

  • 347 - 353

PubMed ID

  • 29181852

Electronic International Standard Serial Number (EISSN)

  • 1443-1661

Digital Object Identifier (DOI)

  • 10.1111/den.12993


  • eng

Conference Location

  • Australia