Tissue damage of different submucosal injection solutions for EMR

被引:140
作者
Fujishiro, M
Yahagi, N
Kashimura, K
Matsuura, T
Nakamura, M
Kakushima, N
Kodashima, S
Ono, S
Kobayashi, K
Hashimoto, T
Yamamichi, N
Tateishi, A
Shimizu, Y
Oka, M
Ichinose, M
Omata, M
机构
[1] Univ Tokyo, Grad Sch Med, Dept Gastroenterol, Bunkyo Ku, Tokyo, Japan
[2] Chugai Pharmaceut Co Ltd, Kamakura Res Labs, Prod Res Dept, Kanagawa, Japan
[3] Chungai Res Inst Med Sci Inc, Nagano, Japan
[4] Wakayama Med Univ, Dept Internal Med 2, Wakayama, Japan
关键词
D O I
10.1016/j.gie.2005.07.052
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: When choosing submucosal injection solutions for EMR, tissue damage should be considered, as well as the lesion-lifting ability. The objective of the study was to find out the potential tissue damage of submucosal injection solutions. Methods: The submucosal injection solutions examined were the following: normal saline solution (NS), 3.75% NaCl, 20% and 50% dextrose water (DW), a glycerin solution (Glyceol; 10% glycerin with 0.9% NaCl plus 5% fructose), and two hyaluronic acid (HA) solutions (0.25% 1900 kDa/NS solution and 0.125% 1900 kDa/ Glyceol solution). Furthermore, DW with different concentrations (5%, 10%, 15%, 30%, 40%) also was examined to find out the tolerable concentration without tissue damage. A total of 2 mL of each solution per stomach were injected by endoscopy into the submucosal layer at the separate sites of 4 living minipigs. Two minipigs were euthanized after 30 minutes of endoscopic observations, and the others were euthanized after additional endoscopic observations a week after injection. Results: There was no apparent tissue damage in NS, 5% and 10% DW, Glyceol, or two solutions of HA, whereas, hypertonic solutions, except Glyceol and 10% DW, have more or less potency of tissue damage. In 3.75% NaCl and DW with concentrations of >= 20%, considerable tissue damage was observed, which might affect resected EMR specimens and ulcer healing. Conclusions: Use of hypertonic solutions except Glyceol is not recommended with respect to tissue damage. A combination of HA and Glyceol is the most favorable submucosal injection solution, considering tissue damage and lesion-lifting ability.
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页码:933 / 942
页数:10
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