Solutions for submucosal injection: What to choose and how to do it
|
摘要
During the past decades, endoscopic resection techniques have gradually improved and gained more importance for the management of premalignant lesions and early cancers. These endoscopic resection techniques can be divided in 3 major groups: snare polipectomy, endoscopic mucosal resection(EMR) and endoscopic submucosal dissection(ESD). The use of submucosal injection is essential for the majority of EMR techniques and is an integral part of ESD,whereas during polipectomy it is not crucial in most cases except to prevent bleeding in large polyps and/or those with large stalks as an alternative to mechanical methods. Injection provides a lifting up effect of the lesion separating it from the muscular layer, thereby reducing thermal injury and the risk of perforation and bleeding while also facilitating en-bloc resection by improving technical feasibility. With this work, we aim to review the most common endoscopic resection techniques and the importance of submucosal injection in each one of them. For that, we present some of the most commonly used submucosal injection solutions, taking into account their advantages and disadvantages. We also discuss, based on current recommendations and our own experience, how and when to preform submucosal injection, depending on lesions features and endoscopic resection technique that′s being used, to assure complete resection and to prevent associated adverse events. Finally, we also present and discuss some new proposed submucosal injection solutions,endoscopic resection techniques and devices that may have a major impact on the future of therapeutic endoscopy.
During the past decades, endoscopic resection techniques have gradually improved and gained more importance for the management of premalignant lesions and early cancers. These endoscopic resection techniques can be divided in 3 major groups: snare polipectomy, endoscopic mucosal resection(EMR) and endoscopic submucosal dissection(ESD). The use of submucosal injection is essential for the majority of EMR techniques and is an integral part of ESD,whereas during polipectomy it is not crucial in most cases except to prevent bleeding in large polyps and/or those with large stalks as an alternative to mechanical methods. Injection provides a lifting up effect of the lesion separating it from the muscular layer, thereby reducing thermal injury and the risk of perforation and bleeding while also facilitating en-bloc resection by improving technical feasibility. With this work, we aim to review the most common endoscopic resection techniques and the importance of submucosal injection in each one of them. For that, we present some of the most commonly used submucosal injection solutions, taking into account their advantages and disadvantages. We also discuss, based on current recommendations and our own experience, how and when to preform submucosal injection, depending on lesions features and endoscopic resection technique that′s being used, to assure complete resection and to prevent associated adverse events. Finally, we also present and discuss some new proposed submucosal injection solutions,endoscopic resection techniques and devices that may have a major impact on the future of therapeutic endoscopy.
During the past decades, endoscopic resection techniques have gradually improved and gained more importance for the management of premalignant lesions and early cancers. These endoscopic resection techniques can be divided in 3 major groups: snare polipectomy, endoscopic mucosal resection(EMR) and endoscopic submucosal dissection(ESD). The use of submucosal injection is essential for the majority of EMR techniques and is an integral part of ESD,whereas during polipectomy it is not crucial in most cases except to prevent bleeding in large polyps and/or those with large stalks as an alternative to mechanical methods. Injection provides a lifting up effect of the lesion separating it from the muscular layer, thereby reducing thermal injury and the risk of perforation and bleeding while also facilitating en-bloc resection by improving technical feasibility. With this work, we aim to review the most common endoscopic resection techniques and the importance of submucosal injection in each one of them. For that, we present some of the most commonly used submucosal injection solutions, taking into account their advantages and disadvantages. We also discuss, based on current recommendations and our own experience, how and when to preform submucosal injection, depending on lesions features and endoscopic resection technique that′s being used, to assure complete resection and to prevent associated adverse events. Finally, we also present and discuss some new proposed submucosal injection solutions,endoscopic resection techniques and devices that may have a major impact on the future of therapeutic endoscopy.
引文
1 Isomoto H.Global dissemination of endoscopic submucosal dissection for early gastric cancer.Intern Med2010;49:251-252[PMID:20154427]
2 Choi KS,Jung HY,Choi KD,Lee GH,Song HJ,Kim DH,Lee JH,Kim MY,Kim BS,Oh ST,Yook JH,Jang SJ,Yun SC,Kim SO,Kim JH.EMR versus gastrectomy for intramucosal gastric cancer:comparison of long-term outcomes.Gastrointest Endosc 2011;73:942-948[PMID:21392757 DOI:10.1016/j.gie.2010.12.032]
3 ASGE Technology Committee;Hwang JH,Konda V,Abu Dayyeh BK,Chauhan SS,Enestvedt BK,Fujii-Lau LL,Komanduri S,Maple JT,Murad FM,Pannala R,Thosani NC,Banerjee S.Endoscopic mucosal resection.Gastrointest Endosc 2015;82:215-226[PMID:26077453 DOI:10.1016/j.gie.2015.05.001]
4 Jung YS,Park DI.Submucosal injection solutions for endoscopic mucosal resection and endoscopic submucosal dissection of gastrointestinal neoplasms.Gastrointest Inte 2013;2:73-77[DOI:10.1016/j.gii.2013.09.003]
5 Uraoka T,Saito Y,Yamamoto K,Fujii T.Submucosal injection solution for gastrointestinal tract endoscopic mucosal resection and endoscopic submucosal dissection.Drug Des Devel Ther 2009;2:131-138[PMID:19920900]
6 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.Tissue damage of different submucosal injection solutions for EMR.Gastrointest Endosc 2005;62:933-942[PMID:16301040 DOI:10.1016/j.gie.2005.07.052]
7 Rastogi A.Optical diagnosis of small colorectal polyp histology with high-definition colonoscopy using narrow band imaging.Clin Endosc 2013;46:120-129[PMID:23614121 DOI:10.5946/ce.2013.46.2.120]
8 Rex DK.Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps.Gastroenterology 2009;136:1174-1181[PMID:19187781 DOI:10.1053/j.gastro.2008.12.009]
9 Ferlitsch M,Moss A,Hassan C,Bhandari P,Dumonceau JM,Paspatis G,Jover R,Langner C,Bronzwaer M,Nalankilli K,Fockens P,Hazzan R,Gralnek IM,Gschwantler M,Waldmann E,Jeschek P,Penz D,Heresbach D,Moons L,Lemmers A,Paraskeva K,Pohl J,Ponchon T,Regula J,Repici A,Rutter MD,Burgess NG,Bourke MJ.Colorectal polypectomy and endoscopic mucosal resection(EMR):European Society of Gastrointestinal Endoscopy(ESGE)Clinical Guideline.Endoscopy 2017;49:270-297[PMID:28212588 DOI:10.1055/s-0043-102569]
10 Khashab MA,Cummings OW,DeWitt JM.Ligation-assisted endoscopic mucosal resection of gastric heterotopic pancreas.World J Gastroenterol 2009;15:2805-2808[PMID:19522034 DOI:10.3748/wjg.15.2805]
11 ASGE TECHNOLOGY COMMITTEE,Kantsevoy SV,Adler DG,Conway JD,Diehl DL,Farraye FA,Kwon R,Mamula P,Rodriguez S,Shah RJ,Wong Kee Song LM,Tierney WM.Endoscopic mucosal resection and endoscopic submucosal dissection.Gastrointest Endosc 2008;68:11-18[PMID:18577472DOI:10.1016/j.gie.2008.01.037]
12 Tanaka S,Haruma K,Oka S,Takahashi R,Kunihiro M,Kitadai Y,Yoshihara M,Shimamoto F,Chayama K.Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm.Gastrointest Endosc 2001;54:62-66[PMID:11427843 DOI:10.1067/mge.2001.115729]
13 Uraoka T,Saito Y,Matsuda T,Ikehara H,Gotoda T,Saito D,Fujii T.Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum.Gut 2006;55:1592-1597[PMID:16682427 DOI:10.1136/gut.2005.087452]
14 Gotoda T.A large endoscopic resection by endoscopic submucosal dissection procedure for early gastric cancer.Clin Gastroenterol Hepatol 2005;3:S71-S73[PMID:16013003]
15 Pimentel-Nunes P,Dinis-Ribeiro M,Ponchon T,Repici A,Vieth M,De Ceglie A,Amato A,Berr F,Bhandari P,Bialek A,Conio M,Haringsma J,Langner C,Meisner S,Messmann H,Morino M,Neuhaus H,Piessevaux H,Rugge M,Saunders BP,Robaszkiewicz M,Seewald S,Kashin S,Dumonceau JM,Hassan C,Deprez PH.Endoscopic submucosal dissection:European Society of Gastrointestinal Endoscopy(ESGE)Guideline.Endoscopy 2015;47:829-854[PMID:26317585 DOI:10.1055/s-0034-1392882]
16 Ohkuwa M,Hosokawa K,Boku N,Ohtu A,Tajiri H,Yoshida S.New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife.Endoscopy 2001;33:221-226[PMID:11293753 DOI:10.1055/s-2001-12805]
17 Ferreira AO,Moleiro J,Torres J,Dinis-Ribeiro M.Solutions for submucosal injection in endoscopic resection:a systematic review and meta-analysis.Endosc Int Open 2016;4:E1-E16[PMID:26793777DOI:10.1055/s-0034-1393079]
18 Fujishiro M,Yahagi N,Kashimura K,Mizushima Y,Oka M,Enomoto S,Kakushima N,Kobayashi K,Hashimoto T,Iguchi M,Shimizu Y,Ichinose M,Omata M.Comparison of various submucosal injection solutions for maintaining mucosal elevation during endoscopic mucosal resection.Endoscopy 2004;36:579-583[PMID:15243878 DOI:10.1055/s-2004-814517]
19 Sumiyoshi T,Fujii T,Sumiyoshi Y.Injected substances to the submucosa in endoscopic mucosal resection:glycerin solution versus normal saline solution.Gastrointest Endosc 2002;55:AB110-AB110
20 Uraoka T,Fujii T,Saito Y,Sumiyoshi T,Emura F,Bhandari P,Matsuda T,Fu KI,Saito D.Effectiveness of glycerol as a submucosal injection for EMR.Gastrointest Endosc 2005;61:736-740[PMID:15855984]
21 Yamamoto H,Yube T,Isoda N,Sato Y,Sekine Y,Higashizawa T,Ido K,Kimura K,Kanai N.A novel method of endoscopic mucosal resection using sodium hyaluronate.Gastrointest Endosc 1999;50:251-256[PMID:10425422]
22 Yamamoto H,Kawata H,Sunada K,Satoh K,Kaneko Y,Ido K,Sugano K.Success rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate.Gastrointest Endosc 2002;56:507-512[PMID:12297765 DOI:10.1067/mge.2002.128108]
23 Yamamoto H,Kawata H,Sunada K,Sasaki A,Nakazawa K,Miyata T,Sekine Y,Yano T,Satoh K,Ido K,Sugano K.Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood.Endoscopy 2003;35:690-694[PMID:12929067 DOI:10.1055/s-2003-41516]
24 Fujishiro M,Yahagi N,Nakamura M,Kakushima N,Kodashima S,Ono S,Kobayashi K,Hashimoto T,Yamamichi N,Tateishi A,Shimizu Y,Oka M,Ogura K,Kawabe T,Ichinose M,Omata M.Successful outcomes of a novel endoscopic treatment for GI tumors:endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid,glycerin,and sugar.Gastrointest Endosc 2006;63:243-249[PMID:16427929 DOI:10.1016/j.gie.2005.08.002]
25 Matsui Y,Inomata M,Izumi K,Sonoda K,Shiraishi N,Kitano S.Hyaluronic acid stimulates tumor-cell proliferation at wound sites.Gastrointest Endosc 2004;60:539-543[PMID:15472675]
26 Ravalico G,Tognetto D,Baccara F,Lovisato A.Corneal endothelial protection by different viscoelastics during phacoemulsification.J Cataract Refract Surg 1997;23:433-439[PMID:9159690]
27 Feitoza AB,Gostout CJ,Burgart LJ,Burkert A,Herman LJ,Rajan E.Hydroxypropyl methylcellulose:Abetter submucosal fluid cushion for endoscopic mucosal resection.Gastrointest Endosc 2003;57:41-47[PMID:12518129 DOI:10.1067/mge.2003.25]
28 Lee SH,Cho WY,Kim HJ,Kim HJ,Kim YH,Chung IK,Kim HS,Park SH,Kim SJ.A new method of EMR:submucosal injection of a fibrinogen mixture.Gastrointest Endosc 2004;59:220-224[PMID:14745395]
29 Lee SH,Park JH,Park DH,Chung IK,Kim HS,Park SH,Kim SJ,Cho HD.Clinical efficacy of EMRwith submucosal injection of a fibrinogen mixture:a prospective randomized trial.Gastrointest Endosc2006;64:691-696[PMID:17055858 DOI:10.1016/j.gie.2006.07.032]
30 Moss A,Bourke MJ,Metz AJ.A randomized,double-blind trial of succinylated gelatin submucosal injection for endoscopic resection of large sessile polyps of the colon.Am J Gastroenterol 2010;105:2375-2382[PMID:20717108 DOI:10.1038/ajg.2010.319]
31 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.Optimal injection solution for endoscopic submucosal dissection:A randomized controlled trial of Western solutions in a porcine model.Dig Endosc 2018;30:347-353[PMID:29181852DOI:10.1111/den.12993]
32 Repici A,Wallace M,Sharma P,Bhandari P,Lollo G,Maselli R,Hassan C,Rex DK.A novel submucosal injection solution for endoscopic resection of large colorectal lesions:a randomized,double-blind trial.Gastrointest Endosc 2018;88:527-535.e5[PMID:29750983 DOI:10.1016/j.gie.2018.04.2363]
33 Huai ZY,Feng Xian W,Chang Jiang L,Xi Chen W.Submucosal injection solution for endoscopic resection in gastrointestinal tract:a traditional and network meta-analysis.Gastroenterol Res Pract 2015;2015:702768[PMID:25705221 DOI:10.1155/2015/702768]
34 US Food and Drug Administration.Available from:https://www.fda.gov
35 Tullavardhana T,Akranurakkul P,Ungkitphaiboon W,Songtish D.Efficacy of submucosal epinephrine injection for the prevention of postpolypectomy bleeding:A meta-analysis of randomized controlled studies.Ann Med Surg(Lond)2017;19:65-73[PMID:28652912 DOI:10.1016/j.amsu.2017.05.035]
36 Soetikno RM,Gotoda T,Nakanishi Y,Soehendra N.Endoscopic mucosal resection.Gastrointest Endosc2003;57:567-579[PMID:12665775 DOI:10.1067/mge.2003.130]
37 Soetikno R,Kaltenbach T.Dynamic submucosal injection technique.Gastrointest Endosc Clin N Am2010;20:497-502[PMID:20656247 DOI:10.1016/j.giec.2010.03.008]
38 Pioche M,Lépilliez V,Déprez P,Giovannini M,Caillol F,Piessevaux H,Rivory J,Guillaud O,Cioc?rlan M,Salmon D,Lienhart I,Lafon C,Saurin JC,Ponchon T.High pressure jet injection of viscous solutions for endoscopic submucosal dissection(ESD):first clinical experience.Endosc Int Open 2015;3:E368-E372[PMID:26356488 DOI:10.1055/s-0034-1391902]
39 Khashab MA,Saxena P,Sharaiha RZ,Chavez YH,Zhang F,Kord Valeshabad A,Aguila G,Canto MI,Pasricha PJ,Kalloo AN.A novel submucosal gel permits simple and efficient gastric endoscopic submucosal dissection.Gastroenterology 2013;144:505-507[PMID:23313267 DOI:10.1053/j.gastro.2013.01.005]
40 Khashab MA,Sharaiha RZ,Saxena P,Law JK,Singh VK,Lennon AM,Shin EJ,Canto MI,Aguila G,Okolo PI,Stavropoulos SN,Inoue H,Pasricha PJ,Kalloo AN.Novel technique of auto-tunneling during peroral endoscopic myotomy(with video).Gastrointest Endosc 2013;77:119-122[PMID:23261101DOI:10.1016/j.gie.2012.09.011]
41 Sumiyama K,Toyoizumi H,Ohya TR,Dobashi A,Hino S,Kobayashi M,Goda K,Imazu H,Kawakita Y,Kato T,Tajiri H.A double-blind,block-randomized,placebo-controlled trial to identify the chemical assistance effect of mesna submucosal injection for gastric endoscopic submucosal dissection.Gastrointest Endosc 2014;79:756-764[PMID:24238308 DOI:10.1016/j.gie.2013.09.027]
2 Choi KS,Jung HY,Choi KD,Lee GH,Song HJ,Kim DH,Lee JH,Kim MY,Kim BS,Oh ST,Yook JH,Jang SJ,Yun SC,Kim SO,Kim JH.EMR versus gastrectomy for intramucosal gastric cancer:comparison of long-term outcomes.Gastrointest Endosc 2011;73:942-948[PMID:21392757 DOI:10.1016/j.gie.2010.12.032]
3 ASGE Technology Committee;Hwang JH,Konda V,Abu Dayyeh BK,Chauhan SS,Enestvedt BK,Fujii-Lau LL,Komanduri S,Maple JT,Murad FM,Pannala R,Thosani NC,Banerjee S.Endoscopic mucosal resection.Gastrointest Endosc 2015;82:215-226[PMID:26077453 DOI:10.1016/j.gie.2015.05.001]
4 Jung YS,Park DI.Submucosal injection solutions for endoscopic mucosal resection and endoscopic submucosal dissection of gastrointestinal neoplasms.Gastrointest Inte 2013;2:73-77[DOI:10.1016/j.gii.2013.09.003]
5 Uraoka T,Saito Y,Yamamoto K,Fujii T.Submucosal injection solution for gastrointestinal tract endoscopic mucosal resection and endoscopic submucosal dissection.Drug Des Devel Ther 2009;2:131-138[PMID:19920900]
6 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.Tissue damage of different submucosal injection solutions for EMR.Gastrointest Endosc 2005;62:933-942[PMID:16301040 DOI:10.1016/j.gie.2005.07.052]
7 Rastogi A.Optical diagnosis of small colorectal polyp histology with high-definition colonoscopy using narrow band imaging.Clin Endosc 2013;46:120-129[PMID:23614121 DOI:10.5946/ce.2013.46.2.120]
8 Rex DK.Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps.Gastroenterology 2009;136:1174-1181[PMID:19187781 DOI:10.1053/j.gastro.2008.12.009]
9 Ferlitsch M,Moss A,Hassan C,Bhandari P,Dumonceau JM,Paspatis G,Jover R,Langner C,Bronzwaer M,Nalankilli K,Fockens P,Hazzan R,Gralnek IM,Gschwantler M,Waldmann E,Jeschek P,Penz D,Heresbach D,Moons L,Lemmers A,Paraskeva K,Pohl J,Ponchon T,Regula J,Repici A,Rutter MD,Burgess NG,Bourke MJ.Colorectal polypectomy and endoscopic mucosal resection(EMR):European Society of Gastrointestinal Endoscopy(ESGE)Clinical Guideline.Endoscopy 2017;49:270-297[PMID:28212588 DOI:10.1055/s-0043-102569]
10 Khashab MA,Cummings OW,DeWitt JM.Ligation-assisted endoscopic mucosal resection of gastric heterotopic pancreas.World J Gastroenterol 2009;15:2805-2808[PMID:19522034 DOI:10.3748/wjg.15.2805]
11 ASGE TECHNOLOGY COMMITTEE,Kantsevoy SV,Adler DG,Conway JD,Diehl DL,Farraye FA,Kwon R,Mamula P,Rodriguez S,Shah RJ,Wong Kee Song LM,Tierney WM.Endoscopic mucosal resection and endoscopic submucosal dissection.Gastrointest Endosc 2008;68:11-18[PMID:18577472DOI:10.1016/j.gie.2008.01.037]
12 Tanaka S,Haruma K,Oka S,Takahashi R,Kunihiro M,Kitadai Y,Yoshihara M,Shimamoto F,Chayama K.Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm.Gastrointest Endosc 2001;54:62-66[PMID:11427843 DOI:10.1067/mge.2001.115729]
13 Uraoka T,Saito Y,Matsuda T,Ikehara H,Gotoda T,Saito D,Fujii T.Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum.Gut 2006;55:1592-1597[PMID:16682427 DOI:10.1136/gut.2005.087452]
14 Gotoda T.A large endoscopic resection by endoscopic submucosal dissection procedure for early gastric cancer.Clin Gastroenterol Hepatol 2005;3:S71-S73[PMID:16013003]
15 Pimentel-Nunes P,Dinis-Ribeiro M,Ponchon T,Repici A,Vieth M,De Ceglie A,Amato A,Berr F,Bhandari P,Bialek A,Conio M,Haringsma J,Langner C,Meisner S,Messmann H,Morino M,Neuhaus H,Piessevaux H,Rugge M,Saunders BP,Robaszkiewicz M,Seewald S,Kashin S,Dumonceau JM,Hassan C,Deprez PH.Endoscopic submucosal dissection:European Society of Gastrointestinal Endoscopy(ESGE)Guideline.Endoscopy 2015;47:829-854[PMID:26317585 DOI:10.1055/s-0034-1392882]
16 Ohkuwa M,Hosokawa K,Boku N,Ohtu A,Tajiri H,Yoshida S.New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife.Endoscopy 2001;33:221-226[PMID:11293753 DOI:10.1055/s-2001-12805]
17 Ferreira AO,Moleiro J,Torres J,Dinis-Ribeiro M.Solutions for submucosal injection in endoscopic resection:a systematic review and meta-analysis.Endosc Int Open 2016;4:E1-E16[PMID:26793777DOI:10.1055/s-0034-1393079]
18 Fujishiro M,Yahagi N,Kashimura K,Mizushima Y,Oka M,Enomoto S,Kakushima N,Kobayashi K,Hashimoto T,Iguchi M,Shimizu Y,Ichinose M,Omata M.Comparison of various submucosal injection solutions for maintaining mucosal elevation during endoscopic mucosal resection.Endoscopy 2004;36:579-583[PMID:15243878 DOI:10.1055/s-2004-814517]
19 Sumiyoshi T,Fujii T,Sumiyoshi Y.Injected substances to the submucosa in endoscopic mucosal resection:glycerin solution versus normal saline solution.Gastrointest Endosc 2002;55:AB110-AB110
20 Uraoka T,Fujii T,Saito Y,Sumiyoshi T,Emura F,Bhandari P,Matsuda T,Fu KI,Saito D.Effectiveness of glycerol as a submucosal injection for EMR.Gastrointest Endosc 2005;61:736-740[PMID:15855984]
21 Yamamoto H,Yube T,Isoda N,Sato Y,Sekine Y,Higashizawa T,Ido K,Kimura K,Kanai N.A novel method of endoscopic mucosal resection using sodium hyaluronate.Gastrointest Endosc 1999;50:251-256[PMID:10425422]
22 Yamamoto H,Kawata H,Sunada K,Satoh K,Kaneko Y,Ido K,Sugano K.Success rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate.Gastrointest Endosc 2002;56:507-512[PMID:12297765 DOI:10.1067/mge.2002.128108]
23 Yamamoto H,Kawata H,Sunada K,Sasaki A,Nakazawa K,Miyata T,Sekine Y,Yano T,Satoh K,Ido K,Sugano K.Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood.Endoscopy 2003;35:690-694[PMID:12929067 DOI:10.1055/s-2003-41516]
24 Fujishiro M,Yahagi N,Nakamura M,Kakushima N,Kodashima S,Ono S,Kobayashi K,Hashimoto T,Yamamichi N,Tateishi A,Shimizu Y,Oka M,Ogura K,Kawabe T,Ichinose M,Omata M.Successful outcomes of a novel endoscopic treatment for GI tumors:endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid,glycerin,and sugar.Gastrointest Endosc 2006;63:243-249[PMID:16427929 DOI:10.1016/j.gie.2005.08.002]
25 Matsui Y,Inomata M,Izumi K,Sonoda K,Shiraishi N,Kitano S.Hyaluronic acid stimulates tumor-cell proliferation at wound sites.Gastrointest Endosc 2004;60:539-543[PMID:15472675]
26 Ravalico G,Tognetto D,Baccara F,Lovisato A.Corneal endothelial protection by different viscoelastics during phacoemulsification.J Cataract Refract Surg 1997;23:433-439[PMID:9159690]
27 Feitoza AB,Gostout CJ,Burgart LJ,Burkert A,Herman LJ,Rajan E.Hydroxypropyl methylcellulose:Abetter submucosal fluid cushion for endoscopic mucosal resection.Gastrointest Endosc 2003;57:41-47[PMID:12518129 DOI:10.1067/mge.2003.25]
28 Lee SH,Cho WY,Kim HJ,Kim HJ,Kim YH,Chung IK,Kim HS,Park SH,Kim SJ.A new method of EMR:submucosal injection of a fibrinogen mixture.Gastrointest Endosc 2004;59:220-224[PMID:14745395]
29 Lee SH,Park JH,Park DH,Chung IK,Kim HS,Park SH,Kim SJ,Cho HD.Clinical efficacy of EMRwith submucosal injection of a fibrinogen mixture:a prospective randomized trial.Gastrointest Endosc2006;64:691-696[PMID:17055858 DOI:10.1016/j.gie.2006.07.032]
30 Moss A,Bourke MJ,Metz AJ.A randomized,double-blind trial of succinylated gelatin submucosal injection for endoscopic resection of large sessile polyps of the colon.Am J Gastroenterol 2010;105:2375-2382[PMID:20717108 DOI:10.1038/ajg.2010.319]
31 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.Optimal injection solution for endoscopic submucosal dissection:A randomized controlled trial of Western solutions in a porcine model.Dig Endosc 2018;30:347-353[PMID:29181852DOI:10.1111/den.12993]
32 Repici A,Wallace M,Sharma P,Bhandari P,Lollo G,Maselli R,Hassan C,Rex DK.A novel submucosal injection solution for endoscopic resection of large colorectal lesions:a randomized,double-blind trial.Gastrointest Endosc 2018;88:527-535.e5[PMID:29750983 DOI:10.1016/j.gie.2018.04.2363]
33 Huai ZY,Feng Xian W,Chang Jiang L,Xi Chen W.Submucosal injection solution for endoscopic resection in gastrointestinal tract:a traditional and network meta-analysis.Gastroenterol Res Pract 2015;2015:702768[PMID:25705221 DOI:10.1155/2015/702768]
34 US Food and Drug Administration.Available from:https://www.fda.gov
35 Tullavardhana T,Akranurakkul P,Ungkitphaiboon W,Songtish D.Efficacy of submucosal epinephrine injection for the prevention of postpolypectomy bleeding:A meta-analysis of randomized controlled studies.Ann Med Surg(Lond)2017;19:65-73[PMID:28652912 DOI:10.1016/j.amsu.2017.05.035]
36 Soetikno RM,Gotoda T,Nakanishi Y,Soehendra N.Endoscopic mucosal resection.Gastrointest Endosc2003;57:567-579[PMID:12665775 DOI:10.1067/mge.2003.130]
37 Soetikno R,Kaltenbach T.Dynamic submucosal injection technique.Gastrointest Endosc Clin N Am2010;20:497-502[PMID:20656247 DOI:10.1016/j.giec.2010.03.008]
38 Pioche M,Lépilliez V,Déprez P,Giovannini M,Caillol F,Piessevaux H,Rivory J,Guillaud O,Cioc?rlan M,Salmon D,Lienhart I,Lafon C,Saurin JC,Ponchon T.High pressure jet injection of viscous solutions for endoscopic submucosal dissection(ESD):first clinical experience.Endosc Int Open 2015;3:E368-E372[PMID:26356488 DOI:10.1055/s-0034-1391902]
39 Khashab MA,Saxena P,Sharaiha RZ,Chavez YH,Zhang F,Kord Valeshabad A,Aguila G,Canto MI,Pasricha PJ,Kalloo AN.A novel submucosal gel permits simple and efficient gastric endoscopic submucosal dissection.Gastroenterology 2013;144:505-507[PMID:23313267 DOI:10.1053/j.gastro.2013.01.005]
40 Khashab MA,Sharaiha RZ,Saxena P,Law JK,Singh VK,Lennon AM,Shin EJ,Canto MI,Aguila G,Okolo PI,Stavropoulos SN,Inoue H,Pasricha PJ,Kalloo AN.Novel technique of auto-tunneling during peroral endoscopic myotomy(with video).Gastrointest Endosc 2013;77:119-122[PMID:23261101DOI:10.1016/j.gie.2012.09.011]
41 Sumiyama K,Toyoizumi H,Ohya TR,Dobashi A,Hino S,Kobayashi M,Goda K,Imazu H,Kawakita Y,Kato T,Tajiri H.A double-blind,block-randomized,placebo-controlled trial to identify the chemical assistance effect of mesna submucosal injection for gastric endoscopic submucosal dissection.Gastrointest Endosc 2014;79:756-764[PMID:24238308 DOI:10.1016/j.gie.2013.09.027]