1
|
Zhang Y, Miao D, Su M, Tang Y, Zhou M, Yu Y, Guo X, Wu D. Synergistic Drug-Loaded Shear-Thinning Star Polymer Hydrogel Facilitates Gastrointestinal Lesion Resection and Promotes Wound Healing. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2309586. [PMID: 38686448 PMCID: PMC11234439 DOI: 10.1002/advs.202309586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/14/2024] [Indexed: 05/02/2024]
Abstract
Easy injection, long-lasting barrier, and drug loading are the critical properties of submucosal injection materials for endoscopic surgery. However, conventional injectable polymers face challenges in simultaneously attaining these properties due to the inherent conflict between injectability and in situ stability. Here, a multi-arm star polymer hydrogel (denoted as βCP hydrogel) with long-lasting submucosal barrier (exceeding 120 min), rapid hemostasis, and sustained antibacterial properties is successfully developed by grafting poly(oligo(ethylene glycol) methyl ether methacrylate) (PEGMA) side-chains from β-CD via atom transfer radical polymerization (ATRP). During the onset of shearing, βCP hydrogel experiences the unwinding of polymer side-chains between neighboring star polymers, which facilitates the process of endoscopic injectability. After submucosal injection, βCP hydrogel undergoes the winding of polymer side-chains, thereby establishing a long-lasting barrier cushion. Meanwhile, owing to its distinctive structures with a hydrophobic inner cavity and an outer layer of hydrophilic polymer side-chains, βCP hydrogel enables simultaneous loading and on-demand release of diverse categories of drugs. This unique performance can adapt to the diverse demands during different stages of wound healing in a porcine endoscopic surgery model. These results indicate an appealing prospect for new application of star polymers as a good submucosal injection material in endoscopic treatments.
Collapse
Affiliation(s)
- Yue Zhang
- PCFM LabSchool of ChemistrySun Yat‐sen UniversityGuangzhou510006P. R. China
| | - Dongtian Miao
- PCFM LabSchool of ChemistrySun Yat‐sen UniversityGuangzhou510006P. R. China
| | - Mingli Su
- Department of General Surgery (Endoscopic Surgery)Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseasesBiomedical Innovation CenterKey Laboratory of Human Microbiome and Chronic Diseases (Sun Yat‐sen University)Ministry of EducationGuangzhou510655P. R. China
- The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhou510655P. R. China
| | - Yinxiang Tang
- PCFM LabSchool of ChemistrySun Yat‐sen UniversityGuangzhou510006P. R. China
| | - Minghong Zhou
- Medical Research InstituteGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhou510080P. R. China
| | - Yang Yu
- Department of General Surgery (Colorectal Surgery)Guangdong Institute of GastroenterologyBiomedical Innovation CenterGuangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseasesThe Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhou510655P. R. China
| | - Xuefeng Guo
- Department of General Surgery (Endoscopic Surgery)Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseasesBiomedical Innovation CenterKey Laboratory of Human Microbiome and Chronic Diseases (Sun Yat‐sen University)Ministry of EducationGuangzhou510655P. R. China
- The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhou510655P. R. China
| | - Dingcai Wu
- PCFM LabSchool of ChemistrySun Yat‐sen UniversityGuangzhou510006P. R. China
| |
Collapse
|
2
|
Wang QQ, Tan C, Qin G, Yao SK. Promising Clinical Applications of Hydrogels Associated With Precise Cancer Treatment: A Review. Technol Cancer Res Treat 2023; 22:15330338221150322. [PMID: 36604973 PMCID: PMC9829993 DOI: 10.1177/15330338221150322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Gastrointestinal cancer is one of the most malignant tumors with high morbidity and mortality, especially colorectal cancer, which has become the second leading cause of cancer-related deaths worldwide. Targeted drug treatment and precise endoscopic resection can significantly improve the overall survival rate and greatly extend the life span. Promising biomedical applications of hydrogels would represent hopeful therapeutic alternatives for patients with different kinds of diseases, particularly providing precise therapy for cancer patients. Although the intersection field of material science and biomedical science has made tremendous advances, major challenges remain. In this review, the application of hydrogel-based technology in cancer precision medicine is the focus of attention, which is the development trend of multidisciplinary cooperation in the future. First, we provide the current clinical landscape of hydrogel applications, and then we highlight precision oncology, including personalized drug treatment and accurate endoscopic intervention. Finally, we discuss major challenges for their clinical translation that have not yet been overcome and future perspectives on cancer precision medicine.
Collapse
Affiliation(s)
- Qian-qian Wang
- Peking University China-Japan Friendship School of Clinical
Medicine, Beijing, China
| | - Chang Tan
- Peking University China-Japan Friendship School of Clinical
Medicine, Beijing, China
| | - Geng Qin
- Department of Gastroenterology, China-Japan Friendship
Hospital, Beijing, China
| | - Shu-kun Yao
- Department of Gastroenterology, China-Japan Friendship
Hospital, Beijing, China,Shu-kun Yao, Department of
Gastroenterology, China-Japan Friendship Hospital, 2nd Yinghua East Road,
Beijing, China.
| |
Collapse
|
3
|
Yang Y, Xu X, Wang M, Zhang Y, Zhou P, Yang S, Shu X, Xie C. Research trends on endoscopic mucosal resection: A bibliometric analysis from 1991 to 2021. Front Surg 2022; 9:994718. [PMCID: PMC9630576 DOI: 10.3389/fsurg.2022.994718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
BackgroundIn recent years, the rapid development of digestive endoscopy technology has brought revolutionary changes to endoscopic therapy. A growing number of articles have been published annually. We aimed to explore global scientific outputs and hotspots of endoscopic mucosal resection (EMR) published by different countries, organizations, and authors.MethodsWe extracted relevant publications from the Web of Science Core Collection (WOSCC) on June 23, 2022. We examined the retrieved data by bibliometric analysis (e.g., cocited and cluster analysis, keyword co-occurrence) using the software CiteSpace and VOSviewer to analyze and predict the trends and hot spots in this field.ResultsA total of 2,695 papers were finally identified. The results showed that the number of articles fluctuated with the year and reached its peak in 2021. NATIONAL CANCER CENTER JAPAN was the most influential institution. MICHAEL J BOURKE and YUTAKA SAITO are two of the most prolific scholars. ENDOSCOPY and GASTROINTESTINAL ENDOSCOPY were the most productive journals. “Early gastric cancer” and “Barrett's esophagus” were the focus of EMR research. “Adverse events”, “cold snare polypectomy” and “outcomes” have become increasingly popular in recent years and could become hot spots in the future.ConclusionIn this study, we summarized the characteristics of the publications; identified the most influential countries, institutions, and journals; and identified the leading topics in the EMR field.
Collapse
Affiliation(s)
- Yihan Yang
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xuan Xu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Menghui Wang
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yang Zhang
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Pinglang Zhou
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Sifan Yang
- Faculty of Basic Medical Sciences, Xizang Minzu University, Xianyang, China
| | - Xu Shu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Correspondence: Chuan Xie Xu Shu
| | - Chuan Xie
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Correspondence: Chuan Xie Xu Shu
| |
Collapse
|
4
|
Saito Y, Ono A, García VAJ, Mizuguchi Y, Hisada I, Takamaru H, Yamada M, Sekiguchi M, Makiguchi M, Sekine S, Abe S. Diagnosis and treatment of colorectal tumors: Differences between Japan and the West and future prospects. DEN OPEN 2022; 2:e66. [PMID: 35310722 PMCID: PMC8828232 DOI: 10.1002/deo2.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 12/24/2022]
Abstract
Dye‐based chromoendoscopy has long been used routinely for endoscopic diagnosis of gastrointestinal tumors including colorectal tumors in Japan. In the West, on the other hand, dye‐based chromoendoscopy was not so commonly used. However, with the development of narrow band imaging (NBI), image‐enhanced endoscopy diagnosis has rapidly increased in the West. The most critical difference between Japan and the West is the histopathological evaluation of the lesions, which determines a major cause of differences in diagnostic and treatment strategies. In the West, intramucosal adenocarcinoma is not diagnosed until the cancer has invaded submucosal layer. In Japan, on the other hand, cancer is mainly diagnosed based on nuclear and structural atypia, and thus intramucosal adenocarcinoma is diagnosed in lesions that correspond to high‐grade adenoma in the West. In the West, since intramucosal carcinoma is not diagnosed by pathology, all benign adenomas are treated by piecemeal endoscopic resection, and only cancer invading the superficial submucosal layer is indicated for endoscopic submucosal dissection (ESD). Because of the risk of lymph node metastasis in the deep submucosal invasion, the European Society of Gastrointestinal Endoscopy and American Society for Gastrointestinal Endoscopy guidelines state that only superficial submucosal cancer is an indication for ESD. Unfortunately, it is impossible to selectively extract only superficial submucosal invasive cancer even with the use of magnified NBI and pit pattern observation. Therefore, we think that pathologists need to diagnose intramucosal adenocarcinoma with the potential to invade the submucosal layer based on the nuclear and structural atypia. Consequently, intramucosal adenocarcinoma and superficial submucosal cancers should be considered for en‐bloc ESD.
Collapse
Affiliation(s)
- Yutaka Saito
- Endoscopy Division National Cancer Center Hospital Tokyo Japan
| | - Akiko Ono
- Dept. of Gastroenterology Hospital Clínico Universitario Virgen de la Arrixaca
| | | | | | - Izumi Hisada
- Endoscopy Division National Cancer Center Hospital Tokyo Japan
| | | | | | - Masau Sekiguchi
- Endoscopy Division National Cancer Center Hospital Tokyo Japan
| | - Mai Makiguchi
- Endoscopy Division National Cancer Center Hospital Tokyo Japan
| | - Shigeki Sekine
- Molecular Pathology Division National Cancer Center Research Institute
| | - Seiichiro Abe
- Endoscopy Division National Cancer Center Hospital Tokyo Japan
| |
Collapse
|
5
|
Jeon HJ, Choi HS, Bang EJ, Lee KW, Kim SH, Lee JM, Kim ES, Keum B, Tae Jeen Y, Lee HS, Chun HJ, Jeong S, Kim JH. Efficacy and safety of a thermosensitive hydrogel for endoscopic submucosal dissection: An in vivo swine study. PLoS One 2021; 16:e0260458. [PMID: 34882721 PMCID: PMC8659419 DOI: 10.1371/journal.pone.0260458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/09/2021] [Indexed: 11/18/2022] Open
Abstract
Injectable thermo-sensitive chitosan hydrogels have recently been developed for the use of submucosal fluids in endoscopic submucosal dissections (ESD). This study aimed to investigate the efficacy and safety of chitosan hydrogels during ESD. Submucosal fluids were administered as follows: 0.9% normal saline (NS), 0.4% hyaluronic acid (HA) and chitosan/β-glycerophosphate (CS/GP) hydrogel. Each solution was administered twice into the stomach and colon of a pig, with a total of 72 ESD procedures performed on 12 pigs. The injected volume and procedure-related parameters were recorded and analyzed. ESDs that created ulcers after 7 days were histologically compared. All ESD specimens were resected en bloc. The total injected volumes during ESD of the stomach (NS, 16.09±3.27 vs. HA, 11.17±2.32 vs. CS/GP, 9.44±2.33; p<0.001) and colon (NS, 9.17±1.80 vs. HA, 6.67±1.50 vs. CS/GP, 6.75±1.57; p = 0.001) were significantly different. Hydrogel showed significant differences from normal saline in terms of fluid power (mm2/vol; NS, 35.70±9.00 vs. CS/GP 57.48±20.77; p = 0.001) and consumption rate (vol/min; NS, 2.59±0.86 vs. CS/GP, 1.62±0.65; p = 0.013) in the stomach. Histological examination revealed preserved muscularis propria, although the chitosan hydrogel resulted in a partial inflammatory response, with a hypertrophied submucosal layer. Chitosan hydrogel was found to be superior to normal saline, with an efficacy similar to that of hyaluronic acid. Nonetheless, long-term histological changes should be evaluated before clinical implementation.
Collapse
Affiliation(s)
- Han Jo Jeon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Eun Ju Bang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kang Won Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang Hyun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Min Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hong Sik Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung Jeong
- Department of Biosystems & Biomaterials Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Jong Hyuk Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States of America
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States of America
| |
Collapse
|
6
|
Maselli R, Belletrutti PJ, Spadaccini M, Galteri PA, Stäbler T, Ederer M, Neugebauer A, Enderle MD, Repici A. Fluid cushion protects against thermal damage during argon plasma coagulation. Ann Gastroenterol 2021; 34:845-851. [PMID: 34815651 PMCID: PMC8596213 DOI: 10.20524/aog.2021.0667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/16/2021] [Indexed: 12/04/2022] Open
Abstract
Background Thermal damage to the muscle layer during mucosal application of argon plasma coagulation (APC) may be avoided by creating a fluid cushion within the submucosal layer, but the minimum injection volume needed or the ideal injection fluid are yet to be established. We conducted a systematic ex vivo study with this aim. Methods All experiments were performed in an ex vivo porcine gastrointestinal tract model. Five different fluids (saline, Glyceol, Gelafundin, Voluven, and Eleview) of different volumes were injected into the submucosa of different parts of the gastrointestinal tract. APC was applied to the mucosa at different power settings. Immediately after APC treatment, the temperature was measured through a thermocouple placed inside the fluid cushion, just on top of the muscle layer. The minimum volume of fluid needed to protect the muscle layer from thermal damage was determined. Results There was no difference in the temperature measured among the different injection fluids at the surface of the muscle, in all the locations, at equal injection volumes and power settings. The minimum amounts of fluid needed to protect the muscle layer were 2 and 3 mL for power settings of 30-90 W and 90-120 W, respectively. Conclusions Normal saline and 4 commercially available submucosal injection fluids possess similar thermal protective effects. To reduce the likelihood of thermal damage to deeper layers when APC is applied, a minimum injection volume of 3 mL is recommended if less than 90 W power will be utilized over 3 sec.
Collapse
Affiliation(s)
- Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy (Roberta Maselli, Marco Spadaccini, Alessandro Repici).,Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy (Roberta Maselli, Paul J. Belletrutti, Marco Spadaccini, Piera Alessia Galteri, Alessandro Repici)
| | - Paul J Belletrutti
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy (Roberta Maselli, Paul J. Belletrutti, Marco Spadaccini, Piera Alessia Galteri, Alessandro Repici)
| | - Marco Spadaccini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy (Roberta Maselli, Marco Spadaccini, Alessandro Repici).,Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy (Roberta Maselli, Paul J. Belletrutti, Marco Spadaccini, Piera Alessia Galteri, Alessandro Repici)
| | - Piera Alessia Galteri
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy (Roberta Maselli, Paul J. Belletrutti, Marco Spadaccini, Piera Alessia Galteri, Alessandro Repici)
| | - Thomas Stäbler
- Research Department Erbe Elektromedizin GmbH, Tubingen, Germany (Thomas Stäbler, Michael Ederer, Alexander Neugebauer, Markus D. Enderle)
| | - Michael Ederer
- Research Department Erbe Elektromedizin GmbH, Tubingen, Germany (Thomas Stäbler, Michael Ederer, Alexander Neugebauer, Markus D. Enderle)
| | - Alexander Neugebauer
- Research Department Erbe Elektromedizin GmbH, Tubingen, Germany (Thomas Stäbler, Michael Ederer, Alexander Neugebauer, Markus D. Enderle)
| | - Markus D Enderle
- Research Department Erbe Elektromedizin GmbH, Tubingen, Germany (Thomas Stäbler, Michael Ederer, Alexander Neugebauer, Markus D. Enderle)
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Milan, Italy (Roberta Maselli, Marco Spadaccini, Alessandro Repici).,Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy (Roberta Maselli, Paul J. Belletrutti, Marco Spadaccini, Piera Alessia Galteri, Alessandro Repici)
| |
Collapse
|
7
|
Histologic mimics and diagnostic pitfalls of gastrointestinal endoscopic lifting media, ORISE™ gel and Eleview®. Hum Pathol 2021; 119:28-40. [PMID: 34606848 DOI: 10.1016/j.humpath.2021.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/20/2021] [Indexed: 12/24/2022]
Abstract
Synthetic lifting media, ORISE™ gel and Eleview®, are increasingly used in gastrointestinal endoscopy, but neither comparative features nor pitfalls are well-established. Media histopathology, morphologic mimics, and complications are described, along with helpful stains and endoscopist media preference. A 3-year retrospective search was performed. A total of 123 cases (108 endoscopies and 15 subsequent surgeries) were identified. ORISE gel was used in 86 (79.6%), Eleview in 20 (13.9%), and others in 7 (6.5%). ORISE gel was histologically identified in 58.1% (n = 50) of endoscopic specimens and all 15 resections. Eleview media were not detected histologically. ORISE gel mimicked mucin in hematoxylin and eosin-stained biopsies, concerning for adenocarcinoma misdiagnosis and/or upstaging, but did not stain for mucin. Acid-fast bacterial staining highlights ORISE gel for specific and definitive identification. In resections, ORISE evolves into an amorphous eosinophilic material, often with exuberant giant cell reaction and transmural bowel penetration. Polyp formation leads to polypectomy in one patient, and operative lesions concerning for adenocarcinoma resulted in frozen sections in two patients. ORISE gel mimics mucin, malignant masses, amyloid, pulse granulomata, elastofibromas, and infectious granulomata. No significant endoscopist media preference was identified. Recognition of ORISE gel in tissues eliminates multiple pitfalls. Eleview was not detectable, yielded none of the pitfalls seen with ORISE gel, and, on our survey, has equivalent endoscopist acceptance. In this largest published series to date, Eleview is clearly preferable to ORISE gel.
Collapse
|
8
|
Jeon HJ, Jeong S, Choi HS, Jang SH, Kim SH, Kim SH, Lee JM, Kim ES, Keum B, Jeen YT, Lee HS, Chun HJ, Chung JH, Kim SN. A Comparative Study on Aqueous Chitosan Solution and Various Submucosal Injection Fluids Using a Three-Dimensional Sensor. Gut Liver 2021; 15:217-224. [PMID: 32390408 PMCID: PMC7960965 DOI: 10.5009/gnl19383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/05/2020] [Accepted: 02/08/2020] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Chitosan, a natural polymer widely used in the biomaterials field, has been proposed as a potential submucosal injection solution. The purpose of this study was to compare the performance and efficacy of aqueous chitosan solution and commercialized submucosal injection fluids using a three-dimensional sensor and to evaluate the efficacy of the measured parameters. Methods Normal saline (0.9% NaCl), as a control, Eleview® (Poloxamer 188), Blue EyeTM (0.4% hyaluronic acid), and aqueous chitosan solution (2.0%) were injected into the submucosa of porcine stomachs ex vivo. The mucosal elevation height, elevated surface area, and angle of the tangent of the submucosal fluid cushion were measured using a three-dimensional sensor. The rates of change for each variable were calculated, and the correlation between parameters was analyzed. Tissue specimens were stained with hematoxylin and eosin. Results All variables exhibited the highest values under chitosan injection. The mucosal elevation height rate of change differed significantly between normal saline and chitosan solution (p=0.024). The elevated surface area rates of change for normal saline and Eleview® were significantly different from those for TS-905 and chitosan solution (p=0.006 and p=0.009, respectively). Further, height, area, and angle showed a positive correlation (p<0.001). A histological examination revealed an even distribution of aqueous chitosan within the submucosa without tissue damage. Conclusions Aqueous chitosan was superior to normal saline and Eleview® and was noninferior to TS-905. A three-dimensional sensor and the measured parameters were effective and useful for evaluating the performance of submucosal fluids.
Collapse
Affiliation(s)
- Han Jo Jeon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Seung Jeong
- Department of Biosystems & Biomaterials Science and Engineering, Seoul National University College of Agriculture and Life Science, Seoul, Korea.,Medical Engineering Research Center, The Standard Co. Ltd., Gunpo, Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Se Hyun Jang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sang Hoon Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Seung Han Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae Min Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hong Sik Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jong Hoon Chung
- Department of Biosystems & Biomaterials Science and Engineering, Seoul National University College of Agriculture and Life Science, Seoul, Korea
| | - Seong Nam Kim
- Medical Engineering Research Center, The Standard Co. Ltd., Gunpo, Korea
| |
Collapse
|
9
|
Chen C, Liu XY, Cheng CE, Xiong YJ, Sun YB, Tan CH, Liu YT, Feng J, Ma YF, Shi DT, Li R. Efficacy and safety of a novel submucosal injection solution for endoscopic resection in porcine models. J Dig Dis 2021; 22:49-56. [PMID: 33236832 DOI: 10.1111/1751-2980.12963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/17/2020] [Accepted: 11/22/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE A submucosal injection is usually required to improve the efficacy and safety of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR). This study aimed to evaluate the performance of 3.3% sodium carboxymethyl starch (Na-CMS) solution, a novel submucosal injection solution, for ESD and EMR. METHODS Na-CMS, normal saline (NS) and two commercially available agents (sigMAVisc and Eleview) were injected into the esophageal submucosa of randomly grouped pigs. The level of submucosal elevation was examined. Subsequently, ESD or EMR procedures using 3.3% Na-CMS or NS as submucosal injections were performed in the gastrointestinal tract of the pigs. RESULTS Submucosal elevation was significantly higher and more sustained in the 3.3% Na-CMS group than in the controls (P < 0.05). The volume required for ESD or EMR was significantly lower in the 3.3% Na-CMS group than in the NS group (ESD: 12.21 ± 4.09 mL vs 28.25 ± 8.02 mL, P < 0.001; EMR: 3.99 ± 1.98 mL vs 7.15 ± 3.67 mL, P = 0.001). The ESD resection time was significantly shorter in the 3.3% Na-CMS group than in the NS group (16.58 ± 7.30 min vs 25.29 ± 11.89 min, P = 0.004). Hemorrhage after ESD in the 3.3% Na-CMS group was less severe than that in the NS group (P = 0.006). CONCLUSION 3.3% Na-CMS is an effective, safe and low-cost submucosal injection solution and holds promise as preferable agent for submucosal injection in ESD and EMR procedures.
Collapse
Affiliation(s)
- Chen Chen
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Xiao Yu Liu
- Department of Gastroenterology, Yulin No. 2 Hospital, Yulin, Shaanxi Province, China
| | - Cui E Cheng
- Department of Gastroenterology, Changshu No. 2 People's Hospital, Changshu, Jiangsu Province, China
| | - Yu Jia Xiong
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Yi Bin Sun
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Chen Huan Tan
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Yi Ting Liu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Ji Feng
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Yi Fan Ma
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Dong Tao Shi
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Rui Li
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| |
Collapse
|
10
|
Nishimura M. ESD and Pit Pattern Diagnosis: Lessons from a Japanese Endoscopist Working in the United States. Clin Colon Rectal Surg 2020; 33:329-334. [PMID: 33162836 DOI: 10.1055/s-0040-1714235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Endoscopic submucosal dissection (ESD) was developed in 2000s to overcome the limitations of endoscopic mucosal resection (EMR), especially to accomplish en-bloc resection, and it has been accepted worldwide in the past decades. Many ESD devices and diagnosis modalities are currently available, which include pit pattern and narrow band imaging (NBI) diagnoses to evaluate the depth of the tumor preoperatively with sensitivities of 70 to 90%. Depending on the Japanese colorectal guideline, the intramucosal cancer and shallow invasion of the submucosal layer are the main good indications of ESD; however, the ESD practices between Japan and Western countries still vary, including pathologic definition of cancer, tumor/node/metastasis classification, and handling of ESD specimen. In the United States, despite the large demand for treatment of colorectal neoplasm, pit pattern and magnified NBI diagnoses are not widely accepted yet, and piecemeal EMR is still the major method in most of the institutions. Moreover, the specific guideline of ESD is also not available yet. More new technologies are being developed other than conventional ESD methods in Eastern and Western countries, and ESD is now expected to change in the next generation. It is recommended that not only gastroenterologists but also colorectal surgeons have appropriate knowledge of colorectal lesions and their management to ensure current treatments is applied to patients.
Collapse
Affiliation(s)
- Makoto Nishimura
- Gastroenterology, Hepatology and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
11
|
Review on colorectal endoscopic submucosal dissection focusing on the technical aspect. Surg Endosc 2020; 34:3766-3787. [PMID: 32342217 DOI: 10.1007/s00464-020-07599-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) enables removal of broad-based colorectal polyps or lateral spreading tumors with a higher rate of en bloc resection and a lower risk of local recurrence. However, it is technically demanding. Over the past 20 years, various equipment and innovative techniques have been developed to reduce the difficulty of ESD. The information in the literature is scattered. Our aim is to provide a comprehensive review on the setup and technical aspects of colorectal ESD. METHODS We searched the PubMed database and systemically reviewed all original and review articles related to colorectal ESD. Further manual search according to reference lists of identified articles were done. The selected articles were categorized and reviewed. Original figures were created to help readers understand some of the ESD techniques. RESULTS A total of 216 articles were identified, in which 25 of them were review articles and 191 of them were original articles. They were categorized and reviewed. An in-depth appraisal of the setting, equipment, and technical aspects of colorectal ESD was performed. CONCLUSIONS Although ESD is a technically demanding procedure that requires expert endoscopic skills, it can be mastered. With good peri-procedural preparation, sufficient knowledge of the equipment, and thorough understanding of the useful endoscopic tricks and maneuvers, colorectal ESD can be performed smoothly and safely.
Collapse
|
12
|
Moles-Aranda C, González-Pérez R, Gallego-Rojo FJ, Martínez-Augustin O, Clares-Naveros B, Sánchez de Medina F, Morales-Molina JA. Efficacy and Safety of a Novel Submucosal Injection Solution for Resection of Gastrointestinal Lesions. J Clin Med 2020; 9:jcm9041162. [PMID: 32325745 PMCID: PMC7230585 DOI: 10.3390/jcm9041162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/29/2020] [Accepted: 04/14/2020] [Indexed: 01/08/2023] Open
Abstract
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are minimally invasive and efficient techniques for the removal of gastrointestinal (GI) mucosal polyps. In both techniques, submucosal injection solutions are necessary for complete effectiveness and safety during the intervention to be obtained. The main objective of this study was to evaluate the efficacy and safety of a new sterile submucosal injection solution for EMR/ESD used within a clinical protocol in patients with intestinal polyps. We carried out a prospective study between 2016 and 2017 with patients who attended the Endoscopy Consultation—Digestive Department of Primary Hospital. Patients were selected for EMR/ESD after the application of clinical protocols. Thirty-six patients were selected (≥ 66 years with comorbidities and risk factors). Lesions were located mainly in the colon. Our solution presented an intestinal lift ≥ 60 min in EMR/ESD and a high expansion of tissue, optimum viscosity, and subsequent complete resorption. The genes S100A9 and TP53 presented an expression increase in the distal regions. TP53 and PCNA were the only genes whose expression was increased in polyp specimens vs. the surrounding tissue at the mRNA level. In EMR/ESD, our solution presented a prolonged effect at the intestinal level during all times of the intervention. Thus, our solution seems be an effective and safe alternative in cases of flat lesions in both techniques.
Collapse
Affiliation(s)
- Cristina Moles-Aranda
- Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071 Granada, Spain; (C.M.-A.); (B.C.-N.)
| | - Raquel González-Pérez
- Department of Pharmacology, CIBERehd, Instituto de Investigación Biosanitaria ibs.GRANADA, School of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, University of Granada, 18071 Granada, Spain; (O.M.-A.); (J.A.M.-M.)
| | | | - Olga Martínez-Augustin
- Instituto de Investigación Biosanitaria ibs.GRANADA, University of Granada, 18071 Granada, Spain; (O.M.-A.); (J.A.M.-M.)
- Department of Biochemical and Molecular Biology II, CIBERehd, Instituto de Investigación Biosanitaria ibs.GRANADA, School of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071 Granada, Spain
| | - Beatriz Clares-Naveros
- Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071 Granada, Spain; (C.M.-A.); (B.C.-N.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, University of Granada, 18071 Granada, Spain; (O.M.-A.); (J.A.M.-M.)
- Nanoscience and Nanotechnology Institute (IN2UB), University of Barcelona, 08193 Barcelona, Spain
| | - Fermín Sánchez de Medina
- Department of Pharmacology, CIBERehd, Instituto de Investigación Biosanitaria ibs.GRANADA, School of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, University of Granada, 18071 Granada, Spain; (O.M.-A.); (J.A.M.-M.)
- Correspondence:
| | - José Antonio Morales-Molina
- Instituto de Investigación Biosanitaria ibs.GRANADA, University of Granada, 18071 Granada, Spain; (O.M.-A.); (J.A.M.-M.)
- Department of Pharmacy, H.U. Torrecárdenas, C/ Hermandad de Donantes de Sangre, 04009 Almería, Spain
| |
Collapse
|
13
|
Westbrook LM, Henn PA, Cornish TC. Lifting Agent Granuloma: Histologic Findings Following Use of ORISE Gel for Endoscopic Resections in the Gastrointestinal Tract. Am J Clin Pathol 2020; 153:630-638. [PMID: 31875886 DOI: 10.1093/ajcp/aqz204] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Histologic findings after endoscopic resection using submucosal lifting agents Eleview and ORISE gel are described. METHODS Four cases were identified based on the histologic presence of ORISE gel. Cases were selected to illustrate the histologic appearance of the lifting agent immediately after injection (day 0) and after an interval of approximately 2 months. RESULTS Immediately after injection, the gel had an appearance similar to acellular mucin on H&E stain and showed mucicarmine positivity but was negative for periodic acid-Schiff stain and Alcian blue. At 2 months, the appearance changed drastically and was characterized by a hard, homogenous eosinophilic quality and elicited a robust foreign body-type giant cell reaction; we have proposed the name lifting agent granuloma for this histologic appearance. The aged material may be mistaken for amyloid or a pulse (legume) granuloma; however, the material was negative on Congo red stain and had a different clinical history and distribution in the tissue from those of a pulse granuloma. CONCLUSIONS It is important to take note of the histologic appearance of these new submucosal lifting agents over a varying time interval, as outlined here, so that they are readily recognized and not mistaken for other entities.
Collapse
Affiliation(s)
- Lindsey M Westbrook
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora
| | - Patrick A Henn
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora
| | - Toby C Cornish
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora
| |
Collapse
|
14
|
Evaluation of Eleview® Bioadhesive Properties and Cushion-Forming Ability. Polymers (Basel) 2020; 12:polym12020346. [PMID: 32033452 PMCID: PMC7077458 DOI: 10.3390/polym12020346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/22/2020] [Accepted: 01/28/2020] [Indexed: 01/06/2023] Open
Abstract
Submucosal injection is generally required for both endoscopic-mucosal resection (EMR) and submucosal dissection (ESD). SIC-8000 (Eleview®) is a new liquid composition in the form of a microemulsion for submucosal injection, approved by the Food and Drug Administration (FDA) 510(k) and Conformité Européene (CE) marked, containing a biocompatible polymer as a cushioning agent. The aim of this study was to evaluate Eleview®’s performance in terms of bioadhesive properties and cushion-forming ability. The bioadhesion was evaluated by measuring the interaction between Eleview® and the extracellular matrix (the main component of the submucosal layer) using the texture analyzer. To better comprehend the mechanism of action of Eleview® after submucosal injection, force of detachment and adhesion work were measured for the following formulations: Eleview®, Eleview® without poloxamer (functional polymer), poloxamer solution alone, normal saline, and MucoUp® (competing product on the Japanese market). The results obtained show the interaction between Eleview® and the extracellular matrix, highlighting the stronger bioadhesive properties of Eleview® compared with Eleview® without poloxamer, poloxamer solution alone, as well as normal saline and MucoUp®. The ability of Eleview® to form a consistent and long-lasting cushion in situ, once injected into the submucosal layer, was tested ex vivo on a porcine stomach. The results obtained show a better permanence in situ for the product compared with normal saline injection and to MucoUp® (t-test, p < 0.05).
Collapse
|
15
|
EndoClot ®SIS Polysaccharide Injection as a Submucosal Fluid Cushion for Endoscopic Mucosal Therapies: Results of Ex Vivo and In Vivo Studies. Dig Dis Sci 2019; 64:2955-2964. [PMID: 31165380 DOI: 10.1007/s10620-019-05686-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 05/25/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND There are many studies on submucosal injection materials, but their clinical use is restricted for various reasons. The objective of this study was to compare the feasibility and safety of injected EndoClot®SIS polysaccharide as a submucosal injection material (SFC) in ESD in the pig stomach to that of injected sigMAVisc™ or Eleview™. METHODS Four pig stomachs were used for the ex vivo study. Eighteen pigs were used for the in vivo study. In the ex vivo study, four injections were made in the gastric submucosa to induce submucosal uplift and extend its duration. Tissue change was observed. The in vivo study was performed in 2 steps. First, 3 injections were made in the esophageal mucosa to induce submucosal uplift and extend its duration. Histological change was observed. Second, ESD was performed in the stomach by injecting EndoClot®SIS polysaccharide, sigMAVisc™, or Eleview™ (each, n = 6) as an SFC. The effects of these agents on wound healing were examined. We evaluated the efficacy and safety of endoscopic surgery after EndoClot®SIS polysaccharide injection. RESULTS EndoClot®SIS polysaccharide produced a longer-lasting elevation with clearer margins than was achieved by sigMAVisc™, Eleview™, or 0.9% NaCl and thereby enabled precise ESD without complications, such as bleeding and perforation. No obvious histopathological damage was observed at the injection site on endoscopy and histology. CONCLUSION Submucosally injected EndoClot®SIS polysaccharide increased the effective separation of the mucosa and submucosa and reduced surgical complications. Hence, EndoClot®SIS polysaccharide injection is a safe and effective submucosal injection material.
Collapse
|
16
|
Kuwai T, Tamaru Y, Kusunoki R, Ishaq S. Submucosal Injection Solutions for ESD: Separating the Winners from the Losers. Dig Dis Sci 2019; 64:2699-2700. [PMID: 31363953 DOI: 10.1007/s10620-019-05743-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-cho, Kure, 737-0023, Japan.
| | - Yuzuru Tamaru
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-cho, Kure, 737-0023, Japan
| | - Ryusaku Kusunoki
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-cho, Kure, 737-0023, Japan
| | - Sauid Ishaq
- Gastroenterology Department, Dudley Group Hospitals, Birmingham City University, Birmingham, UK.,St. George's University, St. George's, Grenada
| |
Collapse
|
17
|
Response. Gastrointest Endosc 2019; 90:533-534. [PMID: 31439134 DOI: 10.1016/j.gie.2019.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/27/2019] [Indexed: 12/11/2022]
|
18
|
Meier B, Wannhoff A, Klinger C, Caca K. Novel technique for endoscopic en bloc resection (EMR+) - Evaluation in a porcine model. World J Gastroenterol 2019; 25:3764-3774. [PMID: 31391771 PMCID: PMC6676554 DOI: 10.3748/wjg.v25.i28.3764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/24/2019] [Accepted: 06/08/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic en bloc resection of larger polyps is relevant because risk of advanced neoplasia or malignancy correlates with tumor size. Recurrence rates after piecemeal endoscopic mucosal resection (EMR) are high and endoscopic submucosal dissection (ESD) is associated with higher complication rates in the western world.
AIM To develop a modified endoscopic en bloc resection technique using an external additional working channel and novel agent for submucosal injection.
METHODS EMR+ was considered as modified grasp and snare technique. For simultaneous use of a grasping and cutting device a novel additional working channel was used (AWC®, Ovesco Endoscopy, Tübingen, Germany). AWC® is installed on the outer surface of the endoscope, covered with a plastic sleeve and designed for single use. For submucosal injection a new agent consisting of poloxamers was used (LiftUp®, Ovesco Endoscopy, Tübingen, Germany). The agent is liquid at room temperature and forms a stable and permanent gel cushion after injection. Safety of LiftUp® has been shown in a pre-clinical study in domestic pigs. LiftUp® is commercially not yet available but approval is expected in early 2019. EMR+ was first developed ex vivo (explanted pig stomach) and subsequently evaluated in vivo (stomach, porcine model, 3 domestic pigs). Main outcome measurements were: Procedure time, macroscopic en bloc resection and adverse events.
RESULTS Concept of EMR+ was first developed ex vivo (explanted pig stomach). Ex vivo, 22 resections were performed after technique was established. Median procedure time (measured from begin of injection to extraction of resection specimen) was 7 min (range 5-11, SD 1.68) and median size of resection specimens was 30 mm × 26 mm × 11 mm ex vivo. Subsequently 13 resections were performed in vivo (stomach, porcine model, 3 domestic pigs). In vivo, median procedure time (measured from begin of injection to extraction of resection specimen) was 5 min (range 3-12, SD 2.72) and median size of resection specimens was 35 mm × 35 mm × 11 mm. In vivo, resection was macroscopic complete in 92.3%, major adverse events were not observed. In one case (7.7%) minor periprocedural bleeding was observed and managed by coagulation.
CONCLUSION EMR+ appeared to be effective and safe and was easy and fast to perform in the porcine model. EMR+ needs to be further evaluated clinically in comparative trials.
Collapse
Affiliation(s)
- Benjamin Meier
- Department of Gastroenterology, Klinikum Ludwigsburg, Ludwigsburg 71640, Germany
| | - Andreas Wannhoff
- Department of Gastroenterology, Klinikum Ludwigsburg, Ludwigsburg 71640, Germany
| | - Christoph Klinger
- Department of Gastroenterology, Klinikum Ludwigsburg, Ludwigsburg 71640, Germany
| | - Karel Caca
- Department of Gastroenterology, Klinikum Ludwigsburg, Ludwigsburg 71640, Germany
| |
Collapse
|
19
|
Wedi E, Koehler P, Hochberger J, Maiss J, Milenovic S, Gromski M, Ho N, Gabor C, Baulain U, Ellenrieder V, Jung C. Endoscopic submucosal dissection with a novel high viscosity injection solution (LiftUp) in an ex vivo model: a prospective randomized study. Endosc Int Open 2019; 7:E641-E646. [PMID: 31058206 PMCID: PMC6497499 DOI: 10.1055/a-0874-1844] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/02/2018] [Indexed: 02/08/2023] Open
Abstract
Introduction Endoscopic submucosal dissection (ESD) is increasingly being used in the western world. Submucosal injectates are an essential tool for the ESD procedure. In this study, we evaluated a novel copolymer injectate (LiftUp, Ovesco, Tübingen Germany) in an established ESD model (EASIE-R) in comparison to existing submucosal injectables. Materials and methods We conducted a prospective, randomized ex vivo study performing ESD with three injectates: LiftUp, hydroxyethyl starch (HAES 6 %) and normal saline solution (NaCl 0.9 %). A total of 60 artificial lesions, each 3 × 3 cm in size, were resected in an ex vivo porcine model, utilizing one of the three studied injectates (n = 20 ESDs per injectate). Study parameters were: en bloc resection rate, perforation rate, lifting property, time of injection, injectate volume, general ESD procedure time, and overall procedure time. Results All 60 lesions were successfully resected using the standard ESD technique. LiftUp had no procedure related perforations, one perforation occurred in the HAES group, and two perforations in the NaCl group ( P > 0.05). Furthermore, adequate lifting was achieved in 16/20 (80 %) using LiftUp, 6/20 (30 %) in the HAES group and 6/20 (30 %) in the NaCl group ( P < 0.0002). En bloc resection was achieved in 19 (95 %) with LiftUp, in 20 (100 %) with HAES, and in 16 (80 %) with NaCl. General ESD procedure time and overall procedure time were not different among the three groups. Conclusion LiftUp appears to be a safe alternative to established fluids for ESD. It had a significantly improved lifting effect and required significantly less injected volume compared to well-established lifting solutions.
Collapse
Affiliation(s)
- E. Wedi
- Department of Gastroenterology and Gastrointestinal Oncology, Center of Interdisciplinary Endoscopy, University Medical Centre Göttingen, Göttingen, Germany
| | - P. Koehler
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut (FLI), Federal Research Institute for Animal Health, Mariensee, Germany
| | - J. Hochberger
- Department of Gastroenterology, Vivantes Klinikum in Friedrichshain, Teaching Hospital of Charité Humboldt University, Berlin, Germany
| | - J. Maiss
- Department of Gastroenterology, Associates Dr. Kerzel and Prof. Maiss, Forchheim, Germany
| | - S. Milenovic
- Department of Gastroenterology and Gastrointestinal Oncology, Center of Interdisciplinary Endoscopy, University Medical Centre Göttingen, Göttingen, Germany
| | - M. Gromski
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - N. Ho
- Ovesco Endoscopy AG, Tübingen, Germany
| | - C. Gabor
- Ovesco Endoscopy AG, Tübingen, Germany
| | - U. Baulain
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut (FLI), Federal Research Institute for Animal Health, Mariensee, Germany
| | - V. Ellenrieder
- Department of Gastroenterology and Gastrointestinal Oncology, Center of Interdisciplinary Endoscopy, University Medical Centre Göttingen, Göttingen, Germany
| | - C. Jung
- Department of Gastroenterology and Gastrointestinal Oncology, Center of Interdisciplinary Endoscopy, University Medical Centre Göttingen, Göttingen, Germany
| |
Collapse
|
20
|
Update on the endoscopic management of colonic neoplasia – how endoscopy is replacing surgery. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2018. [DOI: 10.1016/j.tgie.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
21
|
Girotra M, Triadafilopoulos G, Friedland S. Utility and performance characteristics of a novel submucosal injection agent (Eleview TM) for endoscopic mucosal resection and endoscopic submucosal dissection. Transl Gastroenterol Hepatol 2018; 3:32. [PMID: 30050992 DOI: 10.21037/tgh.2018.06.01] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 05/29/2018] [Indexed: 12/30/2022] Open
Abstract
Background Submucosal injection of a lifting agent is a critical step in endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD). Literature suggests superiority of other viscous solutions over normal saline (NS), but research to determine the ideal submucosal injection is still ongoing. In this prospective cohort study, we evaluated the utility and performance characteristics of a novel submucosal injection agent (EleviewTM) for EMR and ESD. Methods Twelve consecutive patients referred for EMR/ESD to a tertiary referral center with experienced large polyp expert were prospectively enrolled. Ten patients with large colon polyps (mean age 66.3 years), and one patient each with esophageal and gastric lesions were included. EleviewTM was injected as submucosal lifting agent, and EMR/ESD performed. Main outcome measurements included the duration of submucosal elevation, volume and number of injections required to maintain cushion, and complications. Results Single injection of 3-5 cc of EleviewTM outlasted the duration of EMR. However, mean duration of cushion achieved during longer procedures (ESD) was 12.5 min, requiring several additional injections. R0 resection was achieved in 10/12 patients. One patient had minor bleeding which was managed intra-operatively. Conclusions EleviewTM was successful in achieving long duration of submucosal elevation, allowing safe and efficient performance of EMR as a single injection, but needed repeated injections during longer ESD procedures. Prospective controlled trials are required to compare its performance to other available viscous submucosal solutions.
Collapse
Affiliation(s)
- Mohit Girotra
- Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - George Triadafilopoulos
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Shai Friedland
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.,VA Palo Alto Health Care System, Palo Alto, CA, USA
| |
Collapse
|