Yamasaki Masahiro, Kume Keiichiro, Yoshikawa Ichiro, Otsuki Makoto
Third Department of Internal Medicine, University of Occupational and Environmental Health, Japan, School of Medicine, Kitakyusyu, Japan.
Gastrointest Endosc. 2006 Dec;64(6):958-65. doi: 10.1016/j.gie.2006.07.035.
Endoscopic submucosal dissection (ESD), particularly the process of submucosal incision with a knife, is technically difficult and carries a high risk of perforation. Submucosal injection of a viscous substance, eg, jelly, obviates the need of submucosal incision with a knife. Sodium carboxymethylcellulose (SCMC), known as cellulose gum, is highly viscous when dissolved in water.
To evaluate the efficacy and the safety of ESD by submucosal injection of SCMC solution in a porcine stomach.
A prospective, single-center study.
The viscosity of various concentrations (0.5%-3.5%) of SCMC was measured by a viscometry. First, we injected 10 mL of various concentrations of SCMC solution into the submucosal layer of resected porcine stomachs in vitro and examined whether the submucosal injection dissected the mucosal layer from the muscular layer by EUS. Second, we performed ESD by injecting, with an 18-gauge needle, the SCMC solution into the submucosal layer of the stomach in white domestic pigs in vivo to evaluate the efficacy and the safety of SCMC for ESD.
Submucosal injection of the SCMC solution dissected most of the mucosal layer from the muscular layer at the concentration above 2.0%. We, therefore, decided to use 2.5% SCMC for ESD with a 18-gauge needle to ensure dissection. Submucosal injection of 2.5% SCMC dissected the mucosal layer from the muscular layer without complications, such as massive bleeding or perforation, in white domestic pigs. Histologically, injection of 2.5% SCMC revealed no damage to the muscular layer and surrounding tissue.
Our novel injection technique was evaluated in an animal model with a normal stomach; it was relatively easy to approach the target mucosa.
ESD by submucosal injection of viscous SCMC solution appeared to be an easy, safe, and technically efficient method for dissection of gastric lesions.
内镜黏膜下剥离术（ESD），尤其是用刀进行黏膜下切开的过程，技术难度大且穿孔风险高。黏膜下注射粘性物质，如凝胶，可避免用刀进行黏膜下切开。羧甲基纤维素钠（SCMC），即纤维素胶，溶于水时具有高粘性。
评估在猪胃中通过黏膜下注射SCMC溶液进行ESD的有效性和安全性。
一项前瞻性单中心研究。
通过粘度计测量不同浓度（0.5%-3.5%）SCMC的粘度。首先，我们在体外将10毫升不同浓度的SCMC溶液注入切除的猪胃黏膜下层，并通过超声内镜检查黏膜下注射是否能将黏膜层与肌层分离。其次，我们在活体白色家猪的胃黏膜下层用18号针注射SCMC溶液进行ESD，以评估SCMC用于ESD的有效性和安全性。
当浓度高于2.0%时，黏膜下注射SCMC溶液能将大部分黏膜层与肌层分离。因此，我们决定使用2.5%的SCMC与18号针进行ESD以确保分离。在白色家猪中黏膜下注射2.5%的SCMC可将黏膜层与肌层分离，且无大出血或穿孔等并发症。组织学检查显示，注射2.5%的SCMC对肌层和周围组织无损伤。
我们的新型注射技术是在胃正常的动物模型中评估的；接近目标黏膜相对容易。
通过黏膜下注射粘性SCMC溶液进行ESD似乎是一种用于切除胃病变的简便、安全且技术高效的方法。
