Niimi Keiko, Fujishiro Mitsuhiro, Kodashima Shinya, Ono Satoshi, Goto Osamu, Yamamichi Nobutake, Koike Kazuhiko
Keiko Niimi, Mitsuhiro Fujishiro, Shinya Kodashima, Satoshi Ono, Osamu Goto, Nobutake Yamamichi, Kazuhiko Koike, Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
World J Gastrointest Endosc. 2009 Oct 15;1(1):61-4. doi: 10.4253/wjge.v1.i1.61.
To investigate the protective effect of subserosal injection of hyaluronic acid (HA) after endoscopic resection (ER) using ex vivo and in vivo studies.
As the first examination, technical application of subserosal injection was tested 10 times using resected porcine stomachs. As the second examination, ER was applied to make six mucosal defects per stomach in three live minipigs and thermal damage was given on the proper muscle layer by using hemostatic forceps. Following the thermocoagulation, 1 mL of normal saline and HA, respectively, was injected targeting the subserosal layer in two mucosal defects each and the rest kept no injection as the control. The minipigs were recovered from the anesthesia and kept fasting until euthanasia which was carried out around 24 h after the procedures.
Ex vivo study revealed that complete and partial subserosal injection was possible two (20%) and four (40%) times, respectively. In vivo study revealed that no postoperative perforation occurred at any point of the thermocoagulation. Apparent retention of hyaluronic acid was identified at only two (33%) points where HA was injected.
This study failed to show preventative effects of subserosal injection of HA on postoperative perforation due to technical faults. However, this concept has a possibility to change strategy of ER with further technical innovation.
通过体外和体内研究，探讨内镜切除（ER）术后浆膜下注射透明质酸（HA）的保护作用。
作为首次检查，使用切除的猪胃对浆膜下注射的技术应用进行了10次测试。作为第二次检查，对三只活体小型猪的每个胃制造六个黏膜缺损，并使用止血钳对适当的肌层造成热损伤。热凝后，分别向两个黏膜缺损的浆膜下层注射1 mL生理盐水和HA，其余作为对照不进行注射。小型猪从麻醉中苏醒后禁食，直至在手术后约24小时实施安乐死。
体外研究显示，完全和部分浆膜下注射分别有两次（20%）和四次（40%）成功。体内研究显示，热凝过程中任何时候均未发生术后穿孔。仅在注射HA的两个部位（33%）发现透明质酸明显留存。
由于技术缺陷，本研究未能显示浆膜下注射HA对术后穿孔的预防作用。然而，随着技术的进一步创新，这一概念有可能改变内镜切除的策略。
