Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
Gastrointest Endosc. 2012 Apr;75(4):841-8. doi: 10.1016/j.gie.2011.10.035. Epub 2012 Jan 31.
Hypertonic saline solution (HS) as a submucosal fluid cushion (SFC) for endoscopic submucosal dissection (ESD) has several disadvantages, including a short effect duration and increased risk of bleeding and perforation. Photocrosslinkable chitosan hydrogel in DMEM/F12 medium (PCH) can be converted into an insoluble hydrogel by UV irradiation for 30 seconds.
To evaluate the feasibility, usefulness, and safety of PCH as an SFC for ESD of esophagi, compared with HS and sodium hyaluronate (SH).
Survival animal study.
Research laboratory study of 24 pig models in vivo.
Twenty-four pigs were used in the 2 steps: First, ESD of the esophagus was performed with PCH, SH, or HS (each n = 6) as an SFC, and the effects of these agents on wound healing were examined endoscopically and histologically. Second, in vivo degradation of PCH (n = 3) and HS (n = 3) was examined in independent pig esophagi.
Outcome measurements included feasibility and safety of PCH-assisted ESD of esophagus, gross and histologic evidence of the treated esophagus, biodegradation of injected PCH, and clinical tolerance by the animals.
PCH injection led to a longer-lasting elevation with clearer margins compared with SH and HS, thus enabling precise ESD along the margins of the elevated mucosa without complications such as bleeding and perforation. The aspects of wound repair after PCH-assisted ESD were similar to those of SH- and HS-assisted ESDs. Biodegradation of PCH was confirmed to be almost completed within 8 weeks on the basis of endoscopic and histologic observations.
In vivo animal model study.
PCH permits more reliable ESD of the esophagus without complications than do SH and HS. Furthermore, the applied PCH appeared to be completely biodegraded within 8 weeks. Thus, PCH is a promising agent as an SFC in ESD of the esophagus.
高渗盐水溶液（HS）作为内镜黏膜下剥离术（ESD）的黏膜下流体垫（SFC）有几个缺点，包括作用时间短以及增加出血和穿孔的风险。可光交联壳聚糖水凝胶在 DMEM/F12 培养基（PCH）中可以在 30 秒的紫外线照射下转化为不溶性水凝胶。
评估 PCH 作为 ESD 的 SFC 的可行性、有用性和安全性，与 HS 和透明质酸钠（SH）进行比较。
存活动物研究。
在体内 24 只猪模型的研究实验室中进行。
将 24 只猪分为 2 个步骤：首先，PCH、SH 或 HS（每组 n = 6）作为 SFC 进行食管 ESD，通过内镜和组织学检查这些药物对伤口愈合的影响。其次，在独立的猪食管中检查 PCH（n = 3）和 HS（n = 3）的体内降解情况。
包括 PCH 辅助 ESD 食管的可行性和安全性、处理过的食管的大体和组织学证据、注射 PCH 的生物降解以及动物的临床耐受性。
与 SH 和 HS 相比，PCH 注射导致的升高持续时间更长，边界更清晰，因此能够在没有出血和穿孔等并发症的情况下，沿着升高的黏膜精确进行 ESD。PCH 辅助 ESD 后的伤口修复方面与 SH 和 HS 辅助 ESD 相似。基于内镜和组织学观察，证实 PCH 的降解几乎在 8 周内完全完成。
体内动物模型研究。
与 SH 和 HS 相比，PCH 更可靠地进行 ESD 食管，且没有并发症。此外，应用的 PCH 似乎在 8 周内完全生物降解。因此，PCH 是一种很有前途的作为 ESD 食管的 SFC 试剂。
