Endoscopy Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
Dig Endosc. 2017 Sep;29(6):702-711. doi: 10.1111/den.12864. Epub 2017 Apr 24.
A newly developed hydrogel, applied through the endoscope as an endoscopic shielding technique (EndoSTech), is aimed to prevent deep thermal injury and to accelerate the healing process of colonic induced ulcers after therapeutic endoscopy.
Lesions were performed in rats (n = 24) and pigs (n = 8). Rats were randomized to receive EndoSTech (eight rats each) with: saline (control), hyaluronic acid and product. In pigs, three ulcer sites were produced in each pig: endoscopic mucosal resection (EMR)-ulcer with prior saline injection (A; EMR-saline), EMR-saline plus EndoSTech with product (B; EMR-saline-P), and EMR with prior injection of product plus EndoSTech-P (C; EMR-P-P). At the end of the 14-day study, the same lesions were performed again in healthy mucosa to assess acute injury. Animals were sacrificed after 7 (rats) and 14 (pigs) days. Ulcers were macroscopically and histopathologically evaluated. Thermal injury (necrosis) was assessed with a 1-4 scale.
In rats, treatment with product improved mucosal healing comparing with saline and hyaluronic acid (70% vs 30.3% and 47.2%; P = 0.003), avoiding mortality (0% vs 50% and 25%; P = 0.038), and perforation (0% vs 100% and 33.3%; P = 0.02); respectively. In pigs, submucosal injection of product induced a marked trend towards a less deep thermal injury (C = 2.25-0.46 vs A and B = 2.75-0.46; P = 0.127). Mucosal healing rate was higher with product (B = 90.2-3.9%, C = 91.3-5.5% vs A = 73.1-12.6%; P = 0.002).
This new hydrogel demonstrates strong healing properties in preclinical models. In addition, submucosal injection of this product is able to avoid high thermal load of the gastrointestinal wall.
一种新开发的水凝胶，通过内镜作为内镜屏蔽技术（EndoSTech）应用，旨在防止深度热损伤，并加速治疗内镜后结肠诱导溃疡的愈合过程。
在大鼠（n=24）和猪（n=8）中进行病变。大鼠随机分为接受 EndoSTech（每组 8 只）：盐水（对照组）、透明质酸和产品。在猪中，每只猪产生三个溃疡部位：内镜黏膜切除术（EMR）-溃疡伴先前注射盐水（A；EMR-盐水）、EMR-盐水加产品加 EndoSTech（B；EMR-盐水-P）和 EMR 加先前注射产品加 EndoSTech-P（C；EMR-P-P）。在 14 天研究结束时，在健康黏膜上再次进行相同的病变以评估急性损伤。在第 7 天（大鼠）和第 14 天（猪）后处死动物。通过宏观和组织病理学评估溃疡。使用 1-4 级量表评估热损伤（坏死）。
在大鼠中，与盐水和透明质酸相比，产品治疗可改善黏膜愈合（70%比 30.3%和 47.2%；P=0.003），避免死亡率（0%比 50%和 25%；P=0.038）和穿孔（0%比 100%和 33.3%；P=0.02）。在猪中，产品的黏膜下注射导致深度热损伤明显减少的趋势（C=2.25-0.46 比 A 和 B=2.75-0.46；P=0.127）。产品的黏膜愈合率更高（B=90.2-3.9%，C=91.3-5.5%比 A=73.1-12.6%；P=0.002）。
这种新型水凝胶在临床前模型中显示出强大的愈合特性。此外，这种产品的黏膜下注射能够避免胃肠道壁的高热负荷。
