Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Shanghai, China.
United European Gastroenterol J. 2019 Jul;7(6):782-789. doi: 10.1177/2050640619825968. Epub 2019 Jan 22.
Making an optimal and lasting submucosal cushion is critical for endoscopic submucosal dissection. The thermo-sensitive binary hydrogels system composed of poloxamer 407 and poloxamer 188 might be an excellent submucosal injection solution considering the unique feature that it remains liquid at room temperature and becomes gelatinous after being injected in the submucosa of the digestive tract. The present study focuses on preparing the thermo-sensitive binary hydrogels system and testing its capacity in mucosal lifting and its role in the endoscopic submucosal dissection procedure.
Various concentrations of poloxamer 407 and poloxamer 188 were added to normal saline. The gelation temperature viscosity of the thermo-sensitive binary hydrogels system was measured to choose the best formula. The thermo-sensitive binary hydrogels system and normal saline were first compared in extracted porcine stomach. For in vivo study, the thermo-sensitive binary hydrogels system and normal saline were compared for facilitating the endoscopic submucosal dissection procedure.
Among the 46 kinds of thermo-sensitive binary hydrogels system, gelation temperatures of the thermo-sensitive binary hydrogels system I (poloxamer 407/poloxamer 188, 17%/0.5%, w/w) and the thermo-sensitive binary hydrogels system II (poloxamer 407/poloxamer 188, 18%/2%, w/w) were among the ideal range of gelation temperature. The injecting pressure in vitro study of thermo-sensitive binary hydrogels system II was significantly higher than that of thermo-sensitive binary hydrogels system I and normal saline ( < 0.001). Sixteen gastric endoscopic submucosal dissection procedures were performed in a porcine model. The initial volume of normal saline injection (13.88 ± 3.91 ml vs 5.88 ± 3.44 ml, = 0.001) was significantly larger than the thermo-sensitive binary hydrogels system group. The postoperative wound showed a significant difference in the two groups ( = 0.023) indicating that the thermo-sensitive binary hydrogels system can create a cleaner wound.
Considering the gelation temperature, viscosity, injection pressure, and the height of the mucosal elevation, the thermo-sensitive binary hydrogels system I was the better submucosal injection solution.
对于内镜黏膜下剥离术（ESD）来说，形成最佳且持久的黏膜下隆起是非常重要的。由泊洛沙姆 407 和泊洛沙姆 188 组成的温敏双水凝胶系统具有独特的特性，即在室温下呈液态，在注入消化道黏膜下层后变为凝胶状，因此可能是一种极好的黏膜下注射溶液。本研究旨在制备温敏双水凝胶系统，并测试其在黏膜提升方面的能力及其在 ESD 过程中的作用。
向生理盐水（NS）中加入不同浓度的泊洛沙姆 407 和泊洛沙姆 188。测量温敏双水凝胶系统的胶凝温度和黏度，以选择最佳配方。首先在提取的猪胃中比较温敏双水凝胶系统和 NS 的性能。对于体内研究，比较温敏双水凝胶系统和 NS 以促进 ESD 过程。
在 46 种温敏双水凝胶系统中，温敏双水凝胶系统 I（泊洛沙姆 407/泊洛沙姆 188，17%/0.5%，w/w）和温敏双水凝胶系统 II（泊洛沙姆 407/泊洛沙姆 188，18%/2%，w/w）的胶凝温度在理想胶凝温度范围内。体外温敏双水凝胶系统 II 的注射压力明显高于温敏双水凝胶系统 I 和 NS（<0.001）。在猪模型中进行了 16 例胃内镜黏膜下剥离术。NS 注射的初始体积（13.88±3.91ml 比 5.88±3.44ml，=0.001）明显大于温敏双水凝胶系统组。两组术后创面有显著差异（=0.023），表明温敏双水凝胶系统可以创造更清洁的创面。
考虑胶凝温度、黏度、注射压力和黏膜抬高高度，温敏双水凝胶系统 I 是更好的黏膜下注射溶液。
