Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
Department of Gastroenterology, Yulin No. 2 Hospital, Yulin, Shaanxi Province, China.
J Dig Dis. 2021 Jan;22(1):49-56. doi: 10.1111/1751-2980.12963. Epub 2020 Dec 21.
A submucosal injection is usually required to improve the efficacy and safety of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR). This study aimed to evaluate the performance of 3.3% sodium carboxymethyl starch (Na-CMS) solution, a novel submucosal injection solution, for ESD and EMR.
Na-CMS, normal saline (NS) and two commercially available agents (sigMAVisc and Eleview) were injected into the esophageal submucosa of randomly grouped pigs. The level of submucosal elevation was examined. Subsequently, ESD or EMR procedures using 3.3% Na-CMS or NS as submucosal injections were performed in the gastrointestinal tract of the pigs.
Submucosal elevation was significantly higher and more sustained in the 3.3% Na-CMS group than in the controls (P < 0.05). The volume required for ESD or EMR was significantly lower in the 3.3% Na-CMS group than in the NS group (ESD: 12.21 ± 4.09 mL vs 28.25 ± 8.02 mL, P < 0.001; EMR: 3.99 ± 1.98 mL vs 7.15 ± 3.67 mL, P = 0.001). The ESD resection time was significantly shorter in the 3.3% Na-CMS group than in the NS group (16.58 ± 7.30 min vs 25.29 ± 11.89 min, P = 0.004). Hemorrhage after ESD in the 3.3% Na-CMS group was less severe than that in the NS group (P = 0.006).
3.3% Na-CMS is an effective, safe and low-cost submucosal injection solution and holds promise as preferable agent for submucosal injection in ESD and EMR procedures.
黏膜下注射通常用于提高内镜黏膜下剥离术（ESD）和内镜黏膜切除术（EMR）的疗效和安全性。本研究旨在评估新型黏膜下注射溶液 3.3%羧甲基淀粉钠（Na-CMS）溶液在 ESD 和 EMR 中的性能。
将 Na-CMS、生理盐水（NS）和两种市售制剂（sigMAVisc 和 Eleview）随机分组注入猪食管黏膜下，观察黏膜下隆起水平。随后，在猪的胃肠道中进行使用 3.3% Na-CMS 或 NS 作为黏膜下注射的 ESD 或 EMR 操作。
与对照组相比，3.3% Na-CMS 组的黏膜下隆起明显更高且更持久（P<0.05）。3.3% Na-CMS 组进行 ESD 或 EMR 所需的体积明显小于 NS 组（ESD：12.21±4.09 mL 比 28.25±8.02 mL，P<0.001；EMR：3.99±1.98 mL 比 7.15±3.67 mL，P=0.001）。3.3% Na-CMS 组的 ESD 切除时间明显短于 NS 组（16.58±7.30 min 比 25.29±11.89 min，P=0.004）。3.3% Na-CMS 组 ESD 后出血程度明显轻于 NS 组（P=0.006）。
3.3% Na-CMS 是一种有效、安全且低成本的黏膜下注射溶液，有望成为 ESD 和 EMR 中黏膜下注射的首选药物。
