Hirose Ryohei, Yoshida Naohisa, Naito Yuji, Yoshida Takuma, Bandou Risa, Daidoji Tomo, Inoue Ken, Dohi Osamu, Konishi Hideyuki, Nakaya Takaaki, Itoh Yoshito
ACS Biomater Sci Eng. 2019 Dec 9;5(12):6794-6800. doi: 10.1021/acsbiomaterials.9b01373. Epub 2019 Nov 26.
The development of high-performance submucosal injection materials (SIMs) has significantly contributed to the advancement of rapid and safe endoscopic submucosal dissection (ESD). A previous study authored by us described that pseudoplastic fluid was more suitable for high-performance SIMs than Newtonian fluid. Herein, a novel high-performance SIM is developed, which is primarily composed of sodium polyacrylate (SPA) and exhibits pseudoplastic fluid characteristics. As a representative of current high-performance SIMs with Newtonian fluid characteristics, 0.4% sodium hyaluronate (HA) was selected as the target for comparison. Further, viscoelasticity, submucosal elevation height (SEH), and injection pressure (IP) of HA and SPA were evaluated. The results obtained by ESD were compared using HA or SPA in an ex vivo model. According to the measured viscoelasticity, the concentration of SPA was adjusted to 0.07%; this was aimed at obtaining the IP of SPA, which is equal to that of 0.4% HA. Moreover, no significant difference was observed between the IP values (31.6 ± 1.7 vs 31.4 ± 3.1 psi). SEHs of 0.07% SPA were higher than those of 0.4% HA at all postinjection times ( < 0.001). The duration of the ESD procedure using 0.07% SPA was significantly shorter than that obtained using 0.4% HA (16.6 ± 3.7 vs 22.2 ± 2.9 min, = 0.0276); further, the total volume of the injected 0.07% SPA was significantly less than that of 0.4% HA (9.0 ± 3.1 vs 15.7 ± 3.9 mL, = 0.0165). Based on rheological analysis, a high-performance SIM (0.07% SPA) with pseudoplastic fluid characteristics was theoretically developed. It was observed that the SIM performance of 0.07% SPA was higher than that of 0.4% HA.
高性能黏膜下注射材料（SIMs）的发展对快速、安全的内镜黏膜下剥离术（ESD）的进步做出了重大贡献。我们之前撰写的一项研究表明，假塑性流体比牛顿流体更适合高性能SIMs。在此，开发了一种新型高性能SIM，其主要由聚丙烯酸钠（SPA）组成，并具有假塑性流体特性。作为具有牛顿流体特性的当前高性能SIMs的代表，选择0.4%透明质酸钠（HA）作为比较对象。此外，评估了HA和SPA的粘弹性、黏膜下抬高高度（SEH）和注射压力（IP）。在体外模型中比较了使用HA或SPA进行ESD获得的结果。根据测得的粘弹性，将SPA的浓度调整为0.07%；目的是使SPA的IP等于0.4%HA的IP。此外，IP值之间未观察到显著差异（31.6±1.7对31.4±3.1 psi）。在所有注射后时间点，0.07%SPA的SEH均高于0.4%HA（<0.001）。使用0.07%SPA进行ESD手术的持续时间明显短于使用0.4%HA的持续时间（16.6±3.7对22.2±2.9分钟，=0.0276）；此外，注射的0.07%SPA的总体积明显小于0.4%HA的总体积（9.0±3.1对15.7±3.9 mL，=0.0165）。基于流变学分析，从理论上开发了一种具有假塑性流体特性的高性能SIM（0.07%SPA）。观察到0.07%SPA的SIM性能高于0.4%HA。
