Abstract
Submucosal fluid injection, prerequisite to endoscopic mucosal resection, necessitates detailed evaluation for proper selection. We aimed to compare height of gastric tissues after submucosal injection, and to verify electrical implications of injectants. Porcine stomach pieces were cut out, and eight solutions were used: normal saline, 0.5% sodium hyaluronate (SH), 0.25% SH, hydroxypropyl methylcellulose, 10% glycerin, fibrinogen, 1% sodium alginate (SA), and 2.5% SA. Elevated heights were measured after submucosal injection of the eight fluids, and electrical impedance was measured for fluids plus a reference solution (0.01 N KCl) with a potentiostat electro-impedance spectrometry and an insulation-tipped knife. Resistivity was calculated thereafter. Normal saline and 10% glycerin solution showed greater height diminution. Resistivity were in the range of 80–110 Ω cm, except for 309.7 Ω cm for fibrinogen. Higher resistivity may improve performance of electrosurgery, probably by strengthening impedance and heat dissipation. Further studies are required to back up this basic experiment for clinical application.
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Fujishiro M, Yahagi N, Kashimura K, Mizushima Y, Oka M, Enomoto S, Kakushima N, Kobayashi K, Hashimoto T, Iguchi M, Shimizu Y, Ichinose M, Omata M (2004) Comparison of various submucosal injection solutions for maintaining mucosal elevation during endoscopic mucosal resection. Endoscopy 36:579–583
Kakushima N, Fujishiro M, Kodashima S, Muraki Y, Tateishi A, Omata M (2006) A learning curve for endoscopic submucosal dissection of gastric epithelial neoplasms. Endoscopy 38:991–995
Yeh RW, Triadafilopoulos G (2005) Submucosal injection: safety cushion at what cost? Gastrointest Endosc 62:943–945
Yamamoto H, Kawata H, Sunada K, Satoh K, Kaneko Y, Ido K, Sugano K (2002) Success rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate. Gastrointest Endosc 56:507–512
Yamamoto H, Yube T, Isoda N, Sato Y, Sekine Y, Higashizawa T, Ido K, Kimura K, Kanai N (1999) A novel method of endoscopic mucosal resection using sodium hyaluronate. Gastrointest Endosc 50:251–256
Feitoza AB, Gostout CJ, Burgart LJ, Burkert A, Herman LJ, Rajan E (2003) Hydroxypropyl methylcellulose: a better submucosal fluid cushion for endoscopic mucosal resection. Gastrointest Endosc 57:41–47
Lee SH, Cho WY, Kim HJ, Kim YH, Chung IK, Kim HS, Park SH, Kim SJ (2004) A new method of EMR: submucosal injection of a fibrinogen mixture. Gastrointest Endosc 59:220–224
Uraoka T, Fujii T, Saito Y, Sumiyoshi T, Emura F, Bhandari P, Matsuda T, Fu KI, Saito D (2005) Effectiveness of glycerol as a submucosal injection for EMR. Gastrointest Endosc 61:736–740
Yamasaki M, Kume K, Kanda K, Yoshikawa I, Otsuki M (2005) A new method of endoscopic submucosal dissection using submucosal injection of jelly. Endoscopy 37:1156–1157
Eun SH, Cho JY, Jung IS, Ko BM, Hong SJ, Ryu CB, Kim JO, Jin SY, Lee JS, Lee MS, Shim CS, Kim BS (2007) Effectiveness of sodium alginate as a submucosal injection material for endoscopic mucosal resection in animal. Gut and Liver 1:27–32
Fujishiro M, Yahagi N, Kashimura K, Matsuura T, Nakamura M, Kakushima N, Kodashima S, Ono S, Kobayashi K, Hashimoto T, Yamamichi N, Tateishi A, Shimizu Y, Oka M, Ichinose M, Omata M (2005) Tissue damage of different submucosal injection solutions for EMR. Gastrointest Endosc 62:933–942
Fujishiro M, Yahagi N, Kashimura K, Mizushima Y, Oka M, Matsuura T, Enomoto S, Kakushima N, Imagawa A, Kobayashi K, Hashimoto T, Iguchi M, Shimizu Y, Ichinose M, Omata M (2004) Different mixtures of sodium hyaluronate and their ability to create submucosal fluid cushions for endoscopic mucosal resection. Endoscopy 36:584–589
Matsui Y, Inomata M, Izumi K, Sonoda K, Shiraishi N, Kitano S (2004) Hyaluronic acid stimulates tumor-cell proliferation at wound sites. Gastrointest Endosc 60:539–543
Hyun JJ, Chun HR, Chun HJ, Jeen YT, Baeck CW, Yu SK, Kim YS, Lee HS, Um SH, Lee SW, Choi JH, Kim CD, Ryu HS, Hyun JH (2006) Comparison of the characteristics of submucosal injection solutions used in endoscopic mucosal resection. Scand J Gastroenterol 41:488–492
Fujishiro M, Yahagi N, Nakamura M, Kakushima N, Kodashima S, Ono S, Kobayashi K, Hashimoto T, Yamamichi N, Tateishi A, Shimizu Y, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M (2006) Successful outcomes of a novel endoscopic treatment for GI tumors: endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar. Gastrointest Endosc 63:243–249
Tucker RD, Sievert CE, Kramolowsky EV, Vennes JA, Silvis SE (1992) The interaction between electrosurgical generators, endoscopic electrodes, and tissue. Gastrointest Endosc 38:118–122
Goldberg SN, Ahmed M, Gazelle GS, Kruskal JB, Huertas JC, Halpern EF, Oliver BS, Lenkinski RE (2001) Radio-frequency thermal ablation with nacl solution injection: effect of electrical conductivity on tissue heating and coagulation-phantom and porcine liver study. Radiology 219:157–165
Goldberg SN, Gazelle GS, Mueller PR (2000) Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance. AJR Am J Roentgenol 174:323–331
Livraghi T, Goldberg SN, Monti F, Bizzini A, Lazzaroni S, Meloni F, Pellicano S, Solbiati L, Gazelle GS (1997) Saline-enhanced radio-frequency tissue ablation in the treatment of liver metastases. Radiology 202:205–210
Pop GA, de Backer TL, de Jong M, Struijk PC, Moraru L, Chang Z, Goovaerts HG, Slager CJ, Bogers AJ (2004) On-line electrical impedance measurement for monitoring blood viscosity during on-pump heart surgery. Eur Surg Res 36:259–265
Zhao TX, Jacobson B (1997) Quantitative correlations among fibrinogen concentration, sedimentation rate and electrical impedance of blood. Med Biol Eng Comput 35:181–185
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Park, S., Chun, H.J., Kim, C.Y. et al. Electrical Characteristics of Various Submucosal Injection Fluids for Endoscopic Mucosal Resection. Dig Dis Sci 53, 1678–1682 (2008). https://doi.org/10.1007/s10620-007-0051-7
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DOI: https://doi.org/10.1007/s10620-007-0051-7