Tissue damage of different submucosal injection solutions for EMR

Mitsuhiro Fujishiro, Naohisa Yahagi, Koji Kashimura, Toyokazu Matsuura, Masanori Nakamura, Naomi Kakushima, Shinya Kodashima, Satoshi Ono, Katsuya Kobayashi, Takuhei Hashimoto, Nobutake Yamamichi, Ayako Tateishi, Yasuhito Shimizu, Masashi Oka, Masao Ichinose, Masao Omata

Research output: Contribution to journalArticlepeer-review

142 Citations (Scopus)


Background: When choosing submucosal injection solutions for EMR, tissue damage should be considered, as well as the lesion-lifting ability. The objective of the study was to find out the potential tissue damage of submucosal injection solutions. Methods: The submucosal injection solutions examined were the following: normal saline solution (NS), 3.75% NaCl, 20% and 50% dextrose water (DW), a glycerin solution (Glyceol; 10% glycerin with 0.9% NaCl plus 5% fructose), and two hyaluronic acid (HA) solutions (0.25% 1900 kDa/NS solution and 0.125% 1900 kDa/ Glyceol solution). Furthermore, DW with different concentrations (5%, 10%, 15%, 30%, 40%) also was examined to find out the tolerable concentration without tissue damage. A total of 2 mL of each solution per stomach were injected by endoscopy into the submucosal layer at the separate sites of 4 living minipigs. Two minipigs were euthanized after 30 minutes of endoscopic observations, and the others were euthanized after additional endoscopic observations a week after injection. Results: There was no apparent tissue damage in NS, 5% and 10% DW, Glyceol, or two solutions of HA, whereas, hypertonic solutions, except Glyceol and 10% DW, have more or less potency of tissue damage. In 3.75% NaCl and DW with concentrations of ≥20%, considerable tissue damage was observed, which might affect resected EMR specimens and ulcer healing. Conclusions: Use of hypertonic solutions except Glyceol is not recommended with respect to tissue damage. A combination of HA and Glyceol is the most favorable submucosal injection solution, considering tissue damage and lesion-lifting ability.

Original languageEnglish
Pages (from-to)933-942
Number of pages10
JournalGastrointestinal Endoscopy
Issue number6
Publication statusPublished - 2005 Dec
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology


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