Comparison of the characteristics of submucosal injection solutions used in endoscopic mucosal resection

Jong Jin Hyun, Rae Chun Hwang, Jai Chun Hoon, Tae Jeen Yoon, Won Baeck Chang, Kyun Yu Sang, Sik Kim Yong, Sik Lee Hong, Ho Um Soon, Woo Lee Sang, Hyun Choi Jai, Chang Duck Kim, Sang Ryu Ho, Hai Hyun Jin

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    52 Citations (Scopus)


    Submucosal injection is used to prevent complications, such as perforation, during endoscopic mucosal resection (EMR). Since injection of normal saline produces mucosal elevation of short duration, repeated injection is needed for extensive resection. To overcome this limitation, various submucosal injection solutions have been developed but there are few data comparing their efficacy. This study was therefore conducted to compare the physical and chemical properties and the duration of mucosal elevation of various submucosal injection solutions. Material and methods. A fresh transverse colon specimen acquired from a mongrel was used. Experiments were repeated four times. To compare the efficacy of mucosal elevation, 1 ml of each solution was injected into the submucosa: 0.9% NaCl, 20% mannitol, 0.1% sodium hyaluronate, 0.3% hydroxypropyl methylcellulose (HPMC), and 2% fibrinogen. Physical and chemical properties such as viscosity and osmolarity were compared. Results. The heights of initial mucosal elevations were 6.52±0.26 mm, 6.87±0.05 mm, 6.92±0.09 mm, 6.90±0.08 mm, and 6.90±0.08 mm for normal saline, mannitol, sodium hyaluronate, HPMC, and fibrinogen, respectively. Whereas injection of normal saline took about 20 min and mannitol about 30 min for the initial elevation to be reduced to more than half the initial height, it took more than 60 min for all the other agents. A correlation was found between the duration of mucosal elevation and viscosity but not with osmolarity. Conclusions. The mucosal elevation lasted longer with sodium hyaluronate, HPMC, and fibrinogen than with mannitol or normal saline, and this seems to be due to the viscosity rather than the osmolarity of each solution.

    Original languageEnglish
    Pages (from-to)488-492
    Number of pages5
    JournalScandinavian Journal of Gastroenterology
    Issue number4
    Publication statusPublished - 2006 Mar


    • Endoscopic mucosal resection
    • Fibrinogen
    • HPMC
    • Mannitol
    • Normal saline
    • Sodium hyaluronate
    • Submucosal injection solution
    • Viscosity

    ASJC Scopus subject areas

    • Gastroenterology


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