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01-05-2014 | New Technology

High-pressure jet injection of viscous solutions for endoscopic submucosal dissection: a study on ex vivo pig stomachs

Authors: Mathieu Pioche, Mihai Ciocirlan, Vincent Lépilliez, Damien Salmon, Laetitia Mais, Olivier Guillaud, Valérie Hervieu, Marco Petronio, Isabelle Lienhart, Jean-Luc Adriano, Cyril Lafon, Thierry Ponchon

Published in: Surgical Endoscopy | Issue 5/2014

Abstract

Background

Long-lasting lifting is a key factor during endoscopic submucosal dissection (ESD) and can be obtained by water-jet injection of saline solution or by injection of viscous macromolecular solutions. Combination of the jet injection and the macromolecular viscous solutions has never been used yet. We assessed the ability of a new water-jet system to inject viscous solutions in direct viewing and in retroflexion. We compared jet injection of saline solution and hyaluronate 0.5 % to perform ESD on ex vivo pig stomachs in order to evaluate the benefits of macromolecular solutions when injected by a jet-injector system.

Methods

This is a prospective comparative study in pig stomachs. Using the jet injector, four viscous solutions were tested: hydroxyethyl starch, glycerol mix, hyaluronate sodic (0.5 %), and poloxamer mix. Ten ESDs larger than 25 mm (five in direct viewing and five in retroflexion) and one larger than 10 cm were performed with each solution. ESD with hyaluronate jet injection was then compared with ESD with saline jet injection by performing 50 ESDs in each group. A single, minimally-experienced operator conducted all the procedures.

Results

All 145 resections were complete, including all marking points with two perforations. Eleven jet ESDs per solution were conducted without any injection issue. In the second part of the study, when compared with saline, significant benefit of hyaluronate was observed on dissection speed (0.80 vs. 1.08 cm²/min, p < 0.001).

Conclusion

This is the first report on a jet-injector system allowing injection of macromolecular viscous solutions even with retroflexed endoscope. Jet injection of macromolecular solutions can speed up dissection in comparison with saline, and should now be tested on humans

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Title: High-pressure jet injection of viscous solutions for endoscopic submucosal dissection: a study on ex vivo pig stomachs
Authors: Mathieu Pioche
Mihai Ciocirlan
Vincent Lépilliez
Damien Salmon
Laetitia Mais
Olivier Guillaud
Valérie Hervieu
Marco Petronio
Isabelle Lienhart
Jean-Luc Adriano
Cyril Lafon
Thierry Ponchon
Publication date: 01-05-2014
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 5/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-013-3378-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

High-pressure jet injection of viscous solutions for endoscopic submucosal dissection: a study on ex vivo pig stomachs

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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