| Theme |
Endoscopic submucosal dissection using Flush Knife |
| Title |
Endoscopic submucosal dissection using blunt abrasion by submucosal injection of sodium carboxymethylcellulose |
| Author |
Masahiro Yamasaki |
Department of Gastroenterology and Metabolism, University of Occupational and Environmental Health, Japan, School of Medicine |
| Author |
Keiichiro Kume |
Department of Gastroenterology and Metabolism, University of Occupational and Environmental Health, Japan, School of Medicine |
| [ Summary ] |
Endoscopic submucosal dissection (ESD), particularly the process of submucosal incision with a knife, is technically difficult and carries a high risk of perforation. We have reported that submucosal injection of viscous substance such as jells obviates the need for submucosal incision with a knife. Sodium carboxymethylcellulose (SCMC) is a nontoxic cellulose gum with a high viscosity when dissolved in water. In an in vivo study, a submucosal injection of SCMC solution was used to dissect most of the mucosal layer from the muscular layer of porcine stomachs with a concentration over 2.0 %. We, therefore, decided to use 2.5 % SCMC for ESD with an 18-gauge needle to ensure dissection. In an in vivo study using white domesticate pigs, a submucosal injection of 2.5 % SCMC was used to dissect the mucosal layer from the muscular layer without complications such as massive bleeding or perforation.
ESD by submucosal injection of a viscous SCMC solution appears to be an easy, safe and technically efficient method for dissection of gastric lesions. |