A new method of EMR: submucosal injection of a fibrinogen mixture

Background. The technical limitation associated with submucosal injection of normal saline solution during EMR is the relatively short duration of mucosal elevation. The clinical application of a new method of EMR with submucosal injection of a fibrinogen mixture was evaluated. Methods: Thirty-five early stage neoplastic gastric lesions were resected by EMR with submucosal injection of a fibrinogen mixture. The efficacy and clinical outcomes were analyzed. Results: Additional submucosal injection was not required for any of the 35 lesions to complete the EMR with submucosal injection of a fibrinogen mixture procedure. The rates of en bloc resection and complete resection were, respectively, 82.9% and 88.6%. The en bloc resection rate was significantly lower for lesions over 20 mm in diameter (60% vs. 92%; p < 0.05) and for lesions on the lesser curvature or posterior wall of the stomach compared with those on the greater curvature or anterior wall (55.6% vs. 92.3%; p < 0.05). The rate of complete resection also was dependent on the size and location of the lesions. There was no major EMR with submucosal injection of a fibrinogen mixture related complication including bleeding or perforation. Conclusions: EMR with submucosal injection of a fibrinogen mixture is an easy, safe, and technically efficient method for complete EMR.