Comparison of various submucosal injection solutions for maintaining mucosal elevation during endoscopic mucosal resection

Background and Study Aims: One of the major complications of endoscopic mucosal resection (EMR) for gastrointestinal tumors is perforation, and the most effective way of preventing perforation is to elevate the lesion sufficiently by endoscopic injection of fluid into the submucosa. Materials and Methods: In order to compare the lesion-lifting properties of several different solutions, 1 ml of each of the following solutions was injected into the submucosa of the resected porcine stomach: normal saline, 3.75% NaCl, 20% dextrose water, 10% glycerin with 0.9% NaCl plus 5% fructose, and two sodium hyaluronate (SH) solutions. Results: Significantly higher initial elevation was produced by both SH solutions, and it remained higher than that achieved by the other solutions at all times. Hypertonic solutions, especially 10% glycerin with 0.9% NaCl plus 5% fructose, tended to produce and maintain greater mucosal elevation than normal saline, but the difference was not significant. Conclusions: SH solutions were the most suitable ones for producing and maintaining long-term mucosal elevation, while the superiority of hypertonic solutions over normal saline was not clearly demonstrated.