Skip to main content
SpringerLink
Log in

Submucosal Fluid Cushion Injection Fluid: Western Perspective

  • Chapter
Endoscopic Submucosal Dissection

  • 1212 Accesses

Abstract

The success and safety of mucosal resection, whether localized or widespread, is dependent on the submucosal fluid cushion (SFC) created by needle catheter injection. A wide range of materials have been used, including saline, complex carbohydrates, glycerine, hyaluronic acid, methylcellulose, and blood products. The search for the ideal SFC solution continues, with no specific material universally agreed upon. This chapter explores our work in the Mayo Clinic Developmental Endoscopy Unit searching for the ideal solution, along with the work of others. Additionally, investigations into an adjunctive material to the SFC, mesna, which can facilitate mucosal dissection, are presented.

Ode to the SFC

Oh, were I to see, an SFC

Through toil and drudgery

That would brighten sun, moon and star

For anyone to perform EMR

I would sing its praise

And shout for joy

That we found

The ideal toy

by Christopher J. Gostout [1]

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Gostout CJ. Ode to the submucosal fluid cushion. Endoscopy. 2004;36(7):638–9.

    Article  CAS  PubMed  Google Scholar 

  2. Mokenmuller K, Wilcox CM, Munoz-Navas M (editors). Interventional and therapeutic gastrointestinal endoscopy. Front Gastrointest Res. Basel Krager, 2010; 27:156–68.

    Google Scholar 

  3. Othman MO, Wallace MB. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in 2011, a Western perspective. Clin Res Hepatol Gastroenterol. 2011;35:288–94.

    Article  PubMed  Google Scholar 

  4. Neuhaus H. Endoscopic mucosal resection and endoscopic submucosal dissection in the West – too many concerns and caveats? Endoscopy. 2010;42:859–61.

    Article  CAS  PubMed  Google Scholar 

  5. ASGE Technology Status Evaluation Report. Endoscopic mucosal resection and endoscopic submucosal dissection. Gastrointest Endosc. 2008;68(1):11–8.

    Article  Google Scholar 

  6. Conio M, Rajan E, et al. Comparative performance in the porcine esophagus of different solutions used for submucosal injection. Gastrointest Endosc. 2002;56(4):513–6.

    Article  PubMed  Google Scholar 

  7. Feitoza AB, Gostout CJ, et al. Hydroxypropyl methylcellulose: a better submucosal fluid cushion for endoscopic mucosal resection. Gastrointest Endosc. 2003;57(1):41–7.

    Article  PubMed  Google Scholar 

  8. Farrel JJ. Submucosal fluid cushion and EMR: who rules the roost? Gastrointest Endosc. 2008;67(6):840–2.

    Article  Google Scholar 

  9. Rajan E, Gostout CJ, et al. Widespread EMR: a new technique for removal of large areas of mucosa. Gastrointest Endosc. 2004;60(4):623–7.

    Article  PubMed  Google Scholar 

  10. Sumiyama K, Gostout CJ. Novel techniques and instrumentation for EMR, ESD, and full-thickness endoscopic luminal resection. Gastrointest Endosc Clin N Am. 2007;17:471–85.

    Article  PubMed  Google Scholar 

  11. Gostout CJ, Knipshield MA. Submucosal endoscopy with mucosal resection: a hybrid endoscopic submucosal dissection in the porcine rectum and distal colon. Gastrointest Endosc. 2012;76(4):829–34.

    Article  PubMed  Google Scholar 

  12. Sumiyama K, Gostout CJ, et al. Chemically assisted endoscopic mechanical submucosal dissection by using mesna. Gastrointest Endosc. 2008;67(3):534–8.

    Article  PubMed  Google Scholar 

  13. Dobashi A, Sumiyama K, Gostout CJ, et al. Can mechanical balloon dissection be applied to cleave fibrotic submucosal tissues? A pilot study in a porcine model. Endoscopy. 2013;45:661–6.

    Article  CAS  PubMed  Google Scholar 

  14. Al-Taie OH, Bauer Y, et al. Efficacy of submucosal injection of different solutions inclusive blood components on mucosa elevation for endoscopic resection. Clin Exp Gastroenterol. 2012;5:43–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Shastri YM, Kriener S, et al. Autologous blood as a submucosal fluid cushion for endoscopic mucosal therapies: results of an ex vivo study. Scand J Gastroenterol. 2007;42:1369–75.

    Article  PubMed  Google Scholar 

  16. Varadarajulu S, Tamhane A, Slaughter RL. Evaluation of dextrose 50 % as a medium for injection-assisted polypectomy. Endoscopy. 2006;38(9):907–12.

    Article  CAS  PubMed  Google Scholar 

  17. Bacani CJ, Woodward TA, et al. The safety and efficacy in humans of endoscopic mucosal resection with hydroxypropyl methylcellulose as compared with normal saline. Surg Endosc. 2008;22:2401–6.

    Article  PubMed  Google Scholar 

  18. Fasoulas K, Lazaraki G, et al. Endoscopic mucosal resection of giant laterally spreading tumors with submucosal injection of hydroxyethyl starch: comparative study with normal saline solution. Surg Laparosc Endosc Percutan Tech. 2012;22(3):272–8.

    Article  PubMed  Google Scholar 

  19. Fernandez-Esparrach G, Matthes EL, et al. A novel device for endoscopic submucosal dissection that combines water-jet submucosal hydrodissection and elevation with electrocautery: initial experience in a porcine model. Gastrointest Endosc. 2010;71(3):615–8.

    Article  PubMed  Google Scholar 

  20. Neuhaus H, Withs K, et al. Randomized controlled study of EMR versus endoscopic submucosal dissection with a water-jet hybrid-knife of esophageal lesions in a porcine model. Gastrointest Endosc. 2009;70(1):112–20.

    Article  PubMed  Google Scholar 

  21. Kahler GF, Sold M, et al. Selective tissue elevation by pressure injection [STEP] facilitates endoscopic mucosal resection [EMR]. Surg Technol Int. 2007;16:107–12.

    PubMed  Google Scholar 

  22. Lingenfelder T, Fischer K, et al. Combination of water-jet dissection and needle-knife as a hybrid knife simplifies endoscopic submucosal dissection. Surg Endosc. 2009;23:1531–5.

    Article  PubMed  Google Scholar 

  23. Lepilliez V, Robles-Medrana C, et al. Water-jet dissector for endoscopic submucosal dissection in an animal study: outcomes of the continuous and pulsed modes. Surg Endosc. 2013;27:2921.

    Google Scholar 

  24. Belle S, Collet PH, et al. Selective tissue elevation by pressure for endoscopic mucosal resection of colorectal adenoma: first clinical trial. Surg Endosc. 2012;26:343–9.

    Article  CAS  PubMed  Google Scholar 

  25. Khashab MA, Saxena P, et al. A novel submucosal gel permits simple and efficient gastric endoscopic submucosal dissection. Gastroenterology. 2013;144:505–7.

    Article  PubMed  Google Scholar 

  26. Khashab MA, Sharaiha RZ, et al. Novel technique of auto-tunneling during peroral endoscopic myotomy (with video). Gastrointest Endosc. 2013;77(1):119–22.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA

    Christopher J. Gostout M.D., F.A.S.G.E. & Ray I. Sarmiento M.D.

Authors
  1. Christopher J. Gostout M.D., F.A.S.G.E.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ray I. Sarmiento M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christopher J. Gostout M.D., F.A.S.G.E. .

Editor information

Editors and Affiliations

  1. Division of Gastroenterology & Hepatology, University of Colorado, Denver, Aurora, Colorado, USA

    Norio Fukami

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Gostout, C.J., Sarmiento, R.I. (2015). Submucosal Fluid Cushion Injection Fluid: Western Perspective. In: Fukami, N. (eds) Endoscopic Submucosal Dissection. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2041-9_8

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-2041-9_8

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-2040-2

  • Online ISBN: 978-1-4939-2041-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation