Different mixtures of sodium hyaluronate and their ability to create submucosal fluid cushions for endoscopic mucosal resection

M. Fujishiro, N. Yahagi, K. Kashimura, Y. Mizushima, M. Oka, T. Matsuura, S. Enomoto, N. Kakushima, A. Imagawa, K. Kobayashi, T. Hashimoto, M. Iguchi, Y. Shimizu, M. Ichinose, M. Omata

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111 Citations (Scopus)

Abstract

Background and Study Aims: Sodium hyaluronate (SH) is a promising submucosal injection solution during endoscopic mucosal resection, but its high cost is an obstacle to more widespread use. The aim of this study was to identify an appropriate low-cost SH solution by varying the molecular weight of SH and mixing various solutions with it. Materials and Methods: The viscoelasticity of various SH solutions was first measured. The concentrations of two 1% SH preparations with different molecular weights (800 kDa and 1900 kDa) were adjusted to 0.5%, 0.25%, and 0.125%, using 0.9%/3.75% normal saline (NS), 5%/20% dextrose water (DW), and a glycerin solution (Glyceol): 10% glycerin with 0.9% normal saline plus 5% fructose. The ability of these SH solutions to create submucosal fluid cushions (SFCs) was then investigated in the stomachs of two live minipigs. Results: The 0.25% 1900 kDa SH/NS solution and the 0.125% 1900 kDa SH/20% DW solution created a similar viscoelasticity to that of the 0.5% 800 kDa SH/NS solution. The ability of these solutions to create SFCs was also similar. In addition, the 0.125% 1900 kDa SH/Glyceol solution created similar SFCs, with a synergistic effect of increased viscoelasticity and the hypertonic nature of glycerin. Conclusions: A mixture of higher molecular weight sodium hyaluronate with a sugar solution (particularly 20% dextrose), with or without glycerin, should be regarded as a cost-effective option for creating SFCs instead of the conventional SH solution made with the same amount of a 1% 800 kDa SH preparation and normal saline.

Original languageEnglish
Pages (from-to)584-589
Number of pages6
JournalEndoscopy
Volume36
Issue number7
DOIs
Publication statusPublished - 2004 Jul 1
Externally publishedYes

ASJC Scopus subject areas

  • Gastroenterology

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    Fujishiro, M., Yahagi, N., Kashimura, K., Mizushima, Y., Oka, M., Matsuura, T., Enomoto, S., Kakushima, N., Imagawa, A., Kobayashi, K., Hashimoto, T., Iguchi, M., Shimizu, Y., Ichinose, M., & Omata, M. (2004). Different mixtures of sodium hyaluronate and their ability to create submucosal fluid cushions for endoscopic mucosal resection. Endoscopy, 36(7), 584-589. https://doi.org/10.1055/s-2004-814524