Endoscopy 2004; 36(7): 584-589
DOI: 10.1055/s-2004-814524
Original Article
© Georg Thieme Verlag Stuttgart · New York

Different Mixtures of Sodium Hyaluronate and Their Ability to Create Submucosal Fluid Cushions for Endoscopic Mucosal Resection

M.  Fujishiro1 , N.  Yahagi1 , K.  Kashimura2 , Y.  Mizushima2 , M.  Oka1 , T.  Matsuura3 , S.  Enomoto4 , N.  Kakushima1 , A.  Imagawa1 , K.  Kobayashi1 , T.  Hashimoto1 , M.  Iguchi4 , Y.  Shimizu4 , M.  Ichinose4 , M.  Omata1
  • 1Dept. of Gastroenterology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
  • 2Product Research Laboratory, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
  • 3Chugai Research Institute for Medical Science, INC., Nagano, Japan
  • 4Second Dept. of Internal Medicine, Wakayama Medical University, Wakayama, Japan
Further Information

Publication History

Submitted 16 February 2004

Accepted after Revision 2 March 2004

Publication Date:
09 July 2004 (online)

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.

References

  • 1 Ono H, Kondo H, Gotoda T. et al . Endoscopic mucosal resection for treatment of early gastric cancer.  Gut. 2001;  48 225-229
  • 2 Ookuwa M, Hosokawa K, Boku N. et al . New endoscopic treatment for intramucosal tumors using an insulated-tip diathermic knife.  Endoscopy. 2001;  33 221-226
  • 3 Tada M, Shimada M, Murakami F. et al . Development of the strip-off biopsy [in Japanese with English abstract].  Gastroenterol Endosc. 1984;  26 833-839
  • 4 Yamamoto H, Yube T, Isoda N. et al . A novel method of endoscopic mucosal resection using sodium hyaluronate.  Gastrointest Endosc. 1999;  50 251-256
  • 5 Torii A, Sakai M, Kajiyama T. et al . Endoscopic aspiration mucosectomy as curative endoscopic surgery: analysis of 24 cases of early gastric cancer.  Gastrointest Endosc. 1995;  42 475-479
  • 6 Hirao M, Masuda K, Asanuma T. et al . Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine.  Gastrointest Endosc. 1988;  34 264-269
  • 7 Yahagi N, Fujishiro M, Kakushima K. et al . Endoscopic submucosal dissection for early gastric cancer using the tip of an electrosurgical snare (thin type).  Dig Endosc. 2004;  16 34-38
  • 8 Yamamoto H, Koiwai H, Yube T. et al . A successful single-step endoscopic resection of a 40 millimeter flat-elevated tumor in the rectum: endoscopic mucosal resection using sodium hyaluronate.  Gastrointest Endosc. 1999;  50 701-704
  • 9 Yamamoto H, Sekine Y, Higashizawa T. et al . Successful en bloc resection of a large superficial gastric cancer by using sodium hyaluronate and electrocautery incision forceps.  Gastrointest Endosc. 2001;  54 629-632
  • 10 Enomoto S, Yahagi N, Fujishiro M. et al . A 50-mm rectal tumor treated by en bloc endoscopic mucosal resection [in Japanese with English abstract].  Prog Dig Endosc. 2002;  60 22-24
  • 11 Fujishiro M, Yahagi N, Kashimura K. et al . Comparison of various submucosal injection solutions for maintaining mucosal elevation during endoscopic mucosal resection.  Endoscopy. 2004;  36 579-583
  • 12 Conio M, Rajan E, Sorbi D. et al . Comparative performance in the porcine esophagus of different solutions used for submucosal injection.  Gastrointest Endosc. 2002;  56 513-516
  • 13 Nagano K, Goto S, Okabe R, Yamaguchi T. Acute toxicity test of sodium hyaluronate [in Japanese].  Jpn Pharmacol Ther. 1984;  12 5369-5377
  • 14 Nakagawa K, Nozaki F, Sugawara H. et al . Antigenicity studies on sodium hyaluronate, part 1 [in Japanese].  Jpn Pharmacol Ther. 1984;  12 141-150
  • 15 Nakagawa K, Nozaki F, Sugawara H, Yamaguchi T. Antigenicity studies on sodium hyaluronate, part 2 [in Japanese].  Jpn Pharmacol Ther. 1984;  12 151-161
  • 16 Ueno Y, Kuramoto K, Konno N. et al . Investigation on result of use after launch of Artz and Artz disp.: evaluation of the efficacy, safety and utility in the medication for osteoarthritis of the knee and periarthritis of the shoulder resection [sic; in Japanese with English abstract].  Jpn Pharmacol Ther. 1995;  23 2125-2170
  • 17 Yamamoto H, Kawata H, Sunada K. et al . Success rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate.  Gastrointest Endosc. 2002;  56 507-512
  • 18 Roukos D H. Current advances and changes in treatment strategy may improve survival and quality of life in patients with potentially curable gastric cancer.  Ann Surg Oncol. 1999;  6 46-56
  • 19 Feitoza A B, Gostout C J, Burgart L J. et al . Hydroxypropyl methylcellulose: a better submucosal fluid cushion for endoscopic mucosal resection.  Gastrointest Endosc. 2003;  57 41-47

N. Yahagi, M. D.

Dept. of Gastroenterology · Faculty of Medicine · University of Tokyo

7-3-1, Hongo, Bunkyo-ku · Tokyo · Japan

Fax: +81-3-5800-8806

Email: yahagi-tky@umin.ac.jp