Solutions for submucosal injection: What to choose and how to do it

World Journal of Gastroenterology : WJG
Rui CastroMário Dinis-Ribeiro

Abstract

During the past decades, endoscopic resection techniques have gradually improved and gained more importance for the management of premalignant lesions and early cancers. These endoscopic resection techniques can be divided in 3 major groups: snare polipectomy, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). The use of submucosal injection is essential for the majority of EMR techniques and is an integral part of ESD, whereas during polipectomy it is not crucial in most cases except to prevent bleeding in large polyps and/or those with large stalks as an alternative to mechanical methods. Injection provides a lifting up effect of the lesion separating it from the muscular layer, thereby reducing thermal injury and the risk of perforation and bleeding while also facilitating en-bloc resection by improving technical feasibility. With this work, we aim to review the most common endoscopic resection techniques and the importance of submucosal injection in each one of them. For that, we present some of the most commonly used submucosal injection solutions, taking into account their advantages and disadvantages. We also discuss, based on current recommendations and our own experience, how and when to pre...Continue Reading

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Citations

Dec 27, 2019·American Journal of Clinical Pathology·Lindsey M WestbrookToby C Cornish
Jan 15, 2020·The American Journal of Surgical Pathology·Maryam K PezhouhChristina A Arnold
Apr 29, 2020·Surgical Endoscopy·Tak Lit Derek FungKam Hung Kwok
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Sep 23, 2020·International Journal of Colorectal Disease·Belinda L Sun
Oct 17, 2020·ACG Case Reports Journal·Ashwini K EsnakulaDennis Yang
Jul 3, 2021·International Journal of Molecular Sciences·Walter LinzenboldMarkus D Enderle
Jul 20, 2021·VideoGIE : an Official Video Journal of the American Society for Gastrointestinal Endoscopy·Vinay ChandrasekharaDavid R Lichtenstein
Aug 21, 2021·Advanced Drug Delivery Reviews·G Cummins
Feb 12, 2021·Archives of Pathology & Laboratory Medicine·Dipti M KaramchandaniChristina A Arnold

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Methods Mentioned

BETA
dissection
dissecting

Software Mentioned

ERBELift
Eleview

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