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Surgical Endoscopy

, Volume 28, Issue 5, pp 1742–1747 | Cite as

High-pressure jet injection of viscous solutions for endoscopic submucosal dissection: a study on ex vivo pig stomachs

  • Mathieu Pioche
  • Mihai Ciocirlan
  • Vincent Lépilliez
  • Damien Salmon
  • Laetitia Mais
  • Olivier Guillaud
  • Valérie Hervieu
  • Marco Petronio
  • Isabelle Lienhart
  • Jean-Luc Adriano
  • Cyril Lafon
  • Thierry Ponchon
New Technology

Abstract

Background

Long-lasting lifting is a key factor during endoscopic submucosal dissection (ESD) and can be obtained by water-jet injection of saline solution or by injection of viscous macromolecular solutions. Combination of the jet injection and the macromolecular viscous solutions has never been used yet. We assessed the ability of a new water-jet system to inject viscous solutions in direct viewing and in retroflexion. We compared jet injection of saline solution and hyaluronate 0.5 % to perform ESD on ex vivo pig stomachs in order to evaluate the benefits of macromolecular solutions when injected by a jet-injector system.

Methods

This is a prospective comparative study in pig stomachs. Using the jet injector, four viscous solutions were tested: hydroxyethyl starch, glycerol mix, hyaluronate sodic (0.5 %), and poloxamer mix. Ten ESDs larger than 25 mm (five in direct viewing and five in retroflexion) and one larger than 10 cm were performed with each solution. ESD with hyaluronate jet injection was then compared with ESD with saline jet injection by performing 50 ESDs in each group. A single, minimally-experienced operator conducted all the procedures.

Results

All 145 resections were complete, including all marking points with two perforations. Eleven jet ESDs per solution were conducted without any injection issue. In the second part of the study, when compared with saline, significant benefit of hyaluronate was observed on dissection speed (0.80 vs. 1.08 cm2/min, p < 0.001).

Conclusion

This is the first report on a jet-injector system allowing injection of macromolecular viscous solutions even with retroflexed endoscope. Jet injection of macromolecular solutions can speed up dissection in comparison with saline, and should now be tested on humans

Keywords

Therapeutic/palliation Technical Endoscopic submucosal dissection Endoscopy new technologies 

Notes

Disclosures

Mathieu Pioche has received financial support for PHD courses from Nestis. Thierry Ponchon is a co-founder of Nestis but has received no financial support. Mihai Ciocirlan, Vincent Lépilliez, Damien Salmon, Valérie Hervieu, Laetitia Mais, Olivier Guillaud, Marco Petronio, Isabelle Lienhart, Jean-Luc Adriano, and Cyril Lafon have no conflicts of interest to declare.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Mathieu Pioche
    • 1
    • 2
    • 3
  • Mihai Ciocirlan
    • 1
    • 4
  • Vincent Lépilliez
    • 1
  • Damien Salmon
    • 5
  • Laetitia Mais
    • 1
  • Olivier Guillaud
    • 1
  • Valérie Hervieu
    • 6
  • Marco Petronio
    • 1
  • Isabelle Lienhart
    • 1
  • Jean-Luc Adriano
    • 1
  • Cyril Lafon
    • 3
  • Thierry Ponchon
    • 1
    • 3
  1. 1.Endoscopy Unit, Digestive Disease DepartmentH Pavillon - Edouard Herriot HospitalLyon CedexFrance
  2. 2.NestisLyonFrance
  3. 3.Inserm U1032, LabTauLyonFrance
  4. 4.Carol Davila InstituteFundeni Gastroenterology ClinicBucarestRomania
  5. 5.Department of PharmacyEdouard Herriot HospitalLyonFrance
  6. 6.Pathology UnitEdouard Herriot HospitalLyonFrance

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