A Novel Polypectomy Evaluation Platform for the Objective Bench-top Testing of Submucosal Injectables to Improve the Safety and Efficacy of Polypectomy and Endoscopic Mucosal Resection

Abstract

Purpose: Many submucosal injection solutions have been studied for use in endoscopic mucosal resection (EMR) without a standard measure to compare these agents for superiority. Particularly of interest is which agents provide the best lifting ability, prolonged tissue elevation, and optimal barrier to avoid thermal injury to the serosal layer, thus preventing perforation. The aim of this comparative study is to evaluate for a superior agent that can be used in EMR to avoid thermal injury. Methods: A comparative study of three different solutions for EMR using an ex vivo porcine colon model. The injectants were evaluated using a novel Polypectomy Evaluation Platform designed to compare the ability of various solutions to dissipate heat. An additional platform was fashioned to monitor the lifting ability of the different solutions over time. A total of 180 submucosal cushions were performed in fresh ex vivo porcine colons with normal saline (N=60), hydroxypropyl methylcellulose (HPMC) (N=60), and 12.5gm (25%) albumin (N=60). Results: The rate of temperature change was least in the HPMC group (0.1952 oF/sec) over the saline group (0.6544 oF/sec), and 25% Albumin group (0.4705 oF/sec). The dispersion rate was superior in the HPMC group (0.1573 mm/min), compared to the saline group (0.1589 mm/min) and the 25% albumin group (0.2069 mm/min). Conclusion: Here we propose the utility of two bench-top devices designed specifically for standardizing the evaluation of various injection agents used in performing advanced endoscopic resections. With our novel polypectomy and dispersion analysis platforms, HPMC was the superior injectant over normal saline and 25% albumin.Figure: Novel polypectomy evaluation platform designed to evaluate the ability of various solutions to prevent thermal injury.Figure: Custom designed platform used to examine the ability to maintain the height of a submucosal fluid cushion.