Abstract
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been used for surgical treatment of early gastric cancer. These endoscopic techniques require proper submucosal injections beneath the tumor to provide a sufficiently high submucosal fluid cushion (SFC) to facilitate clean dissection and resection of the tumor. Until now, the submucosal injection materials developed for endoscopic techniques such as EMR and ESD of tumors have been composed of macromolecules, proteins, or polysaccharides. We have been investigating the use of chitosan, a product that is obtained by the alkaline deacetylation of chitin, the second-most abundant natural polysaccharide. Specifically, we have been studying a photocrosslinked chitosan hydrogel (PCH) and solubilized chitosan derivatives for use as novel submucosal injections for endoscopic techniques. Notably, chitosan derivatives with lactose moieties linked to the amino groups of its glucosamine units can specifically interact with acidic mucopolysaccharides and mucins in submucosa without the need for the incorporation of harmful photoreactive groups nor potentially mutagenic ultraviolet irradiation.
Highlights
Gastric cancers are typically classified into early and advanced stages
We describe various submucosal injection materials, focusing on photocrosslinked chitosan hydrogel (PCH) and the chitosan derivatives that we have been studying
Endoscopic appearance immediately after endoscopic submucosal dissection (ESD) assisted by photocrosslinkable chitosan hydrogel (PCH), (PCH), hypertonic saline(HS), solution andhyaluronate sodium hyaluronate (SH)
Summary
Gastric cancers are typically classified into early and advanced stages. Early-stage cancers are defined as those in which lesions have infiltrated up to the submucosa without metastasis into the lymph node; in contrast, advanced-stage cancers exhibit submucosal infiltration and metastasis. To test an example of such a possible agent, we characterized a soluble chitosan derivative containing 2% lactobionic acid on the free amino groups, demonstrating that this version exhibited good aqueous solubility, even at neutral pH [27]. We further examined this derivative’s interactions with anionic polysaccharides and proteins to determine its potential use as a submucosal injection agent for safe endoscopic techniques [27]. We describe various submucosal injection materials, focusing on PCH and the chitosan derivatives that we have been studying
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