Abstract
Introduction: Numerous new techniques for endoscopic mucosal resection (EMR) have been published in the recent years to enable endoscopists to treat large flat lesions of the GI tract. While some authors compared different substances for submucosal injection, others developed new cutting devices. The water jet is well established as an instrument for the dissection of parenchymatous organs due to its tissue selectivity. We report about the experimental use of a water jet in order to create submucosal cushions to prepare the mucosa for EMR. Aims & Methods: The effectiveness of creating submucosal cushions is tested by a direct application of the water jet to the mucosa. First we determined the pressure necessary to establish a submucosal fluid cushion [SFC] using saline solution in isolated stomachs of domestic pigs. Then we checked the influence of the angle of application between applicator and mucous membrane. Based on these findings, we generated 75 SFC's in different parts of the stomach and quantified the size of the cushions by a special software programme. To verify these results the investigations were repeated in vivo in a pig model. Results: SFC's of the gastric wall were created regularly with a pressure between 30 to 70 bar. The necessary pressure varied according to the spot of application. The angle of application had no effect on the formation of the SFC's. After the first 10 seconds of applying the fluid the cushions seemed saturated and did not show a major change in size. The ex vivo results could be confirmed in a living pig model. Conclusion: The possibility of using a precisely focused water jet to penetrate the mucosa and to selectively create fluid cushions into the submucosa facilitates the endoscopic mucosal resection and is a promising alternative of the standard needle injection. The water jet application is potentially more efficient and could therefore help to develop a new minimal invasive therapy of mucosal tumors which could not be treated endoscopically so far for reasons of size, extension and position.
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