Abstract
Is Blood the Ideal Submucosal Cushioning Agent? A Comparative Study in a Porcine Model Samuel A. Giday, Priscilla Magno, Jonathan Buscaglia, Marcia I. Canto, Wroblewski Lori, Chung-Wang Ko, John O. Clarke, Anthony N. Kalloo, Sanjay B. Jagannath, Sergey V. Kantsevoy Creation of a submucosal cushion for endoscopic mucosal resection or polypectomy of sessile lesions has been shown to reduce the risk of perforation. There is larger variation as to the type of agents used in clinical practice. The ideal cushioning agent should be inexpensive, easy to administer, long lasting and readily available. Aim: To compare six solutions as cushioning agents in the porcine esophagus. Methods: Following standard upper endoscopy, injection of an equal volume (5 ml) of saline, saline plus epinephrine, 0.125 gm/ml albumin, 0.25 gm/ml albumin, Hydroxypropyl methylcellulose (Gonak) and the pig’s own whole blood were performed into the submucosa of the porcine esophagus. The blood was obtained from the peripheral vein of the pig immediately before use as an injectate. Four pigs were used in the study. The injections were made every 4 cm from the GE junction. A 25-gauge sclerotherapy needle (US Endoscopy ) was used to inject saline, saline plus epinephrine and albumin. A 23-gauge sclerotherapy needle (Microvasive ) was used to inject Gonak and blood. The time from the completion of the submucosal injection to disappearance of the cushion was recorded. Statistical analysis was performed using 1-way analysis of variance (ANOVA) followed by pairwise t-test comparisons using Bonferroni correction. Results: The mean time to dissipation was significantly different among the 6 types of injectates (p ! 0.0001). Mean time to dissipation of mucosal elevation was shortest in the saline plus epinephrine group (2.87 minutes SD 2.21) followed by saline (4.8 minutes SD 1.56), albumin 0.125 gm/ml (5.68 minutes SD 3.48), albumin 0.25 gm/ ml (7.83 minutes SD 2.02), Gonak (9.77 minutes SD 1.55) and blood (38.6 minutes SD 6.07). Injection of blood resulted in significantly longer mucosal elevation than any other solution used (p ! .0001). Conclusions: Albumin 0.25gm/ml lasts as long as Gonak. Blood produces the most durable cushion compared to standard agents having the advantages of being readily available and without cost.
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