Published online Feb 21, 2019. doi: 10.3748/wjg.v25.i7.777
Peer-review started: November 14, 2018
First decision: January 6, 2019
Revised: January 18, 2019
Accepted: January 26, 2019
Article in press: January 26, 2019
Published online: February 21, 2019
Processing time: 99 Days and 16.5 Hours
During the past decades, endoscopic resection techniques have gradually improved and gained more importance for the management of premalignant lesions and early cancers. These endoscopic resection techniques can be divided in 3 major groups: snare polipectomy, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). The use of submucosal injection is essential for the majority of EMR techniques and is an integral part of ESD, whereas during polipectomy it is not crucial in most cases except to prevent bleeding in large polyps and/or those with large stalks as an alternative to mechanical methods. Injection provides a lifting up effect of the lesion separating it from the muscular layer, thereby reducing thermal injury and the risk of perforation and bleeding while also facilitating en-bloc resection by improving technical feasibility. With this work, we aim to review the most common endoscopic resection techniques and the importance of submucosal injection in each one of them. For that, we present some of the most commonly used submucosal injection solutions, taking into account their advantages and disadvantages. We also discuss, based on current recommendations and our own experience, how and when to preform submucosal injection, depending on lesions features and endoscopic resection technique that´s being used, to assure complete resection and to prevent associated adverse events. Finally, we also present and discuss some new proposed submucosal injection solutions, endoscopic resection techniques and devices that may have a major impact on the future of therapeutic endoscopy.
Core tip: In this work, we review the importance of submucosal injection and present some of the most commonly used solutions, comparing them taking into account their advantages and disadvantages. Unlike most of the previous papers about this subject, we organized this review in a more practical point of view. For that, we try to answer some essential questions like: what is the need for submucosal injection, when should we use it, what type of solution is more suitable for each endoscopic resection technique and how should we use them.