Brief Article
Copyright ©2009 Baishideng. All rights reserved.
World J Gastrointest Endosc. Oct 15, 2009; 1(1): 61-64
Published online Oct 15, 2009. doi: 10.4253/wjge.v1.i1.61
Subserosal injection of hyaluronic acid may prevent perforation after endoscopic resection
Keiko Niimi, Mitsuhiro Fujishiro, Shinya Kodashima, Satoshi Ono, Osamu Goto, Nobutake Yamamichi, Kazuhiko Koike
Keiko Niimi, Mitsuhiro Fujishiro, Shinya Kodashima, Satoshi Ono, Osamu Goto, Nobutake Yamamichi, Kazuhiko Koike, Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
Author contributions: Fujishiro M designed the study protocol, and Niimi K, Goto O, and Fujishiro M performed and analyzed the study results; Niimi K drafted the manuscript, and Fujishiro M intensively revised the manuscript; All of the authors provided intellectual, critical comments on the revision and approved the final version.
Correspondence to: Mitsuhiro Fujishiro, MD, PhD, Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. mtfujish-kkr@umin.ac.jp
Telephone: +81-3-38155411 Fax: +81-3-58008806
Received: March 23, 2009
Revised: August 26, 2009
Accepted: September 2, 2009
Published online: October 15, 2009
Abstract

AIM: To investigate the protective effect of subserosal injection of hyaluronic acid (HA) after endoscopic resection (ER) using ex vivo and in vivo studies.

METHODS: As the first examination, technical application of subserosal injection was tested 10 times using resected porcine stomachs. As the second examination, ER was applied to make six mucosal defects per stomach in three live minipigs and thermal damage was given on the proper muscle layer by using hemostatic forceps. Following the thermocoagulation, 1 mL of normal saline and HA, respectively, was injected targeting the subserosal layer in two mucosal defects each and the rest kept no injection as the control. The minipigs were recovered from the anesthesia and kept fasting until euthanasia which was carried out around 24 h after the procedures.

RESULTS: Ex vivo study revealed that complete and partial subserosal injection was possible two (20%) and four (40%) times, respectively. In vivo study revealed that no postoperative perforation occurred at any point of the thermocoagulation. Apparent retention of hyaluronic acid was identified at only two (33%) points where HA was injected.

CONCLUSION: This study failed to show preventative effects of subserosal injection of HA on postoperative perforation due to technical faults. However, this concept has a possibility to change strategy of ER with further technical innovation.

Keywords: Subserosal injection; Endoscopic submucosal dissection; Endoscopic mucosal resection; Animal model; Thermal injury; Perforation