Document Detail


Is blood the ideal submucosal cushioning agent? A comparative study in a porcine model.
MedLine Citation:
PMID:  17163324     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND STUDY AIMS: Creation of a submucosal cushion before endoscopic mucosal resection (EMR) significantly reduces perforation risk. We evaluated six solutions as cushioning agents in live pigs. MATERIAL AND METHODS: 5 ml of normal saline, normal saline plus epinephrine, albumin 12.5 %, albumin 25 %, hydroxypropyl methylcellulose, and the pig's own whole blood were endoscopically injected into the porcine esophageal submucosa. Blood was obtained from a peripheral vein immediately before injection. Injections were made every 4 cm from the gastroesophageal junction. The time from completion of the injection to disappearance of the cushion was recorded. Endoscopy was repeated at 48 hours post injection. Two EMRs were performed after blood injection. Statistical analysis employed one-way analysis of variance followed by pairwise T test comparisons using the Bonferroni correction. RESULTS: Five animal experiments were completed. The mean time to dissipation of the submucosal cushion was shortest for saline plus epinephrine sites (2.87 minutes, SD 2.21) followed by the saline (4.8 minutes, SD 1.56), albumin 12.5 % (5.68 minutes, SD 3.48), albumin 25 % (7.83 minutes, SD 2.02), hydroxypropyl methylcellulose (9.77 minutes, SD 1.55), and blood sites (38.6 minutes, SD 6.07). Injection of blood resulted in significantly longer mucosal elevation than any other solution ( P < 0.0007). Blood from the cushion did not hamper visualization and facilitated EMR. CONCLUSION: Blood produces the most durable cushion compared with standard agents, also having the advantages of being readily available and without cost. Albumin 25 % provides as durable a cushion as hydroxypropyl methylcellulose.
Authors:
S A Giday; P Magno; J M Buscaglia; M I Canto; C-W Ko; E J Shin; L Xia; L M Wroblewski; J O Clarke; A N Kalloo; S B Jagannath; S V Kantsevoy
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Endoscopy     Volume:  38     ISSN:  0013-726X     ISO Abbreviation:  Endoscopy     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2006-12-13     Completed Date:  2007-02-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0215166     Medline TA:  Endoscopy     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1230-4     Citation Subset:  IM    
Affiliation:
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD 21205, USA.
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MeSH Terms
Descriptor/Qualifier:
Albumins / administration & dosage
Animals
Blood Transfusion, Autologous / methods*
Esophagus
Injections
Methylcellulose / administration & dosage,  analogs & derivatives
Models, Animal
Mucous Membrane*
Swine
Time Factors
Chemical
Reg. No./Substance:
0/Albumins; 8063-82-9/hypromellose; 9004-67-5/Methylcellulose

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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