Submucosal Injection

The gastrointestinal wall has two components, the mucosal layer and the muscle layer. The two components are attached by a loose connective tissue of submucosa. Injecting a solution into the submucosa, creates a fluid cushion between the lesion and the deeper layers of the gut wall before removal. The piecemeal removal of large sessile polyps (SP) without injection can result in deep thermal ulceration. A more durable submucosal fluid cushion may result in safer procedures, avoiding the need for repeated injections. Several solutions have been proposed, including the following: normal saline with or without epinephrine, 50% dextrose, Glyceol (which contains 10% glycerol and 5% fructose), and hyaluronic acid. Hyaluronic acid appears to be the ideal solution for submucosal injection. However, 50% glucose is more readily available and may be a more practical alternative to hyaluronic acid. Yamamoto and colleagues (2002) evaluated the use of sodium hyaluronate in 70 patients with early gastric cancers. "En bloc" resection of 20 mm lesions was successful in 89% of cases and in 48% of cases with greater lesions (Yamamoto et al, 2002).

The effects of hydroxypropyl methylcellulose were studied in the esophagus of pigs (Feitoza et al, 2003). The mean submucosal fluid cushion duration was 36 minutes, without causing tissue reaction. In our endoscopic practice, we elevate the lesion by injecting a large amount (15 to 100 cc) of normal saline plus epinephrine solution (1:60/100,000) into and around the lesion. Normal saline only is used when supplemental injections are required during EMR. Methylene blue is added for visual enhancement of the fluid cushion in contrast to the lesion.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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