| Background: Endoscopic mucosal resection (EMR) is an established and widely accepted treatment modality for both gastrointestinal early-stage neoplasia and precancerous lesions. One of the major complications of EMR is perforation, and the most effective way of preventing perforation is to elevate the lesion sufficiently by endoscopic injection of fluid into the submucosa, creating submucosal fluid cushion (SFC) which can isolates the submucosa from muscularis propria, thereby reduces perforation and the risk for thermal injury and hemorrhage. In the world, There are kinds of solutions assisting EMR, including normal saline solution (NS), normal saline plus epinephrine solution (NSE), 50% dextrose, 10% dextrose, 10% glycerine/5% fructose in normal saline solution (Glycerol), different concentration of sodium hyaluronate, and Hydroxy- d for empirical study. In china, injection-assisted EMR is as the submuc also inject 10% glycerin with .9% NaCl plus 5% fructose into submucosa. All of solutions are inexpensive and readily available. Howerer, each hospital or medical institution is used to appling only one of solution for EMR, no research has being showed comparative performance of three of solutions used for submucosal injection in endoscopic submucosal resection by far. In addition, 50% Dextrose (D50) was reported in abroad to maintain the elevation of the mucosa for prolonged periods, and easy to available.Study aims: This study was conducted to compare the duration of mucosal Propyl-Methy-Cellulose, et al. Sodium hyaluronate (SH) is a promising submucosal injection solution during endoscopic mucosal resection, but its high cost is an obstacle to more widespread use. Hydroxy -Propyl-Methyl-Cellulose now is only limitetraditionally carried out by using normal saline or normal saline plus epinephrine osal fluid cushion. Several hospitals0 elevation of submucosal injection different solutions (NS,NSE,D50,Glycerol) and the evaluation of efficacy and safety of EMR,in order to select the best tes), which were significantly shorter compared with the other test solution used submucosal injection.Methods: Eight resected porcine stomachs and eight living rabbits in all were used for the whole study. In order to compare the mucosa-lifting properties of several different solutions, according to four solutions, Four porcine stomachs and four rabbits were used for submucosal-injection at first, The time required for the submucosal bleb to flatten completely was recorded after each injection. The solutions used were as follows: normal saline solution, normal saline plus epinephrine solution, 50% dextrose, and 10% glycerine/5% fructose in normal saline solution. In each porcine model and each rabbit, 10 separate submucosal injections of 5 mL,10ml respectively of a single solution were performed within the porcine stomach and the rabbit intestinal tract.Secondly, Remaining four porcine stomachs and all of rabbits were performed EMR, Injury sites should be observed carefully. The best solution intended to be selected preliminarily as optimal submucosal injection based on animal experiments in vitro and vivo. Eventually, 98 patients with gastrointestinal early-stage neoplasia or precancerous lesions undergoing EMR during gastroscopy or colonoscopy were randomly assigned to receive either normal saline or glycerol as the submucosal fluid cushion. A total of 55 patients were treated by EMR with NS.For comparison, 43 patients treated by using glycerol were studied. The duration of lesion elevation, The time of operation, and associated complications rates of two submucosal injection solutions were compared in the two groups.Results: In vitro, the normal saline solution and normal saline plus epinephrine solutions had the shortest elevation times (respectively, mean 4.86and 5.09 minusolutions. The mean elevation times for 50% dextrose and glycerol were, respectively, 8.15and 9.85minutes. likewise, in vivo, the mean times of maintaining submucosal fluid cushion were NS 2.37, NSE 2.52, D50 4.34, and glycerol 4.77min. the normal saline solution and the normal saline plus NS and NSE during epinephrine solution created a similar SFC (P>0.05), The ability of 50% dextrose and glycerol to create SFCs was also similar (P>0.05).Nevertheless, 50% dextrose and glycerol, tended to maintain longer mucosal elevation than normal saline or normal saline plus epinephrine, the difference was significant (P<0.05). All of injury sites presenting blue proved that the depth of resection was suitable and not involved in muscularis propria. All of rabbits except for one dying from over dose of anesthetic were eusemia without serious complications. In the clinical study,injection of glycerol resulted in significantly longer mucosal elevation than normal saline (mean time: Glycerol:6.72, NS 3.03 minutes P=0.00000). it was confirmed the elevation effect of glycerol was superior to the normal saline solution's. The operation time was shorter with glycerol than with normal saline (Glycerol: 12.81±0.37min, NS: 13.20±0.56min, P<0.05). In the NS group the immediate blood rate was 40% (22/55) compared with 39.5% (17/43) in the glycerol group which was similar in both groups (P=0.9628). It was thus clear that there was no significant difference in the rates of complications between the two groups. No patient occurred perforation or Transmural Burn Syndrome.Conclusions: As the solution of submucosal injection, 50% dextrose and glycerol, being hypertonic and hyperviscoelastic were superior to isotonic solutions of normal saline and normal saline plus epinephrine, as they allowed longer duration of mucosal elevation than injection-associated EMR. By clinical study, using glycerol assiting EMR can reduce the operation times more obviously than using normal saline, while the superiority of hypertonic and hyperviscoelastic solution over normal saline in respect of complication rates was not clearly demonstrated (P>0.05).
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