A review of hydrogels used in endoscopic submucosal dissection for intraoperative submucosal cushions and postoperative management

Abstract

Endoscopic submucosal dissection (ESD) has been clinically proven to have prominent advantages in the treatment of early gastrointestinal cancers over traditional surgery, including less trauma, fewer complications, a quicker recovery, and lower costs. During the procedure of ESD, appropriate and multifunctional submucosal injected materials (SIMs) as submucosal cushions play an important role, however, even with many advances in design strategies of SIMs over the past decades, the performance of the submucosal cushions with postoperative management function seems to be still unsatisfactory. In this review, we gave a brief historical recount about the clinical development of SIMs, then some common applications of hydrogels used as SIMs in ESD were summarized, while an account of the universal challenges during ESD procedure was also outlined. Going one step further, some cutting-edge functional strategies of hydrogels for novel applications in ESD were exhibited. Finally, we concluded the advantages of hydrogels as SIMs for ESD as well as the treatment dilemma clinicians faced when it comes to deeply infiltrated lesions, some technical perspectives about linking the clinical demand with commercial supply were also proposed. Encompassing the basic elements of SIMs used in ESD surgery and the corresponding postoperative management requirements, this review could be a good reference for relevant practitioners in expanding the research horizon and improving the well-being index of patients.

Injectable Modified Sodium Alginate Microspheres for Enhanced Operative Efficiency and Safety in Endoscopic Submucosal Dissection

“…As a result, the microspheres bonded with each other from the SEM images in Figure A, indicating a certain degree of collapse. However, the overall shape was still spherical with a mean diameter of less than ∼5 μm, which was consistent with the standards for the preparation of injections and beneficial for surgical operation …”

“…However, the overall shape was still spherical with a mean diameter of less than ∼5 μm, which was consistent with the standards for the preparation of injections and beneficial for surgical operation. 34 After analysis, the particle size distributions of the four microspheres were concentrated in the range of 3−5 μm, and the average diameters of the SA, Cipro-SA, ThSA, and Cipro-ThSA microspheres were 4.15, 4.73, 3.62, and 3.82 μm, respectively, as shown in Figure 3B,C. These results revealed that the average particle sizes of the drug-loaded microspheres were considerably bigger than SA ones, which might be attributed to ciprofloxacin sticking to the microspheres and increasing particle size.…”