Usefulness of Ready-to-Use 0.4% Sodium Hyaluronate (Endo-Ease) in the Endoscopic Resection of Gastrointestinal Neoplasms

Abstract

Background/AimsCommercially available sodium hyaluronate solutions are usually too thick to inject through catheters and need dilution with normal saline (NS) before use, which increases the risk of contamination. We evaluated the usefulness of ready-to-use 0.4% sodium hyaluronate, Endo-Ease (EE; UNIMED Pharm. Inc., Seoul, Korea).MethodsWe performed a prospective multicenter randomized study from May 2011 to September 2012. Patients requiring endoscopic resection (ER) for gastric or colorectal neoplasm at two referral hospitals were enrolled.ResultsOne hundred fifty-four patients (72 with a gastric neoplasm and 82 with a colorectal neoplasm) were included in intention-to-treat analysis. Thirty-seven gastric neoplasms and 43 colorectal neoplasms were enrolled in the EE group. The usefulness rate was significantly higher in the EE group than in the NS group (89.2% vs. 60.0% for gastric neoplasms and 95.3% vs. 67.7% for colorectal neoplasms, p<0.001). In the EE group, the ease of mucosal resection was significantly higher than in the NS group (p<0.001). The injected volume was smaller in the EE group than in the NS group (p<0.05).ConclusionsThe use of EE reduced the need for additional injections and improved the ease of ER. A submucosal injection of EE is useful for the ER of both gastric and colorectal neoplasms.

Efficacy and safety of a submucosal injection solution of sodium alginate for endoscopic resection in a porcine model

“…However, the chance of tissue injury increases as the concentration of glucose solution rises, and there is a risk of virus infection in using a fibrinogen mixture purified from human serum 2 , 11 – 13 . Although sodium hyaluronate has been reported to be the most effective submucosal injection for creating and maintaining mucosal elevation and has been successfully commercialized 9 , 10 , 14 , 15 , it also has the disadvantage of high cost.…”

“…In this study, the novel submucosal injection solution MC-003 was assessed in comparison with normal saline-indigo carmine mixed solution and a commercially licensed 0.4% sodium hyaluronate solution, Endo-Ease. Normal saline-indigo carmine-mixed solution is widely used as a standard material for mucosal elevation during EMR or ESD and has been used as a control to evaluate the safety and efficacy of experimental injection solutions 9 , 14 , 15 . Endo-Ease was selected as a representative product of 0.4% sodium hyaluronate, the only commercially successful solution among various solutions examined so far.…”

Injectable temperature-sensitive hydrogel facilitating endoscopic submucosal dissection

“…Then researchers experimented with low-concentration solutions, such as 0.4% hyaluronic acid, which is approved for clinical submucosal injection in Japan. Hyaluronic acid has been shown in several studies to provide longer-lasting submucosal augmentation, higher ESD resection rates, and lower complication rates ( Yamamoto et al, 2002 ; Kim et al, 2015 ), but it is less economical and may stimulate the proliferation of residual tumor cells ( Matsui et al, 2004 ).…”

Injectable Thermosensitive Chitosan Solution with β-Glycerophosphate as an Optimal Submucosal Fluid Cushion for Endoscopic Submucosal Dissection

“…However, complications of bleeding (~15.6%) and perforation (~9.7%) commonly occur during the procedure [ 3 ]. Adequate mucosal elevation by injecting submucosal injection agents is essential to remove flat or sessile type lesions to maintain a clear cutting view and reduce perforation [ 4 ]. The ideal submucosal injection agents in ESD should provide long-lasting mucosal cushion, convenient injectability, biocompatibility and biodegradability [ 5 ].…”

“…Many other types of materials for SFC have been developed to overcome the defects of NS. Hyaluronic acid (HA), a non-sulfated glycosaminoglycan present in connective tissue, is used frequently for submucosal injection as a 0.4% solution [ 4 , 7 ]. The solution has a relatively high viscosity to provide long-lasting fluid cushion compared to other agents such as glycerol, dextrose water, and hydroxypropyl methylcellulose [ 8 ].…”