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Comparative Study
. 2021 Dec 9;16(12):e0260458.
doi: 10.1371/journal.pone.0260458. eCollection 2021.

Efficacy and safety of a thermosensitive hydrogel for endoscopic submucosal dissection: An in vivo swine study

Han Jo Jeon  1 , Hyuk Soon Choi  1 , Eun Ju Bang  1 , Kang Won Lee  1 , Sang Hyun Kim  1 , Jae Min Lee  1 , Eun Sun Kim  1 , Bora Keum  1 , Yoon Tae Jeen  1 , Hong Sik Lee  1 , Hoon Jai Chun  1 , Seung Jeong  2 , Jong Hyuk Kim  3   4
Affiliations
Comparative Study

Efficacy and safety of a thermosensitive hydrogel for endoscopic submucosal dissection: An in vivo swine study

Han Jo Jeon et al. PLoS One. .

Abstract

Injectable thermo-sensitive chitosan hydrogels have recently been developed for the use of submucosal fluids in endoscopic submucosal dissections (ESD). This study aimed to investigate the efficacy and safety of chitosan hydrogels during ESD. Submucosal fluids were administered as follows: 0.9% normal saline (NS), 0.4% hyaluronic acid (HA) and chitosan/β-glycerophosphate (CS/GP) hydrogel. Each solution was administered twice into the stomach and colon of a pig, with a total of 72 ESD procedures performed on 12 pigs. The injected volume and procedure-related parameters were recorded and analyzed. ESDs that created ulcers after 7 days were histologically compared. All ESD specimens were resected en bloc. The total injected volumes during ESD of the stomach (NS, 16.09±3.27 vs. HA, 11.17±2.32 vs. CS/GP, 9.44±2.33; p<0.001) and colon (NS, 9.17±1.80 vs. HA, 6.67±1.50 vs. CS/GP, 6.75±1.57; p = 0.001) were significantly different. Hydrogel showed significant differences from normal saline in terms of fluid power (mm2/vol; NS, 35.70±9.00 vs. CS/GP 57.48±20.77; p = 0.001) and consumption rate (vol/min; NS, 2.59±0.86 vs. CS/GP, 1.62±0.65; p = 0.013) in the stomach. Histological examination revealed preserved muscularis propria, although the chitosan hydrogel resulted in a partial inflammatory response, with a hypertrophied submucosal layer. Chitosan hydrogel was found to be superior to normal saline, with an efficacy similar to that of hyaluronic acid. Nonetheless, long-term histological changes should be evaluated before clinical implementation.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Schematic flow chart of experiments.
Fig 2
Fig 2. Endoscopic view of submucosal dissection procedure according to solution.
(A) 0.9% normal saline (B) 0.4% hyaluronic acid (C) chitosan/β-glycerophosphate (first row, marking; second row, injection; third row, precutting; fourth row, dissection).
Fig 3
Fig 3. Histologic representation of endoscopic submucosal dissection (ESD) induced ulcer after 7 days.
The first and second row indicate gastric and colonic ulcers after ESD, respectively. Administered by (A) normal saline and (B) 0.4% hyaluronic acid revealing a microscopically sharply demarcated ulcer (arrow) without hemorrhage (asterisk), and by (C) chitosan/β-glycerophosphate, presenting a loss of the mucosal layer with a hypertrophied submucosal layer (asterisk) at the ulcer base. Hematoxylin-Eosin (H & E) stain; x40. The colonic ulcer injected by (D) normal saline, (E) 0.4% hyaluronic acid showing a smooth margin without hemorrhage and perforation (asterisk), and (F) a chitosan/β-glycerophosphate ulcer presenting with a thickened submucosal layer (asterisk), and focal lysis (arrow) with granulation tissue, H & E; x40, (G) The gastric tissue administered with chitosan/β-glycerophosphate solution exhibiting focal cell lysis (asterisk) and fibrinolysis (arrow), which is indicative of minimal hemorrhaging (strong pink). H & E; x200.
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References

    1. Tamegai Y, Saito Y, Masaki N, Hinohara C, Oshima T, Kogure E, et al.. Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy. 2007;39(5):418–22. doi: 10.1055/s-2007-966427 - DOI - PubMed
    1. Choi IJ, Lee JH, Kim YI, Kim CG, Cho SJ, Lee JY, et al.. Long-term outcome comparison of endoscopic resection and surgery in early gastric cancer meeting the absolute indication for endoscopic resection. Gastrointestinal endoscopy. 2015;81(2):333–41.e1. doi: 10.1016/j.gie.2014.07.047 - DOI - PubMed
    1. Saito Y, Uraoka T, Yamaguchi Y, Hotta K, Sakamoto N, Ikematsu H, et al.. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections. Gastrointestinal endoscopy. 2010;72(6):1217–25. doi: 10.1016/j.gie.2010.08.004 - DOI - PubMed
    1. Chung IK, Lee JH, Lee SH, Kim SJ, Cho JY, Cho WY, et al.. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointestinal endoscopy. 2009;69(7):1228–35. doi: 10.1016/j.gie.2008.09.027 - DOI - PubMed
    1. Mehta N, Strong AT, Franco M, Stevens T, Chahal P, Jang S, et al.. Optimal injection solution for endoscopic submucosal dissection: A randomized controlled trial of Western solutions in a porcine model. Digestive endoscopy: official journal of the Japan Gastroenterological Endoscopy Society. 2018;30(3):347–53. doi: 10.1111/den.12993 - DOI - PubMed

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Grants and funding

This work was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare (Grant number: HI14C3477) awarded to HSC. This work was also supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (Grant number: No.2020R1A2C4002621) awarded to HSC and (Grant number: No.2021R1I1A1A01057303) awarded to HJJ.