Chemically assisted submucosal injection facilitates endoscopic submucosal dissection of gastric neoplasms

Background and study aims: A randomized in vivo animal study previously demonstrated that topical injection of mesna solution (sodium-2- mercaptoethanesulfonate) chemically softened submucosal connective tissues and facilitated mechanical dissection of the submucosal tissue plane. The present study evaluated the technical feasibility and safety of chemically assisted endoscopic submucosal dissection (CA-ESD) using mesna in 20 consecutive patients who underwent endoscopic excision of gastric neoplasm. Materials and methods: Following the margination of the lesion with a mucosal circumcision, 412mL of 10% mesna solution was injected into the submucosal layer. Mechanical submucosal dissection was then performed by bluntly cleaving the chemically treated submucosal layer with the tip of a cap-fitted gastroscope. The use of cautery was restricted to prophylactic hemostasis, dissection of the coagulated vessels and persistent submucosal tissues, and the final snare resection. Post-therapeutic ulceration repair and adverse events were followed up during a 1-week hospitalization and by repeat endoscopies at 1 day, 1 week, and 1 month after the procedure. Results: Sixteen gastric cancers and four adenomas were treated in this study. The sampled tissue measured 38.2514.53mm, with an en bloc resection rate of 100%. Mean operation time was 21.1711.6 minutes. The time spent using cautery was limited to 26.1% of the total submucosal dissection time. Ulcerations healed normally without complications. Conclusions: This preliminary study demonstrates that submucosal injection of mesna facilitates and expedites mechanical submucosal dissection. The major limitations in this study include the single-arm study design and a small patient population.