Experimental evaluation of photocrosslinkable chitosan hydrogel as injection solution for endoscopic resection

 

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Background and study aims: Saline as an injection solution for endoscopic resection techniques has several disadvantages such as a short-lasting effect leading to a potentially higher risk of bleeding and perforation. The new substance of photocrosslinkable chitosan hydrogel in a DMEM/F12 medium (PCH) can be converted into an insoluble hydrogel by ultraviolet irradiation for 30 s, and was evaluated in two sets of animal experiments.

Methods: 18 pigs were used in the two parts of the study. First, mucosal resections were done with either PCH or hypertonic saline; the effects of both agents on wound healing were examined endoscopically and histologically. Second, in vivo degradation of PCH was examined using six pig stomachs.

Result: PCH injection led to a longer-lasting elevation with clearer margins, compared with hypertonic saline, thus enabling precise endoscopic submucosal dissection (ESD) along the margins of the elevated mucosa. The endoscopic appearance after ESD was similar in both groups. PCH biodegradation was completed within 8 weeks according to endoscopic and histologic analyses.

Conclusion: PCH is a promising agent for submucosal injection prior to various techniques of endoresection. It should be evaluated in clinical trials after biocompatibility testing for PCH is completed.

• 1 Hirano M, Masuda K, Asanuma T. et al . Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine.  Gastrointest Endosc. 1988;  34 264-269
  CrossrefPubMedGoogle Scholar
• 2 Tada M, Inoue H, Yabata E. et al . Colonoscopic mucosal resection using a transparent cap-fitted endoscope.  Gastroentest Endosc. 1996;  44 63-65
  PubMedGoogle Scholar
• 3 Inoue H, Kawano T, Tani M. et al . Endoscopic mucosal resection using a cap: techniques for use and preventing perforation.  Can J Gastroentrol. 1999;  13 477-480
  PubMedGoogle Scholar
• 4 Suzuki H. Endoscopic mucosal resection using ligating device for early gastric cancer.  Gastrointest Endosc Clin N Am. 2001;  11 511-518
  PubMedGoogle Scholar
• 5 Fujishiro M, Yahagi N, Kashimura K. et al . Tissue damage of different submucosal injection solutions for EMR.  Gastrointest Endosc. 2005;  62 933-942
  CrossrefPubMedGoogle Scholar
• 6 Kiyozumi T, Kanatani Y, Ishihara M. et al . The effect of chitosan hydrogel containing DMEM/F12 medium on full-thickness skin defects after deep dermal burn.  Burns. 2007;  33 642-648
  CrossrefPubMedGoogle Scholar
• 7 Kiyozumi T, Kanatani Y, Ishihara M. et al . Medium (DMEM/F12)-containing chitosan hydrogel as adhesive and dressing in autologous skin grafts and accelerator in the healing process.  J Biomed Mater Res. 2006;  798B 129-136
  PubMedGoogle Scholar
• 8 Ishizuka T, Hayashi T, Ishihara M. et al . Submucosal injection, for endoscopic mucosal resection, of photocrosslinkable chitosan hydrogel in DMEM/F12 medium.  Endoscopy. 2007;  39 428-433
  Google Scholar
• 9 Ono K, Saito Y, Yura H. et al . Photo-crosslinkable chitosan as a biological adhesive.  J Biomed Res. 2000;  49 289-295
  PubMedGoogle Scholar
• 10 Inoue H. Endoscopic mucosal resection for the entire gastrointestinal mucosal lesions.  Gsatrointest Endosc Clin N Am. 2001;  11 459-478
  PubMedGoogle Scholar
• 11 Takekoshi T, Baba Y, Ota H. et al . Endoscopic resection of early gastric carcinoma; results of a retrospective analysis of 308 cases.  Endoscopy. 1994;  26 352-358
  Article in Thieme ConnectPubMedGoogle Scholar
• 12 Tada M, Shimada M, Murakami F. et al . Development of the strip-off biopsy.  Gastroenterol Endosc. 1984;  26 833-839
  PubMedGoogle Scholar
• 13 Makuuchi H, Mitomi T, Machimura T. et al . Endoscopic mucosal resection for early esophageal cancer by EMR-tube method.  Stomach Intest. 1988;  28 153-159
  PubMedGoogle Scholar
• 14 Yamamoto H, Yube T, Isoda N. et al . A novel method of endoscopic mucosal resection using sodium hyaluronate.  Gastrointest Endosc. 1999;  50 251-256
  CrossrefPubMedGoogle Scholar
• 15 Yamamoto H, Koiwai H, Yube T. et al . A successful single-step endoscopic resection of a 40 millimeter flat-elevated tumor in the rectum: endoscopic mucosal resection using sodium hyaluronate.  Gastrointest Endosc. 1999;  50 701-704
  CrossrefPubMedGoogle Scholar
• 16 Yamamoto H, Kawata H, Sunada K. et al . Successful en bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood.  Endoscopy. 2003;  35 690-694
  Article in Thieme ConnectPubMedGoogle Scholar
• 17 Feitoza A B, Gostout C J, Burgard L J. et al . Hydroxypropyl methylcellulose: a better subumcosal fluid cushion for mucosal resection.  Gastrointest Endosc. 2003;  57 41-47
  PubMedGoogle Scholar
• 18 Fujishiro M. Endoscopic submucosal dissection for stomach neoplasms.  W J Gastroendosc. 2006;  12 5108-5112
  CrossrefPubMedGoogle Scholar
• 19 Ito M, Ban A, Ishihara M. et al . Anti-ulcer effects of chitin and chitosan, healthy foods, in rats.  Jpn J Pharmacol. 2000;  82 218-225
  CrossrefPubMedGoogle Scholar
• 20 Ishihara M, Nakanishi K, Ono K. et al . Photo-crosslinkable chitosan as a dressing for wound occlusion and accelerator in healing process.  Biomaterials. 2002;  23 833-840
  CrossrefPubMedGoogle Scholar
• 21 Ishihara M, Ono K, Sato M. et al . Acceleration of wound contraction and healing with a photocrosslinkable chitosan hydrogel.  Wound Rep Regen. 2001;  9 513-521
  CrossrefPubMedGoogle Scholar
• 22 Hayashi T, Matsuyama T, Hanada K. et al . Usefulness of photoclosslinkable chitosan for endoscopic cancer treatment in alimentary tract.  J Biomed Mater Res B Appl Biomater. 2004;  71 367-372
  PubMedGoogle Scholar

M. MaeharaMD 

Department of Surgery
National Defense Medical College

3-2 Namiki
Tokorozawa, Saitama
359-8513 Japan

Fax: +81-429-91-1611

Email: maeharat57@yahoo.co.jp