Solutions for submucosal injection: What to choose and how to do it

Table 1 Main features of some submucosal injection solutions

Solution	Cushion duration	Price	Advantages	Disadvantages
NS	+	Low	Widely available; Inexpensive; Non-toxic	Poor submucosal elevation
DW	++	Low	Widely available; Inexpensive	Moderate submucosal elevation; Significant tissue damage at high concentrations of dextrose
HPMC	+++	Moderate	Great submucosal elevation; Widely available	Moderately expensive; Risk of antigenic reactions
HES	++++	Low/moderate	Excellent submucosal elevation; FDA-approved for submucosal injection; Reasonably priced	None
HA	++++	High	Excellent submucosal elevation	Expensive; Can stimulate the growth of residual tumour cells
Eleview®	++++	High	Excellent submucosal elevation; Non-toxic	Expensive

NS: Normal saline; DW: Dextrose water; HPMC: Hydroxypropyl methylcellulose; HES: Hydroxyethyl starch; HA: Hyaluronic acid; FDA: Food and Drug Administration.