Submucosal injection fluid and tattoo agents.

BACKGROUND AND AIMS

EMR and endoscopic submucosal dissection (ESD) are minimally invasive endoscopic techniques, developed for the removal of benign and early malignant lesions throughout the GI tract. Submucosal injection of a marking agent can help to identify lesions during surgery. Endoscopic resection frequently involves "lifting" of the lesions by injection of a substance within the submucosal space to create a cushion for safe resection. This review summarizes the current techniques and agents available for endoscopic marking and lifting of GI tract lesions.

METHODS

The MEDLINE database was searched through April 2023 for relevant articles related to the lifting and marking aspect of EMR by using key words such as "endoscopy" or "endoscopic" combined with "marking," "tattoo," and "lifting." The report was drafted, reviewed, and edited by the American Society for Gastrointestinal Endoscopy Technology Committee and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy.

RESULTS

This technology review describes the techniques for endoscopic tattoo placement and submucosal lifting, along with currently available agents, safety, and costs.

CONCLUSIONS

Endoscopists performing EMR and ESD have several choices in submucosal injection materials for lifting and marking agents for tattoos. These may be commercially prepared agents or off-the-shelf materials with or without additives to facilitate visualization. A thorough understanding of the indications, techniques, properties of various agents, costs, and adverse events is necessary in choosing the appropriate materials and technique to optimize lesion resection in EMR and ESD.

Informations de copyright

Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Disclosure The following authors disclosed financial relationships: A. Bhatt: Consultant for Medtronic, Inc, US Endoscopy, Olympus Corporation, and Intuitive Surgical Inc; patent-holder for a commercial device licensed to Medtronic, Inc. V. S. Akshintala: Board member for Origin Endoscopy Inc; consultant for Dragonfly Endoscopy Inc; research support from Abbvie, Boston Scientific Corporation, and Medtronic. Y. Chen: President of Chess Medical; consultant for Boston Scientific Corporation. K. K. Das: Consultant for Olympus Medical Systems Corporation; patent-holder with Interpace Biosciences. A. Kahn: Consultant for MiMedx. K. Krishnan: Consultant for Boston Scientific Corporation and Olympus Corporation of the Americas. G. Leung: Consultant for Boston Scientific Corporation, Steris Corporation, AI Medical Service, and Mirai Medical. D. R. Lichtenstein: Consultant for Olympus Corporation of the Americas and Boston Scientific Corporation; speaker for Olympus Corporation of the Americas and Boston Scientific Corporation; Clinical Events Committee for Boston Scientific Corporation (chair) and SafeHeal; advisory board and research committee for Iterative Health; GI boards committee for the American Board of Internal Medicine. G. Mishra: Consultant for Pentax of America, Inc and Cook Medical LLC. V. Raman Muthusamy: Consultant for Medtronic and Boston Scientific Corporation; research support from Boston Scientific Corporation; stock options/equity in Capsovision; advisory board for Endogastric Solutions and Motus GI. J. V. Obando: Shareholder with Surgenly LLC. S. Pawa, T. Rustagi, G. Trikudanathan: Consultant for Boston Scientific Corporation. M. Saumoy: Consultant for Becton, Dickinson and Company and Intuitive Surgical, Inc. A. J. Trindade: Consultant for Pentax of America, Inc, Boston Scientific Corporation, Lucid Diagnostics, and Exact Science. J. Yang: Consultant for Cook Medical, Interscope, and Steris. R. Law: Consultant for Conmed Corporation, Boston Scientific Corporation, Olympus America Inc, and Medtronic USA Inc; royalties from UpToDate. All other authors disclosed no financial relationships.