Submucosal injection fluid and tattoo agents.

Amit Bhatt, Daniela Guerrero Vinsard, Jorge V Obando, Girish Mishra, Allon Kahn, Koushik K Das, Andrew P Copland, Dennis Chen, Maaza Abdi, Samuel Han, V Raman Muthusamy, Swati Pawa, Guru Trikudanathan, Venkata S Akshintala, Yen-I Chen, David J Desilets, Mohit Girotra, Julie Yang, Tarun Rustagi, Sonali S Sakaria, Kumar Krishnan, Nikrad Shahnavaz, Galen Leung, Ryan Law, Juan Carlos Bucobo, Arvind J Trindade, David R Lichtenstein, Frances U Onyimba, Monica Saumoy

Journal: Gastrointestinal endoscopy 2024;100(5):797-806

PMID: 39269377

Full Text on Elsevier Science View on PubMed

Abstract

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.

Address: Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, Ohio, USA.; Gastroenterology Services, Northwell Health Gastroenterology Institute, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA.; Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA.; Digestive Diseases Center, University of Chicago, Chicago, Illinois, USA.; Division of Gastroenterology & Hepatology, McGill University Health Centre, Montreal, Quebec, Canada.; Division of Gastroenterology and Hepatology, University of Virginia Health Systems, Charlottesville, Virginia, USA.; Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.; Division of Gastroenterology, Baystate Medical Center, Springfield, Massachusetts, USA.; Department of Gastroenterology, Swedish Medical Center, Issaquah, Washington, USA.; Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.; Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA.; Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA.; Department of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.; Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.; Department of Gastroenterology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.; Division of Digestive Diseases, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.; Division of Gastroenterology, Duke University Health System, Raleigh, North Carolina, USA.; Department of Gastroenterology, WellSpan Digestive Health, York, Pennsylvania, USA.; Department of Gastroenterology, Kern Medical Center, Bakersfield, California, USA.; Division of Digestive Diseases, Emory University, Atlanta, Georgia, USA.; Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.; Department of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, New Hyde Park, New York, USA.; Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.; Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.

DOI: 10.1016/j.gie.2024.07.002

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MeSH Terms: Humans, Endoscopic Mucosal Resection, Tattooing, Coloring Agents, Injections, Intestinal Mucosa, Gastric Mucosa