Xu PW, Xiao ZH, Yu M, Zhang XY. Advancements in injection materials for submucosal lifting in endoscopic interventions. World J Gastrointest Surg 2025; 17(11): 110323 [DOI: 10.4240/wjgs.v17.i11.110323]
Corresponding Author of This Article
Xue-Yan Zhang, PhD, Professor, Department of Gastroenterology, The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Nangang District, Harbin 150086, Heilongjiang Province, China. zxycxw@sina.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Peng-Wei Xu, Zheng-Han Xiao, Miao Yu, Xue-Yan Zhang, Department of Gastroenterology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
Author contributions: Xu PW conceptualized the review, conducted the primary literature screening, performed data extraction and analysis, and drafted the manuscript; Xiao ZH and Yu M assisted in literature retrieval and contributed to data collation; Zhang XY supervised the overall study, provided critical revisions to the manuscript, and is responsible for manuscript submission; and all authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xue-Yan Zhang, PhD, Professor, Department of Gastroenterology, The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Nangang District, Harbin 150086, Heilongjiang Province, China. zxycxw@sina.com
Received: June 4, 2025 Revised: July 19, 2025 Accepted: September 9, 2025 Published online: November 27, 2025 Processing time: 174 Days and 11.5 Hours
Abstract
Endoscopic submucosal dissection and endoscopic mucosal resection rely on submucosal injection cushions to effectively separate lesions from the muscularis propria, thereby expanding the operative field, improving resection precision, and minimizing procedure-related complications. Although recent advances have yielded cushions with enhanced lift durabilities and biofunctional properties, their widespread clinical adoption remains limited. Key barriers include poor injectability, uncertain long-term biocompatibility, restricted multifunctionality, manufacturing and supply chain constraints, and a lack of robust clinical and reimbursement evidence. This article comprehensively evaluated the current submucosal injection materials and assessed their mechanical performance, biocompatibility, and intraoperative usability. It compares conventional agents with emerging functionalized materials, identifies critical translational hurdles, and proposes actionable strategies to overcome them. These include the implementation of standardized biosafety protocols, early engagement with regulatory agencies, optimization of production processes, and incorporation of clinical and cost-effectiveness analyses. Bridging the gap between laboratory innovation and routine clinical use requires coordinated efforts across biomaterial research, industrial scalability, regulatory science, and health policies.
Core Tip: Submucosal injection cushions are essential adjuncts for achieving safe and effective endoscopic resection. Despite advances in material design - aimed at enhancing lift durability and incorporating biofunctional properties - their clinical translation remains constrained. Key limiting factors include suboptimal injectability, insufficient long-term biocompatibility data, restricted functional versatility, and substantial hurdles in manufacturing scalability, regulatory approval, and reimbursement. This article provides a critical comparison of conventional and next-generation submucosal injection materials, delineates major translational bottlenecks, and proposes integrative strategies to support their clinical implementation.
