Advancements in injection materials for submucosal lifting in endoscopic interventions

Table 1 A comparative overview of submucosal injection materials

Material	Validation stage	Injection volume (mL)	Initial elevation height/height at 60 minutes (mm)	60-min retention (%)	Repeat injection	Biocompatibility	Adverse events
Normal saline	Clinical use	1	NR/0	0	Yes	No observable tissue damage	Increased intraoperative bleeding and perforation risk
Hypertonic saline	In vivo	1	4.6/0	0	Yes	No observable tissue damage	None observed
50% glucose injection	Clinical trial	5	NR/NR	NA	No	No observable tissue damage	None observed
Glycerol fructose	Ex vivo; retrospective clinical study	1	4.6/0	0	Yes	No observable tissue damage	Bleeding: 9%
Sodium hyaluronate	Ex vivo; in vivo; multicenter clinical trial	1	6.8/NR	NA	No	Mild inflammation	None observed
Hydroxypropyl methylcellulose	Ex vivo; in vivo; phase II clinical trial	5	9/NR	NA	Yes	Minimal tissue reaction	None observed
Sodium carboxymethyl cellulose	Ex vivo; in vivo; clinical studies	2	15/14	93%	Yes	No observable tissue damage	Intraoperative perforation: 1 case; postoperative bleeding: 4 cases
Sodium carboxymethyl starch	Ex vivo; in vivo; preclinical	23	NR/NR	NA	Yes	No observable tissue damage	Intraoperative bleeding: 4 cases
Hydroxyethyl starch	In vivo; clinical trial	10.5	NR/0	0	Yes	No observable tissue damage	Intraoperative bleeding: 1 case; postoperative bleeding: 1 case; macro-perforation: 1 case
Sodium alginate	Ex vivo; preclinical; pilot clinical study	1	6.1/4.5	74%	No	No observable tissue damage	None observed
Sodium polyacrylate	Ex vivo	2	16/15	94%	No	NA	None observed
Autologous blood	Ex vivo; clinical feasibility study	7.5	6.4/4.3	67%	No	Mild local tissue response	None observed
Fibrin glue	Ex vivo	2	6.2/5.6	90%	No	No observable tissue damage	Gel hardening led to procedural challenge
IDEEP hydrogel	Ex vivo	1	5.7/5	88%	No	No observable tissue damage	None observed
LiftUp	In vivo	1	5.8/4.9	84%	No	No observable tissue damage	None observed
Eleview® (SIC-8000)	In vivo; clinically validated	9	NR/NR	NA	Yes	No observable tissue damage	Postoperative bleeding rate: 2%; postoperative discomfort (abdominal pain/fever): 1%
LeGoo-endo (PS137-25)	Ex vivo; in vivo	5	10/NR	NA	No	No observable tissue damage	Mild bleeding: 1 case
DDFP-NS	Ex vivo; in vivo	1	5.8/5.0	86%	No	No observable tissue damage	Mild bleeding: 1 case
Carbon dioxide	Ex vivo; in vivo	41	2/2	100%	No	No observable tissue damage	No adverse events reported
Chitosan-based hydrogels	Ex vivo; in vivo	9	4.8/3.9	81%	No	No observable tissue damage	No adverse events reported
PLGA-PEG-PLGA hydrogel	In vivo	1	4.8/3.6	75%	No	No observable tissue damage	No adverse events reported
PSC/Ge hydrogel	In vivo	1	5.6/4.4	79%	No	No observable tissue damage	Mild bleeding (controllable)
Cat-PBA-ApGltn hydrogel	Ex vivo; in vivo	0.5	3.8/NR	NA	No	No observable tissue damage	None observed
Gellan gum hydrogel	Ex vivo; in vivo	1	5.7/4.7	82%	No	No observable tissue damage	Mild bleeding: 1 case

NR: Not reported; NA: Not available; 60-min retention (%): Percentage of initial lift height maintained at 60 minutes; DDFP-NS: Dodecafluoropentane - normal saline; IDEEP: Injectable, degradable, and elastic hydrogel; PSC/Ge: Pepsin-solubilized collagen/genipin; Cat-PBA-ApGltn: Catechol-phenylboronic acid-Alaska pollock gelatin; PLGA-PEG-PLGA hydrogel: Poly(lactic-co-glycolic acid)-poly(ethylene glycol)-poly(lactic-co-glycolic acid) hydrogel.