APPROPRIATE MIXTURE OF HYALURONIC ACID, GLUCOSE AND GLYCERIN FOR A SUBMUCOSAL FLUID CUSHION DURING ENDOSCOPIC SUBMUCOSAL DISSECTION IN THE DOG STOMACH

Background:  A mixture of a 1% 1900 KDa hyaluronic acid (HA) preparation (Suvenyl) and a 10% glycerin with 5% fructose and 0.9% saline preparation (Glyceol) to make a 0.125% HA is considered to be the best ready‐made submucosal fluid cushion (SFC). When the concentration of glycerin is changeable, a more appropriate SFC may be created. Methods:  For two beagles, 1 mL of 10%, 15%, 20%, 25%, and 50% glycerin per stomach was submucosally injected to investigate mucosal damage. After the results, 1 mL of a mixture of 0.125% 1900 KDa HA, 10% glucose, and glycerin of the recommended concentration was submucosally injected onto each stomach of two additional beagles to investigate mucosal lifting and damage. 10% glucose was added to increase the viscoelasticity of HA. Furthermore, endoscopic submucosal dissection (ESD) was performed using the mixture in the rest of the stomachs and the feasibility was investigated. Results:  20% or more concentration of glycerin showed apparent damage and 10% was considered to be a recommended concentration. The mixture of HA and glucose with 10% glycerin showed sufficient mucosal lifting without damage. ESD was completed successfully and no apparent damage was observed in the ESD specimens and its related ulcers. Conclusion:  Although the mixture of 0.125%1900 KDa HA, 10% glucose, and 10% glycerin may create a more appropriate SFC than ready‐made ones, the fact that 10% is a recommended concentration of glycerin may mean the usefulness of alternative use of a commercially available glycerin solution, Glyceol, as an appropriate mixture with HA.