For EMR and UEMR, midazolam was used for sedation, and butylscopolamine or glucagon was used to suppress peristalsis. A gastroscope with a water‐jet function (GIF‐Q260J or GIF‐H290T; Olympus Medical Systems) was used. For lesions located in the distal duodenum that could not be reached using gastroscopy, a colonoscope (CF‐H290TI; Olympus) was used. A transparent hood (TOP Corporation) was attached to the tip of the endoscope. Depending on the lesion size, a 10 or 15 mm electro‐surgical snare (Captivator II; Boston Scientific, or SnareMaster; Olympus) was chosen. For cEMR, 0.4% sodium hyaluronate (Muco Up; Boston Scientific) diluted twice with a 10% glycerin solution containing a small amount of indigo carmine was used for submucosal injection. For UEMR, the lumen was filled with saline using a water jet after air deflation. After the resection, the mucosal defect was completely closed using an EZ clip (Olympus).
Mucoup
Manufactured by Boston Scientific
Sourced in Japan, United States
MucoUp is a medical device designed for submucosal injection in endoscopic procedures. It is used to create a submucosal cushion, which can facilitate endoscopic mucosal resection and endoscopic submucosal dissection procedures.
Automatically generated - may contain errors
Lab products found in correlation
Gif q260j, by Olympus (8 mentions)
Dualknife j, by Olympus (7 mentions)
Vio300d, by Erbe (7 mentions)
Dualknife, by Olympus (5 mentions)
Gif h290t, by Olympus (4 mentions)
Itknife nano, by Olympus (4 mentions)
Standard tip hood, by Olympus (3 mentions)
St hood, by Fujifilm (3 mentions)
Ksmart, by Olympus (3 mentions)
It knife 2, by Olympus (2 mentions)
Vio 3, by Erbe (2 mentions)
Evis x1, by Olympus (2 mentions)
Kd 612l, by Olympus (2 mentions)
Pcf h290zi, by Olympus (2 mentions)
Evis lucera spectrum, by Olympus (2 mentions)
Kd 655q, by Olympus (2 mentions)
It nano knife, by Olympus (2 mentions)
Evis lucera elite, by Olympus (2 mentions)
Sb knife jr, by Sumitomo Bakelite (2 mentions)
Kd 655l, by Olympus (2 mentions)
22 protocols using mucoup
1
Endoscopic Mucosal Resection Techniques
2
Endoscopic Submucosal Dissection Protocol
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All endoscopic procedures were performed by experts in ESD who had experience with more than 500 clinical cases. There were no restrictions on the scopes and devices used by each endoscopist for ESD. The scopes used were GIF-Q260J or GIF-H260 (Olympus, Tokyo, Japan), and the devices were an insulation-tipped diathermic knife (IT Knife), IT Knife 2, IT Knife nano, or Dual Knife J (Olympus, Tokyo, Japan). Other devices, such as an argon plasma coagulation probe (ERBE, Tubingen, Germany) for marking dots or a needle knife (ZEON MEDICAL, Tokyo, Japan) for the initial incision, were occasionally used.
First, marking dots for the incision lines were placed around the lesion. Next, fructose-added glycerol (Glyceol; TAIYO Pharma CO, Tokyo, Japan) with a minute amount of indigo carmine dye was injected into the submucosal layer. In some cases, 0.4% sodium hyaluronate (MucoUp; Boston Scientific, Tokyo, Japan) was used. After submucosal injection, a precut was made with the Dual Knife J or needle knife, followed by a circumferential mucosal incision around the lesion using the dots as a landmark and submucosal dissection with the IT Knife, IT Knife 2, IT Knife nano, or Dual Knife J. The resected specimens were evaluated pathologically.
First, marking dots for the incision lines were placed around the lesion. Next, fructose-added glycerol (Glyceol; TAIYO Pharma CO, Tokyo, Japan) with a minute amount of indigo carmine dye was injected into the submucosal layer. In some cases, 0.4% sodium hyaluronate (MucoUp; Boston Scientific, Tokyo, Japan) was used. After submucosal injection, a precut was made with the Dual Knife J or needle knife, followed by a circumferential mucosal incision around the lesion using the dots as a landmark and submucosal dissection with the IT Knife, IT Knife 2, IT Knife nano, or Dual Knife J. The resected specimens were evaluated pathologically.
3
Comparing Submucosal Elevation Properties
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The ability of FG (Bolheal; KM Biologics Co., Ltd.) to maintain submucosal elevation was compared with those of HA (MucoUP; Boston Scientific.) and NS. Preparation of the resected porcine gastric specimen and the injection methods were demonstrated according to the study by Fujishiro et al, which evaluated the lesion lifting properties of several submucosal injection agents
2 (link)
. Considering that FG contains fibrinogen and thrombin solutions, 1 mL of each solution (2 mL total) was injected into the submucosal layer. Accordingly, the injection volume of HA and NS was adjusted to 2 mL. After injecting each solution, we recorded the submucosal elevation immediately after, and 5, 10, 20, 25, 30, 45, and 60 minutes after injections. Then, images were taken from the same distance using a fixed camera (Q7; Pentax Corp.). Using an image analysis software (Hakarundesu v. 0.7.1, onegland.net), we measured the height of each submucosal elevation. The same procedure was conducted five times individually for each submucosal injection solution. Thereafter, we compared the mean submucosal elevation of the three submucosal injection solutions at each time point.
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The ability of FG (Bolheal; KM Biologics Co., Ltd.) to maintain submucosal elevation was compared with those of HA (MucoUP; Boston Scientific.) and NS. Preparation of the resected porcine gastric specimen and the injection methods were demonstrated according to the study by Fujishiro et al, which evaluated the lesion lifting properties of several submucosal injection agents
2 (link)
. Considering that FG contains fibrinogen and thrombin solutions, 1 mL of each solution (2 mL total) was injected into the submucosal layer. Accordingly, the injection volume of HA and NS was adjusted to 2 mL. After injecting each solution, we recorded the submucosal elevation immediately after, and 5, 10, 20, 25, 30, 45, and 60 minutes after injections. Then, images were taken from the same distance using a fixed camera (Q7; Pentax Corp.). Using an image analysis software (Hakarundesu v. 0.7.1, onegland.net), we measured the height of each submucosal elevation. The same procedure was conducted five times individually for each submucosal injection solution. Thereafter, we compared the mean submucosal elevation of the three submucosal injection solutions at each time point.
4
Colonoscopic Submucosal Dissection Techniques
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A colonoscope, either PCF‐Q260AZI (Olympus Medical Systems Co., Tokyo, Japan) or PCF‐H290TI (Olympus), was used. A standard tip hood (Olympus), ST hood (FUJIFILM, Tokyo, Japan), or its short type (FUJIFILM) was attached to the tip of the colonoscope. For submucosal injection, 0.4% sodium hyaluronate (Muco Up; Boston Scientific, Tokyo, Japan) diluted twice with a 10% glycerin solution was used. Of the three devices DualKnife (Olympus), DualKnife J (Olympus), or ITknife nano (Olympus), one or two devices were used as appropriate in each case. For BA‐ESD cases, SBO (ST‐CB1; Olympus) connected to a balloon control unit (OBCU; Olympus) was placed onto a colonoscope before insertion.18 SBO is a single‐use device and is less expensive than the ESD knife used in this study.
5
Endoscopic Submucosal Dissection Techniques
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ESD was performed using a high-vision therapeutic endoscope with a water jet function (GIF-H290T; Olympus Medical Systems, Tokyo, Japan). Submucosal injections of a 10 % glycerin solution (Glyceol; Chugai Pharmaceutical Co, Ltd, Tokyo, Japan) were performed with a 25G needle (NeedleMaster, Olympus Medical Systems, Tokyo, Japan). For difficult cases, 0.4 % sodium hyaluronate (MucoUp, Boston Scientific, Marlborough, Massachusetts, United States) was used as required.
As an energy device, the operator used a needle type knife with injection function (DualKnife J, Olympus Medical Systems, Tokyo, Japan) in all cases. In tESD group, DualKnife J was only used for marking, mucosal incision and creation of small mucosal flap, and a high-frequency scissors forceps (ClutchCutter, Fujifilm, Tokyo, Japan) was used for submucosal dissection. DualKnife J was powered by a high-frequency electrosurgical unit (VIO 3, ERBE Elektromedizin, Tübingen, Germany), which supported lesion marking (soft coagulation function, effect 6.0), hemostasis with the knife tip (spray coagulation function, effect 1.2), mucosal incision (dry cut function, effect 2.2), and submucosal dissection (swift coagulation, effect 3.5). ClutchCutter was also powered by VIO3, which supported submucosal dissection (Endocut I function [effect 1.0, duration 1, interval 1] and forced coagulation [effect 3.0]).
As an energy device, the operator used a needle type knife with injection function (DualKnife J, Olympus Medical Systems, Tokyo, Japan) in all cases. In tESD group, DualKnife J was only used for marking, mucosal incision and creation of small mucosal flap, and a high-frequency scissors forceps (ClutchCutter, Fujifilm, Tokyo, Japan) was used for submucosal dissection. DualKnife J was powered by a high-frequency electrosurgical unit (VIO 3, ERBE Elektromedizin, Tübingen, Germany), which supported lesion marking (soft coagulation function, effect 6.0), hemostasis with the knife tip (spray coagulation function, effect 1.2), mucosal incision (dry cut function, effect 2.2), and submucosal dissection (swift coagulation, effect 3.5). ClutchCutter was also powered by VIO3, which supported submucosal dissection (Endocut I function [effect 1.0, duration 1, interval 1] and forced coagulation [effect 3.0]).
6
Endoscopic Resection Techniques for Colorectal Lesions
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In the present study, ER included CSP, EMR, or ESD. The method that was used for resection depended on lesion size and endoscopic findings, for which the final decision was made by the endoscopist. At our hospital, we attempted en bloc resection of lesions as much as possible, without selecting planned endoscopic piecemeal mucosal resection and piecemeal CSP.
Our institution's polyp resection policy is to remove all detected polyps > 5 mm. Polyps < 5 mm are also basically resected if detected, but some endoscopists follow up JNET type 1 polyps < 5 mm in the distal colon and rectum.
The video processor units EVIS LUCERA SPECTRUM, EVIS LUCERA ELITE, EVIS X1 (Olympus Corporation, Tokyo, Japan), and a single-channel lower gastrointestinal endoscope (PCF-H290ZI, PCF-H290I, PCF-PQ260L, PCF-H290TI, CF-HQ290ZI, PCF-Q260AZI, and PCF-Q260AI) were used.
Disposable high-frequency snare SnareMaster Plus (Olympus Co.), Captivator COLD (Boston Scientific), and COLD SNARE (MC Medical) were used for resection. IN addition, disposable high-frequency knife DualKnife, DualKnife J (KD-655Q or KD-655L, Olympus Co.) and IT-nano knife (KD-612L, Olympus Co.) were used for dissection. For local injection, MucoUP (Boston Scientific, Tokyo, Japan) or K smart (Olympus Co.), a sodium hyaluronate solution, was used for ESD. In addition, saline was used for EMR.
Our institution's polyp resection policy is to remove all detected polyps > 5 mm. Polyps < 5 mm are also basically resected if detected, but some endoscopists follow up JNET type 1 polyps < 5 mm in the distal colon and rectum.
The video processor units EVIS LUCERA SPECTRUM, EVIS LUCERA ELITE, EVIS X1 (Olympus Corporation, Tokyo, Japan), and a single-channel lower gastrointestinal endoscope (PCF-H290ZI, PCF-H290I, PCF-PQ260L, PCF-H290TI, CF-HQ290ZI, PCF-Q260AZI, and PCF-Q260AI) were used.
Disposable high-frequency snare SnareMaster Plus (Olympus Co.), Captivator COLD (Boston Scientific), and COLD SNARE (MC Medical) were used for resection. IN addition, disposable high-frequency knife DualKnife, DualKnife J (KD-655Q or KD-655L, Olympus Co.) and IT-nano knife (KD-612L, Olympus Co.) were used for dissection. For local injection, MucoUP (Boston Scientific, Tokyo, Japan) or K smart (Olympus Co.), a sodium hyaluronate solution, was used for ESD. In addition, saline was used for EMR.
7
Characterization of Cellulose Nanofiber Dispersions
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The CNF concentrations of TOCN dispersions in this study were 0.35–0.45 %. CNF dispersion takes a transparent gel-like form under static conditions and will become less viscous and flow over time when shaken or agitated. When movement ceases, it will return to a gel-like state almost instantly because of its high thixotropy. For analysis, 0.4 % SH solution (Muco Up; Boston Scientific Corp., Natick, Massachusetts, United States) and physiological saline (isotonic sodium chloride solution; Otsuka Pharmaceutical Factory Corp., Tokushima, Japan) were used as the control and reference materials to examine the catheter injectability and mucosa-elevating capacity of the CNF dispersion.
8
Endoscopic Submucosal Dissection Technique
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A standard tip hood (Olympus Medical Systems Co., Tokyo, Japan), ST hood (FUJIFILM, Tokyo, Japan), or its short-type (FUJIFILM) was attached to the tip of the endoscope as was appropriate. For submucosal injection, 0.4% sodium hyaluronate (Muco Up; Boston Scientific, Tokyo, Japan) diluted twice with 10% glycerin solution was used. One or two devices of DualKnife (Olympus), DualKnife J (Olympus), ITknife nano (Olympus), and SB Knife Jr (Sumitomo Bakelite, Tokyo, Japan) were used as appropriate in each case. All specimens were fixed in 10% formalin buffer, sliced into 2-mm widths, and examined under a microscope.
9
Endoscopic Submucosal Dissection for Colorectal Neoplasia
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The ESD procedure for colorectal neoplasia was performed using a 1.5‐mm DualKnife J (KD‐655Q; Olympus Optical Co., Tokyo, Japan) and a Mucosectome 2 (Pentax‐Hoya Co., Tokyo, Japan). Glycerol (10% glycerol and 5% fructose; Chugai Pharmaceutical Co., Tokyo, Japan), MucoUp (0.4% sodium hyaluronate; Boston Scientific Co., Tokyo, Japan), and a small amount of epinephrine and indigo carmine were injected into the submucosal layer to lift the mucosa. High‐frequency generators (VIO 300D; ERBE Elektromedizin GmbH, Tübingen, Germany) were used. After the tumor removal, clip closure for the mucosal defect was performed according to the endoscopist's decision. Complete closure was defined as no substantial submucosal areas in the closure line. All patients were administered an intravenous dose of 1 g of cefmetazole sodium twice on the day of the ESD and twice on the day after ESD.
10
Endoscopic Submucosal Dissection for Gastric Tumors
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ESD was carried out by endoscopists at Asahikawa Medical University. A single-channel upper gastrointestinal endoscope (GIF-Q260J; Olympus Medical Systems, Tokyo, Japan) was used with a high-frequency generator (VIO-300D; Erbe Elektromedizin GmbH, Tübingen, Germany). The endoscopists selected an electrosurgical knife from FlushKnife BT-S (DK2620J; Fujifilm, Tokyo, Japan), a DualKnifeJ (KD-655L; Olympus Medical Systems, Tokyo, Japan), or an IT knife 2 (KD-610L; Olympus Medical Systems, Tokyo, Japan). Circumferential markings were made outside the tumor margin under the magnifying endoscopy with narrow-band imaging. Hyaluronic acid solution (Mucoup; Boston Scientific, Tokyo, Japan or Ksmart; Olympus Medical Systems, Tokyo, Japan) was injected into the submucosal layer to lift the surrounding mucosa. The mucosal incision was completed around the markings. Submucosal dissection was then initiated from the proximal side to the distal side and en bloc resection was performed. Immediately after ESD, a coagrasper (FD-412LR; Olympus Medical Systems, Tokyo, Japan) was utilized to discontinue hemorrhage from exposed blood vessels on the artificial ulcer. Ulcer base closure was not performed in any cases.
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