Scientific Reports (Mar 2021)

Differences between two sodium hyaluronate-based submucosal injection materials currently used in Japan based on viscosity analysis

  • Ryohei Hirose,
  • Takuma Yoshida,
  • Yuji Naito,
  • Naoto Watanabe,
  • Hikaru Hashimoto,
  • Satoshi Sugino,
  • Risa Bandou,
  • Tomo Daidoji,
  • Ken Inoue,
  • Osamu Dohi,
  • Naohisa Yoshida,
  • Takaaki Nakaya,
  • Yoshito Itoh

DOI
https://doi.org/10.1038/s41598-021-85118-4
Journal volume & issue
Vol. 11, no. 1
pp. 1 – 10

Abstract

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Abstract In Japan, two 0.4% sodium hyaluronate (HA)-based submucosal injection materials (SIMs) are currently used in endoscopic submucosal dissection (ESD): MucoUp (HA-Mc) and Ksmart (HA-Ks). HA-Mc and HA-Ks have the same concentration and are, thus, construed by most endoscopists to have no difference. Nevertheless, visual observation conveys the impression that HA-Ks have a higher viscosity than HA-Mc, suggesting that HA-Ks performs better than HA-Mc. This study aimed to examine the differences between HA-Mc and HA-Ks. HA-Ks exhibited higher viscosity due to greater weight-average molecular weight compared with HA-Mc. HA-Ks had significantly greater submucosal elevation height (SEH) than HA-Mc; the SEH of HA-Ks-80% (80% dilution of HA-Ks) was the same as that of HA-Mc. The ESD procedure time was significantly shorter with HA-Ks than with HA-Mc (15.2 ± 4.1 vs. 19.5 ± 5.9; P = 0.049). The total injection volume for HA-Ks was significantly lower than that for HA-Mc (10.8 ± 3.6 vs. 14.4 ± 4.6; P = 0.045). However, no significant difference in these items was observed between HA-Mc and HA-Ks-80%. HA-Mc and HA-Ks were considered to be almost the same. Nonetheless, HA-Ks exhibited higher viscosity and SIM performance than HA-Mc. HA-Ks-80% had almost the same performance as HA-Mc. Thus, understanding SIM performance and characteristics requires a focus on the viscosity of SIMs.