Injectable shear-thinning sodium alginate hydrogels with sustained submucosal lift for endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) is one of the most effective approaches for the minimally invasive treatment of early gastrointestinal cancers. Submucosal injections help safely and successfully remove lesions during ESD by elevating the mucosa and separating the submucosal muscle layer. Herein, we report dynamic injectable sodium alginate hydrogels (ISAHs) with shear-thinning for ESD surgery, which were easily fabricated by the sulfhydryl group of GSH-modified sodium alginate (SA-GSH) reacting with the aldehyde group of oxidized sodium alginate (OSA) at room temperature. ISAHs have advantageous self-healing abilities and antioxidant activity. Additionally, according to an in vitro test on porcine colorectal submucosal lifting, the submucosal elevation heights created by ISAHs were 13 %-18 % greater than those created by commercial ESD solutions (0.4 w/v% sodium hyaluronate). These properties and biocompatibility were confirmed in vitro and in vivo ex-periments. ISAHs will hopefully become a novel submucosal injectable hydrogel to assist ESD surgery.

Automated summary

Endoscopic submucosal dissection (ESD) is an effective method for treating early gastrointestinal cancers. In this study, a dynamic injectable hydrogel with shear-thinning properties was developed for ESD surgery. The hydrogel demonstrated self-healing abilities and antioxidant activity, and resulted in higher submucosal elevation heights compared to commercial ESD solutions. These findings suggest that the hydrogel has the potential to assist in ESD surgery.