CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(05): E623-E627
DOI: 10.1055/a-1119-6387
Innovation forum

Cellulose nanofiber dispersion as a new submucosal injection material for endoscopic treatment: preliminary experimental study

Toshiyuki Morisawa
1   Department of Gastroenterology and Hepatology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
Akihiko Okada
1   Department of Gastroenterology and Hepatology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
Yuuki Kataoka
2   Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
Sho Masaki
3   Department of Gastroenterology and Hepatology, Kinki University, Osaka, Japan
Takayuki Hayashi
4   Life Sciences R&D Department, R&D Headquarters, DKS Co. Ltd., Kyoto, Japan
› Author Affiliations


Background and aims Although various solutions have been tested for submucosal injections during endoscopic treatment, the ideal solution has not been established. We investigated the suitability of a cellulose nanofiber (CNF) dispersion with high viscosity and thixotropy as a potential submucosal injection material for endoscopic treatment.

Methods We evaluated the catheter injectability and mucosa-elevating capacity of CNF dispersion compared with sodium hyaluronate (SH) solution, which has been reported to be a promising submucosal injection solution. The catheter injectability of CNF dispersion was examined under conditions equivalent to those used clinically in endoscopic treatment. The mucosa-elevating capacity of CNF dispersion was examined in porcine stomachs.

Results There was no significant difference between the catheter injectability of 0.4 % CNF dispersion and 0.4 % SH solutions; however, 0.4 % CNF dispersion maintained significantly higher and longer elevation of the submucosal layer than 0.4 % SH solution. A clear separation of the mucosal layer from the underlying muscle layer was achieved by injecting 0.4 % CNF dispersion.

Conclusion This preliminary study suggests that CNF dispersion could be an ideal submucosal injection material for endoscopic treatment because of its unique high thixotropy index.

Publication History

Received: 03 October 2019

Accepted: 06 January 2020

Article published online:
17 April 2020

© 2020. Owner and Copyright ©

© Georg Thieme Verlag KG
Stuttgart · New York

  • References

  • 1 Tada M, Murakami A, Karita M. et al. Endoscopic resection of early gastric cancer. Endoscopy 1993; 25: 445-450
  • 2 Oka S, Tanaka S, Kaneko I. et al. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 2006; 64: 877-883
  • 3 Fujishiro M, Yahagi N, Kashimura K. et al. Comparison of various submucosal injection solutions for maintaining mucosal elevation during endoscopic mucosal resection. Endoscopy 2004; 36: 579-583
  • 4 Tran RT, Palmer M, Tang SJ. et al. Injectable drug-eluting elastomeric polymer: a novel submucosal injection material. Gastrointest Endosc 2012; 75: 1092-1097
  • 5 Kusano T, Etoh T, Akagi T. et al. Evaluation of 0.6% sodium alginate as a submucosal injection material in endoscopic submucosal dissection for early gastric cancer. Dig Endosc 2014; 26: 638-645
  • 6 Brown EE, Hu D, Abu Lail N. et al. Potential of nanocrystalline cellulose-fibrin nanocomposites for artificial vascular graft applications. Biomacromolecules 2013; 14: 1063-1071
  • 7 Nuutila K, Laukkanen A, Lindford A. et al. Inhibition of skin wound contraction by nanofibrillar cellulose hydrogel. Plast Reconstr Surg 2018; 141: 357-366
  • 8 Barriga S. 2,2,6,6-Tetramethylpiperidin-1-oxyl (TEMPO). Synlett 2001; 4: 563
  • 9 Isogai A, Saito T, Fukuzumi H. TEMPO-oxidized cellulose nanofibers. Nanoscale 2011; 3: 71-85
  • 10 Vartiainen J, Pohler T, Sirola K. et al. Health and environmental safety aspects of friction grinding and spray drying of microfibrillated cellulose. Cellulose 2011; 18: 775-786