• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / Ex vivo bovine needle puncture bowel wall lift histological study: Lifts are most commonly generated with a sclerotherapy catheter/needle.

Ex vivo bovine needle puncture bowel wall lift histological study: Lifts are most commonly generated with a sclerotherapy catheter/needle.

Carl Winkler, MD1, Jaspreet Sandhu, MD2, Xiaohong Yan, PhD1, Neil Mitra, MD1, Dasuni Niyagama Gamage1, Vesna Cekic, RN1, Hmc Shantha Kumara, PhD1, Richard L Whelan, MD1. 1Mount Sinai West Hospital, 2Brookdale University Hospital Medical Center

Introduction:  A mucosal “lift”, generated by injecting fluid into the submucosal layer, needs to be established prior to endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR). Lifts are most often generated with a sclerotherapy catheter/needle. Although the muscularis propria or subersosal bowel wall layers may be inadvertently injected it is assumed that only submucosal injection can result in a “stable” lift. Recently, it was noted that stable “deep wall lifts” can result from injection into the muscularis propria or subserosal layers. This ex vivo bovine study was carried out to histologically assess needle injection generated bowel wall lifts to determine how often deep wall lifts occur.

Methods:  Ex vivo bovine colorectal specimens were injected: 1) via colonoscope and sclerotherapy needle into an intact colon or 2) via a syringe and needle into the wall of an opened colon specimen. After visually grading each lift (superficial or deep) a full thickness piece of the bowel wall (including the lift) was harvested and placed in formalin. Days later, after dehydration in alcohol, the specimens were paraffin embedded and then cut into sections that were H & E stained.  A pathologist assessed each slide to determine which layer(s) had actually expanded.

Results:  A total of 5 bovine large bowel specimens were utilized and 83 stable lifts generated that were visually and histologically assessed (46 via scope and sclerotherapy needle into closed colon; 37 via direct syringe injection into opened colon).  As per visual inspection, the location of the lifts was judged to be submucosal in 25 (30%), deep in 16 (19%), and mixed (submucosal & intramuscular) in 42 (51%).  As per the histologic evaluation of “readable” slides (74/83), the lift location(s) were; submucosal in 12 (16%), deep in 31 (42%), and mixed in 31 (42 %).  The deep lift location breakdown was muscularis propria in 25 (34%) and subserosal in 6 (18%).

Conclusions:  A pure submucosal lift was obtained only 16% of the time with needle injection into ex vivo bovine colon; mixed (42%) and deep lifts (42%) where more common. Ex vivo models increase the odds of deep wall lifts because the tissue is non vital and easily damaged, however, deep wall lifts do occur in the clinical setting. Safe ESD is not possible with a deep lift. Lifts must be carefully assessed before starting ESD and a more superficial layer sought if a deep lift is suspected.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 93783

Program Number: P371

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

View this Poster

42

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals