Submucosal injection solutions for endoscopic treatment of gastrointestinal tumors

Endoscopic mucosal resection and endoscopic submucosal dissection are minimally invasive procedures that rely on submucosal injection solutions to create a cushion that separates the mucosal layer from the underlying muscularis propria, thus improving safety and procedural success.These lifting agents reduce the risk of adverse events, such as perforation and bleeding, while the quality and duration of the cushion affect the ease and success rate of the procedure.This review outlines the ideal characteristics of lifting agents, such as their viscosity, biocompatibility, and durability, and discusses their clinical relevance.This review highlights commonly used solutions, including normal saline, hypertonic saline, hyaluronic acid, dextrose, hydroxyethyl starch, and commercial products, such as Eleview and ORISE.Each has distinct advantages and limitations based on the clinical situation.Additionally, innovations, such as dye-enhanced gels and polymer-based agents, have enhanced procedural safety and visibility, although costeffectiveness and patient-specific factors remain important.Emphasis is placed on the clinical considerations of lifting agent selection, particularly in managing large or fibrotic lesions, and further studies are needed to evaluate the longterm outcomes and adverse events.