By Klaus Mönkemüller, MD, PhD, FASGE, FJGES Professor of Medicine, Virginia Tech Carilion School of Medicine, Virginia, USA; Universidad de la República, Montevideo, Uruguay; University of Belgrade, Belgrade, Serbia, Universidad Espiritu Santo; Ecuador, University of Osijek, Croatia

Mini Review on Devices, Accessories and Utensils: Eleview® Submucosal Injection Solution

Eleview is a microemulsion injection solution used for endoscopic resection of gastrointestinal lesions, mainly colon polyps, approved by the Food and Drug Administration (FDA) 510(k) and Conformité Européene (CE)-marked. The component ingredients of Eleview^® include water for injection, medium-chain triglycerides, poloxamer 188, polyoxyl-15-hydroxystearate, sodium chloride, and methylene blue (1). Eleview contains a biocompatible polymer as a cushioning agent and methylene blue as the “contrasting” agent. Because it includes the contrasting agent, it reduces time needed to prepare the submucosal fluid for injection and thus may improve procedure efficiency (2, 3). 

In a randomized study of 211 patients comparing Eleview to normal saline, the authors concluded that this submucosal agent appeared to be a “more effective and equally safe submucosal agent for EMR injection than saline solution” (3).

The conclusion about “effectiveness” appears somewhat biased to me, as there were no differences at all in clinically important patient outcomes, including adverse events (18% in each group), easiness of use, number of injections used, number of polyp pieces resected (5.7. versus 5), resection time and time to complete the colonoscopy. Another aspect that merits analysis of this trial is the relatively long resection times taken for endoscopic mucosal resection, considering that the mean size of the lesions was about 30 +12 mm (3). Lastly, in the group randomized to normal saline there were more lesions located in the rectum and rectosigmoid, areas known to harbor larger laterally spreading tumors with more complex morphology (18 versus 29). The only endpoint with significant difference was amount of fluid injected (16 versus 31 ml). Whether this endpoint is enough to justify the use of an expensive agent (about $300 versus $5) is a matter of debate. Indeed, preparing blue solutions for submucosal injection is quite easy (see here: community.endocollab.com)

Nevertheless, it is nice to have an additional substance for submucosal injection available, especially when dealing with larger lesions and performing endoscopic submucosal dissection (ESD), when submucosal elevation time is a factor that may determine success. In addition, this solution comes already prepared and mixed, thus facilitating usage and diminishing the risk of mixing errors (i.e. making the solution too light blue or dark blue).

For more insights into advanced endoscopic techniques and the latest developments, subscribe to our newsletter.

References:

1. Cosmo Technologies Ltd. Eleview [Instructions for Use] Cosmo Technologies Ltd.; Dublin, Ireland: 2018.

2. Giannino V, Salandin L, Macelloni C, Longo LM. Evaluation of Eleview^® Bioadhesive Properties and Cushion-Forming Ability. Polymers (Basel). 2020 Feb 5;12(2):346. doi: 10.3390/polym12020346. PMID: 32033452; PMCID: PMC7077458.

3. Repici A, Wallace M, Sharma P, Bhandari P, Lollo G, Maselli R, Hassan C, Rex DK. A novel submucosal injection solution for endoscopic resection of large colorectal lesions: a randomized, double-blind trial. Gastrointest Endosc. 2018 Sep;88(3):527-535.e5. doi: 10.1016/j.gie.2018.04.2363. Epub 2018 May 8. PMID: 29750983.

EndoCollab

Unlock immediate access to our support network, growing video encyclopedia, library of courses, live events, recordings, and more.

Join EndoCollab:

• Monthly

• Yearly

• Lifetime