Post written by Naoki Akizue, MD, PhD, from the Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.

Viscoclear (Otsuka Pharmaceutical Factory, Tokushima, Japan) is a new gel without electrolytes that consists of xanthan gum, locust bean gum, concentrated glycerin, and purified water. The gel used for gel-immersion EMR is highly viscous and easily fills the peri-lesion area, creating a space for endoscopic visualization and treatment.

Furthermore, bleeding from the resection site is less likely to spread because of the effect of a loss tangent in Viscoclear, making it easier to maintain a clear field of view afterward.

This article presents the case of a 79-year-old man with a 10-mm polyp bleeding at the lesser curvature of the antrum. As water immersion was difficult because of the location, gel-immersion EMR instead of underwater EMR using Viscoclear was selected.

After successful en bloc resection, the blood under the gel did not spread, despite minor bleeding from the post-endoscopic resection defect, maintaining a clear visual field. As a result, it was easy to close the ulcer with clips.

Using gel during EMR improves visibility and safety. Enhanced visibility makes the resection procedure easier, and the gel provides a hemostatic effect post-resection. For gastric polyps, particularly in cases where underwater procedures are challenging, gel-immersion EMR is considered an effective approach.

Gel-immersion EMR is an effective option for the removal of gastric polyps. By enhancing visibility and increasing safety, it offers many advantages over traditional EMR methods.

Even considering the cost of injection needles and clips, gel-immersion EMR is deemed more cost-effective than conventional EMR.

Images of gel-immersion EMR for the gastric polyp. A, Endoscopic image of the gastric polyp at the lesser curvature of the antrum. B, Endoscopic image of the gastric polyp observed under gel immersion. C, Under-gel condition made it easy to recognize the margin and snare the polyp. D, Bleeding from the post-resected defect did not spread, owing to a clear field of view. E, Clip closure was successfully performed. F, The histopathological diagnosis was foveolar hyperplastic polyp.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.