Gastroenterology Accessories Endoscopic Sclerotherapy Injection Needle

(a) Submucosal injection, (b) passage of grasping forceps through the open polypectomy snare, (c) tightening of the snare at the base of the lesion, and (d) completion of the snare excision.
A sclerotherapy needle is used to inject fluid into the submucosal space to elevate the lesion away from the underlying muscularis propria and create a less flat target for resection. The injection is often done with saline, but other solutions have been used to achieve longer maintenance of the bleb including hypertonic saline (3.75% NaCl), 20% dextrose, or sodium hyaluronate [2]. Indigo carmine (0.004%) or methylene blue is often added to the injectate to stain the submucosa and provides a better evaluation of the depth of resection. The submucosal injection can also be used to determine if a lesion is appropriate for endoscopic resection. Lack of elevation during injection indicates adherence to the muscularis propria and is a relative contraindication to proceeding with EMR. After creating the submucosal elevation, the lesion is grasped with a rat tooth forceps that has been passed through an open polypectomy snare. The forceps lifts the lesion and the snare is pushed down around its base and resection ensues. This “reach-through” technique requires a double lumen endoscope which can be cumbersome to use in the esophagus. As a result, lift-and-cut techniques are used less commonly for esophageal lesions.