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

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).

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).

Aspect

Eleview®

Saline

Composition

A mixture of synthetic absorbable copolymer and 0.9% saline

A solution of sodium chloride in water

Efficacy in lifting the mucosa

Provides long-lasting submucosal elevation

Provides a submucosal fluid cushion, but may require additional injections to maintain elevation

Safety

Well-tolerated, with no reported adverse events

Generally safe, but may lead to complications such as bleeding

Cost

More expensive

Economical

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.

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