Use of submucosal injection in endoscopy procedures
We, a research team from the Montreal University Hospital, would like to ask your participation in a survey evaluating practice patterns, preferences and barriers for using submucosal injection for endoscopic procedures.

We do greatly appreciate it if you can complete this short survey!

1- Where do you practice?
2- What is your practice setting?
3- What is your training specialty and level?
4- Did you have specific advanced training in endoscopy (e.g. fellowship)?
5- Which techniques were you training in? (all that apply)
6- When did you complete your most advanced training?
7- Where did you complete your most advanced training?
8- How many endoscopies do you perform per year?
9- How many of EMR, ESD, POEM and/or Barretts ablation (excluding ERCP and EUS) do you perform per year?
10- How is your endoscopy practice reimbursed?
11- Do you believe using submucosal injection is beneficial for…? (all that apply)
12- What options for lifting and/or colloring agents are available in your institution? (all that apply)
13- What is the threshold in preparation time beyond you would not use lifting agents for standard polypectomies (excluding EMR and ESD)?
14- What is an acceptable price range for a lifting agent?
15- How much injection volume do you typically use for an average lesion (excluding wide field EMR, ESD, POEM)?
16- Classify the features of a good lifting agent from the most important (1) to the less important (6) for you.
Preparation time
Excellent submucosal elevation
Extended length of action
Improve identification of adenoma tissue versus healthy mucosa
Decreasing procedural time
Decreasing pieces' number in piecemeal EMR
Improve en-bloc rate
17- Are you using submucosal injection for...? (all that apply)
18- In your opinion, for which lesion type according to Paris Classification is submucosal injection helpful? (all that apply)
19- At what size of colorectal polyps do you usually start using a lifting agent?
20- Which of these factors affects the size threshold to use a lifting agent in your practice? (all that apply)
21- Has the size threshold to use a lifting agent changed in the past years in your practice?
22- What are your concerns when using lifting agents or coloring agents in endoscopy? Select all the answers that apply.
I never use this agent
No concerns
Short lasting lift
Impaired visibility (eg. bubbling)
Recurrence's stimulation
Preparation time
Voluven (6% hydroxyethyl starch plus saline)
Hyaluronic acid
Hydroxypropyl methylcellulose
Indigo Carmine
23- Do you have any of the following concerns when using Methylene blue? (all that apply)
24- Would you use submucosal injection more often for mid-sized polypectomies (5-20mm) if it was readily available in your endoscopy unit?
25- Are you involved in the choice of lifting agents available in your institution?
26- What are the barriers for using and introducing new lifting agents in your institution? (all that apply)
27- In what proportion of submucosal injections do you add a coloring agent?
28- Do you use lifting without coloring agents? (all that apply)
29- Which coloring agent do you most commonly use?
30- Which lifting agent do you preferrably use?
31- Does the anticipated procedure time (e.g. EMR, ESD) have any influence on your choice of the submucosal injection agent?
32- What lifting agent do you mostly use to remove polyps of the following sizes? Choose only one option for each polyp size.
1-5 mm
6-10 mm
11-15 mm
16-20 mm
Over 20 mm
Hyaluronic acid
Hydroxypropyl methylcellulose
33- For which procedures are you using epinephrine in conjunction with submucsal injection to prevent bleeding (not as treatment)?
Polypectomy 5-10mm
Polypectomy 11-15mm
Polypectomy 16-20mm
34- What is the epinephrine dilution that do you use for submucosal injection to prevent bleeding (not as treatment)?
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