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.
1
2
3
4
5
6
Price
Availability
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
Costs
Saline
Eleview
Voluven (6% hydroxyethyl starch plus saline)
Hyaluronic acid
Fibrinogen
Hydroxypropyl methylcellulose
Glycerol
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
None
Saline
Eleview
Hyaluronic acid
Voluven
Fibrinogen
Hydroxypropyl methylcellulose
Glycerol
Other
33- For which procedures are you using epinephrine in conjunction with submucsal injection to prevent bleeding (not as treatment)?
Never
Rarely
Sometimes
Often
Always
Polypectomy 5-10mm
Polypectomy 11-15mm
Polypectomy 16-20mm
EMR
ESD
34- What is the epinephrine dilution that do you use for submucosal injection to prevent bleeding (not as treatment)?
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