Endoscopic Injection Procedure
Compared to open or laparoscopic surgery, endoscopic injection offers faster recovery, fewer complications, and better precision — all essential for improving patient outcomes and optimizing healthcare resources.
What Is an Endoscopic Injection?
An endoscopic injection procedure involves inserting a sterile endoscopic injection needle through the working channel of a flexible endoscope to deliver medication or a diagnostic agent.
This can be done to treat, manage, or assess a wide range of GI conditions.
The needle is advanced under direct visualization until it penetrates the submucosa or lesion site. The therapeutic agent is then injected in a controlled, localized manner.
Injectables vary depending on the clinical indication and may include:
- Epinephrine to reduce active bleeding via vasoconstriction
- Sclerosants (e.g., ethanolamine oleate or sodium tetradecyl sulfate) for variceal obliteration
- Normal saline or dyes for submucosal lifting and lesion delineation
- Steroids such as triamcinolone to prevent stricture recurrence after dilation
This targeted approach allows for both diagnostic and therapeutic precision in a single session.
When is Endoscopic Injection Used?
Endoscopic injection is a versatile technique, often forming part of a combined therapeutic strategy. Common indications include:
Upper GI bleeding
Peptic ulcer disease, Mallory-Weiss tears, and Dieulafoy lesions are frequent causes of upper GI hemorrhage.
Injection of epinephrine can rapidly stabilize the bleeding site and may be followed by mechanical or thermal therapy.
Esophageal and gastric varices
Injection sclerotherapy is a key intervention for acute variceal bleeding, particularly when band ligation is not feasible.
Sclerosants induce thrombosis and fibrosis of the varices, reducing the risk of rebleeding.
Gastric antral vascular ectasia (GAVE) and angiodysplasia
These vascular lesions are often diffuse and fragile, making them difficult to treat surgically. Endoscopic injection is commonly used alongside argon plasma coagulation or laser therapy to control bleeding.
Agents like epinephrine help achieve temporary hemostasis, while combination therapy improves long-term outcomes and reduces the risk of rebleeding.
Early gastrointestinal neoplasms
In endoscopic mucosal resection (EMR) or submucosal dissection (ESD), fluid agents (e.g., saline, glycerol) may be injected into the submucosa to elevate the lesion.
Dyes such as indigo carmine are sometimes added for improved visualization.
Esophageal strictures
Steroid injections after dilation reduce inflammation and fibrosis, helping prevent recurrence in patients with refractory or anastomotic strictures.
By tailoring the injection technique to the condition being treated, clinicians can achieve excellent therapeutic outcomes with minimal invasiveness.
Devices and Needle Design Considerations
The sterile endoscopic injection needle is the central tool in this procedure. It must deliver reliable performance while minimizing trauma and reducing infection risk.
Key attributes include:
- Sterility: Critical to prevent transmission of infection, especially in immunocompromised patients.
- Sharpness: A finely honed needle tip ensures smooth mucosal penetration with minimal resistance.
- Controlled extension: Most needles feature a sheath that allows controlled advancement and retraction to prevent inadvertent injury.
- Lumen compatibility: The needle must be compatible with the viscosity of the injected solution to avoid clogging.
Many commercially available needles come in a variety of lengths and gauges to accommodate different anatomical locations and agent types.
Some are specifically designed for single use to preserve sterility and eliminate cross-contamination risk.
Step-by-Step Overview of the Technique
While the injection technique may vary slightly based on the clinical goal, the general process includes the following steps:
- Insertion and positioning: The endoscope is advanced to the target location. Clear visualization of the lesion or injection site is achieved using the built-in camera and light source.
- Needle deployment: The injection needle is passed through the working channel and extended beyond the endoscope tip. The tip is carefully aligned with the mucosal surface.
- Injection: The physician punctures the mucosa or submucosa and slowly injects the therapeutic agent while observing the tissue response. For example, a submucosal lift will result in a visible bleb, indicating successful fluid delivery.
- Needle retraction and removal: Once the injection is complete, the needle is retracted into its sheath and withdrawn. Additional therapies (e.g., clipping or cautery) may follow as needed.
This precise, visualized control is what makes endoscopic injection a cornerstone of GI intervention.
Patient Preparation and Pre-Procedure Considerations
As with all GI endoscopic procedures, proper patient preparation reduces complications and improves procedural outcomes.
Key steps include:
- Fasting: Patients are asked to avoid food and drink for 6–8 hours before the procedure.
- Medication review: Anticoagulants or antiplatelet agents may need to be paused, with appropriate bridging protocols as required.
- Consent and sedation planning: Depending on the procedure’s complexity and patient factors, sedation or general anesthesia may be used.
Patients should also be advised on what to expect during and after the procedure, including mild discomfort, potential side effects, and post-procedural instructions.
Post-Procedure Monitoring and Recovery
Recovery from an endoscopic injection procedure is typically rapid. In many cases, patients are discharged the same day.
Post-procedure care may include:
- Monitoring for complications such as delayed bleeding or perforation
- Gradual reintroduction of food, beginning with clear fluids and advancing as tolerated
- Follow-up endoscopy in cases where additional therapy is required or the initial treatment was part of a multi-step approach
Patients should be given clear discharge instructions and a point of contact in case of symptoms such as persistent pain, vomiting, or signs of infection.
Risks and Considerations
While endoscopic injection is considered low risk, complications can occur, particularly in high-risk patients or when treating fragile tissue.
Common risks include:
- Perforation: Especially in patients with thinning or friable mucosa
- Bleeding: From the injection site or the underlying lesion
- Allergic reaction: To the injected agent, though this is rare
- Infection: Minimized through use of sterile, single-use equipment
- Pain or local irritation: Usually self-limiting
The choice of a high-quality, sterile injection needle and an experienced endoscopist are key factors in minimizing these risks.
Role of Endoscopic Injection in Modern GI Care
Therapeutic endoscopy has evolved significantly over the last two decades, with injection therapy remaining an essential technique for both emergency and elective procedures.
Its benefits include:
- Minimally invasive intervention
- Precise delivery of medication
- Combination use with other modalities
- Lower cost and shorter hospital stay compared to surgical alternatives
Ongoing advancements in needle technology, injection agents, and imaging are likely to further enhance this procedure’s safety and effectiveness.
Training in Endoscopic Injection Procedures
Proficiency in endoscopic injection requires familiarity with the tools, sound clinical judgment, an understanding of anatomical nuance, and the ability to respond quickly to procedural complications.
As GI endoscopy continues to expand its therapeutic scope, the need for standardized training and ongoing skill development has become increasingly important.
Many gastroenterologists first learn injection techniques during fellowship programs, often in simulated environments before performing supervised procedures on patients.
However, given the range of injectables and the complexity of certain cases, such as treating post-surgical anatomy or fragile mucosa, continuous education is essential throughout a clinician’s career.
Best practices in training include:
- Simulation-based learning to practice needle control, targeting, and injection techniques
- Mentorship and proctorship during live procedures for feedback and refinement
- Case-based reviews to analyze outcomes and adapt decision-making
- Hands-on workshops offered by medical societies and device manufacturers
Staying current with evolving guidelines, new injection agents, and updated device technologies also plays a role in maintaining high standards of care. This is particularly relevant for hospitals and ambulatory surgery centers looking to improve procedural consistency across teams.
Ultimately, a strong foundation in endoscopic injection improves not only technical execution but also diagnostic confidence and procedural efficiency, directly translating to better patient care. Institutions that invest in regular training and competency assessments can expect improved outcomes, fewer complications, and enhanced team collaboration in the endoscopy suite.
Supporting Excellence in GI Procedures
IML works closely with North American healthcare providers to deliver innovative, high-quality medical technologies across multiple specialties. While we do not supply endoscopic injection needles, we are committed to supporting clinicians with educational resources and access to trusted solutions that enhance patient care.
If you’re looking to expand your GI capabilities or want to explore the latest advancements in minimally invasive procedures, reach out to our team.
