Stenting to prevent esophageal stricture after circumferential endoscopic submucosal dissection: an experimental study

Abstract Background and study aims Circular ESD (CESD) is a treatment option for patients with extensive early esophageal cancer. Its major drawback is the development of a stricture. Stenting may represent an attractive prevention strategy. We designed an experimental study to assess the effect of stents covered with acellular biomatrix (AB) and a drug-eluting stent. Materials and methods Thirty-five 35 pigs underwent CESD and were randomized into six groups: G1 (control), G2 (SEMS), G3 (SEMS + AB), G4 (SEMS + AB + steroid-eluting layer), G5 (biodegradable stent [BD]), G6 (BD + AB). SEMS were placed alongside the post-CESD defect, fixed and removed after 21 days. The main outcomes were stricture development, severity, and histopathology. Results Pigs with BD stents (G5, 6) experienced severe inflammation and hypergranulation without biodegradation, therefore, these groups were closed prematurely. Significant strictures developed in 29 of 30 pigs (96.7 %). The most severe stricture developed in G2 and G4 (narrowest diameter (mm) 8.5 ± 3, 3 (G2) and 8.6 ± 2.1 (G4) vs. 17 ± 7.3 (G1) and 13.5 ± 8.3 (G3); P < 0.01. Signs of re-epithelization were present in 67 % and 71 % in G1 and G2 and in 100 % in G3 and G4. The most robust re-epithelization layer was present in G4. The inflammation was the most severe in G1 (mean score 2.3) and least severe in G4 (0.4). Conclusions Stenting did not effectively prevent development of post-CESD esophageal stricture. SEMS with AB resulted in improved re-epithelization and decreased stricture severity. Steroid-eluting SEMS suppressed inflammation. BD stents seem inappropriate for this indication.

[1]  M. Hargraves,et al.  The Children , 2020, Bring Now the Angels.

[2]  J. Martínek.  How to prevent post-ESD esophageal stricture , 2019, Endoscopy International Open.

[3]  Hiroki Sato,et al.  Evaluating the effect of injecting triamcinolone acetonide in two sessions for preventing esophageal stricture after endoscopic submucosal dissection , 2019, Endoscopy International Open.

[4]  E. Linghu,et al.  Efficacy of triamcinolone-soaked polyglycolic acid sheet plus fully covered metal stent for preventing stricture formation after large esophageal endoscopic submucosal dissection. , 2019, Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus.

[5]  Z. Vackova,et al.  Prevention of esophageal strictures after circumferential endoscopic submucosal dissection. , 2018, Minerva chirurgica.

[6]  N. Ge,et al.  Acellular dermal matrix for esophageal stricture prevention after endoscopic submucosal dissection in a porcine model. , 2017, Gastrointestinal endoscopy.

[7]  K. Chayama,et al.  Risk factors for esophageal stenosis after entire circumferential endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma , 2016, Surgical Endoscopy.

[8]  E. Moura,et al.  Prevention of esophageal stricture after endoscopic submucosal dissection: a systematic review and meta-analysis , 2016, Surgical Endoscopy.

[9]  Xian-Bin Zhou,et al.  Complete circular endoscopic resection using submucosal tunnel technique combined with esophageal stent placement for circumferential superficial esophageal lesions , 2016, Surgical Endoscopy.

[10]  M. Rugge,et al.  Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline , 2015, Endoscopy.

[11]  Y. Shinomura,et al.  A randomized controlled trial of endoscopic steroid injection for prophylaxis of esophageal stenoses after extensive endoscopic submucosal dissection , 2015, BMC Gastroenterology.

[12]  E. Matoušková,et al.  The effect of different biologic and biosynthetic wound covers on keratinocyte growth, stratification and differentiation in vitro , 2014, Journal of tissue engineering.

[13]  F. Beuvon,et al.  Amniotic Membrane Grafts for the Prevention of Esophageal Stricture after Circumferential Endoscopic Submucosal Dissection , 2014, PloS one.

[14]  Meidong Xu,et al.  Risk factors for postoperative stricture after endoscopic submucosal dissection for superficial esophageal carcinoma , 2014, Endoscopy.

[15]  H. Isomoto,et al.  Oral prednisolone and triamcinolone injection for gastric stricture after endoscopic submucosal dissection. , 2014, Annals of translational medicine.

[16]  Jing Wen,et al.  Preventing Stricture Formation by Covered Esophageal Stent Placement After Endoscopic Submucosal Dissection for Early Esophageal Cancer , 2014, Digestive Diseases and Sciences.

[17]  E. Pauli,et al.  Commercially available biological mesh does not prevent stricture after esophageal mucosectomy , 2013, Endoscopy.

[18]  E. Pauli,et al.  Biodegradable esophageal stent placement does not prevent high-grade stricture formation after circumferential mucosal resection in a porcine model , 2012, Surgical Endoscopy.

[19]  E. Matoušková,et al.  Human Keratinocyte Growth and Differentiation on Acellular Porcine Dermal Matrix in relation to Wound Healing Potential , 2012, TheScientificWorldJournal.

[20]  D. Bausch,et al.  Risk of biodegradable stent-induced hypergranulation causing re-stenosis of a gastric conduit after esophageal resection , 2012, Endoscopy.

[21]  M. Takeuchi,et al.  The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection. , 2011, Gastrointestinal endoscopy.

[22]  T. Nakayama,et al.  Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. , 2011, Gastrointestinal endoscopy.

[23]  E. Matoušková,et al.  New biological temporary skin cover Xe-Derma(®) in the treatment of superficial scald burns in children. , 2011, Burns : journal of the International Society for Burn Injuries.

[24]  N. Nitta,et al.  Novel Biodegradable Stents for Benign Esophageal Strictures Following Endoscopic Submucosal Dissection , 2008, Digestive Diseases and Sciences.