Abstract
Background and AimsThe prevention of esophageal strictures following circumferential mucosal resection remains a major clinical challenge. Human amniotic membrane (AM) is an easily available material, which is widely used in ophthalmology due to its wound healing, anti-inflammatory and anti-fibrotic properties. We studied the effect of AM grafts in the prevention of esophageal stricture after endoscopic submucosal dissection (ESD) in a swine model.Animals and MethodsIn this prospective, randomized controlled trial, 20 swine underwent a 5 cm-long circumferential ESD of the lower esophagus. In the AM Group (n = 10), amniotic membrane grafts were placed on esophageal stents; a subgroup of 5 swine (AM 1 group) was sacrificed on day 14, whereas the other 5 animals (AM 2 group) were kept alive. The esophageal stent (ES) group (n = 5) had ES placement alone after ESD. Another 5 animals served as a control group with only ESD.ResultsThe prevalence of symptomatic strictures at day 14 was significantly reduced in the AM group and ES groups vs. the control group (33%, 40% and 100%, respectively, p = 0.03); mean esophageal diameter was 5.8±3.6 mm, 6.8±3.3 mm, and 2.6±1.7 mm for AM, ES, and control groups, respectively. Median (range) esophageal fibrosis thickness was 0.87 mm (0.78–1.72), 1.19 mm (0.28–1.95), and 1.65 mm (0.7–1.79) for AM 1, ES, and control groups, respectively. All animals had developed esophageal strictures by day 35.ConclusionsThe anti-fibrotic effect of AM on esophageal wound healing after ESD delayed the development of esophageal stricture in our model. However, this benefit was of limited duration in the conditions of our study.
Highlights
Endoscopic therapy has become a valid therapeutic option in the management of Barrett’s esophagus (BE) complicated with high grade dysplasia or early adenocarcinoma [1]
The prevalence of symptomatic strictures at day 14 was significantly reduced in the amniotic membrane (AM) group and esophageal stent (ES) groups vs. the control group (33%, 40% and 100%, respectively, p = 0.03); mean esophageal diameter was 5.863.6 mm, 6.863.3 mm, and 2.661.7 mm for AM, ES, and control groups, respectively
Radiofrequency ablation has a number of limitations: it is restricted to flat lesions, does not allow for histological analysis of ablated tissues, lacks long-term (.5 years) efficacy data [3], and subsequent follow-up appears to be difficult, with cases of buried metaplasia, high grade dysplasia and adenocarcinoma reported after complete BE eradication [4]
Summary
Endoscopic therapy has become a valid therapeutic option in the management of Barrett’s esophagus (BE) complicated with high grade dysplasia or early adenocarcinoma [1]. To address the first problem, we developed a CESD technique on a swine model allowing for safe en bloc resection of 5 cm-long cylinders of esophageal mucosa and submucosa in less than an hour [11]. This procedure led to a 100% stricture rate by day 14. We studied the effect of AM grafts in the prevention of esophageal stricture after endoscopic submucosal dissection (ESD) in a swine model In this prospective, randomized controlled trial, 20 swine underwent a 5 cm-long circumferential ESD of the lower esophagus. Another 5 animals served as a control group with only ESD
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