Autologous Free Skin Transplantation to Prevent Esophageal Stricture After Complete Circular Endoscopic Submucosal Dissection for Superficial Esophageal Neoplasms

Abstract

Introduction: Endoscopic submucosal dissection (ESD) of circumferential superficial esophageal neoplasms (SENs) was associated with extremely high rate of postoperative stricture, which decreases the patient’s quality of life substantially. So far, no standard guideline for preventing esophageal stricture in patients after ESD has been established. We aimed to assess the effectiveness and safety of endoscopic transplantation of autologous free skin in preventing stricture formation after circumferential ESD. Methods: A total of 8 patients who underwent circumferential ESD were included in the study. After undergoing ESD, autologous free skin harvested from the right outer thigh of the patient was sewed into a “oversleeve-like” skin and then covered on the outside of a fully-covered esophageal stent. Finally, the stent was placed at the location of the artificial ulcer of esophagus. The stent was removed 4 weeks after the procedure. The patients were followed up with endoscopy at scheduled times. Results: Complete circular ESD and autologous free skin transplantation were successfully performed in all patients. The mean longitudinal diameter of the resected specimens was 98.8 mm (range 70 - 160 mm). The skin grafts grew well and biopsy-proven squamous epithelium with hyperkeratosis at the site of transplant. Five patients (5 / 8, 62.5 %) didn’t experience dysphagia and stricture with a mean follow-up of 4.9 months (range 3 - 8 months). No complications including perforation, bleeding, wound infection, and stent migration were observed during the follow-up. Conclusion: Endoscopic transplantation of free skin could be a safe and effective way of preventing esophageal stricture after circumferential ESD. Long-term follow-up and experience with a large series are needed to further evaluation of this method.352_A Figure 1. Clinical outcomes for 8 patients with early esophageal cancer after circumferential ESD.352_B Figure 2. ESD resulted in a completely circumferential resection. B, The stent was placed on the esophageal ulcer.352_C Figure 3. At endoscopic follow-up 6 months after ESD, the skin graft grew well without any evidence of stricture. A, C: White-light view. B, D: Iodine stain view.