Sa2065 THE NOVEL USE OF A BIODEGRADABLE EXTRACELLULAR MATRIX MEMBRANE FOR THE TREATMENT OF REFRACTORY BENIGN ESOPHAGEAL STRICTURES: FIRST REPORTED CASE SERIES

Abstract

The natural history of recurrent benign esophageal stricture (RBES) remains uncertain. Various therapeutic options for the treatment of RBES including dilation, incisional therapy, injection of steroids, and use of self-expandable metal stents (SEMS) have been reported. However, the efficacy of these interventions remains unclear with a wide clinical range of stricture resolution rates between 20% to 63.6%. We devised a novel endoscopic technique that utilizes a biodegradable scaffold membrane composed of porcine extracellular matrix (ECM) to reinforce soft tissue repair. It is an acellular matrix that serves as a temporary reinforcement while it is assimilated into the host tissue and replaced with native, site-specific tissue to reduce scarring. Our study aims to assess the efficacy of this technique in improving RBES. Five patients with RBES underwent therapeutic endoscopic intervention involving the placement of the ECM membrane. Patients underwent incisional therapy of the stricture to expose the submucosa with or without concurrent dilation, followed by trans-endoscopic placement of the ECM membrane across the stenosis. The ECM membrane was anchored in place by endoclips, followed by a fully covered esophageal SEMS placement over the membrane to help stabilize the membrane and prevent migration with food intake. A median follow-up period was 60 days (range 1 to 112 days) to remove the esophageal SEMS and evaluate response to therapy. We reviewed the outcomes of ECM placement in regard to stricture resolution with the need for, and frequency of repeat endoscopic intervention before and after the ECM application. Our study noted a complete stricture resolution rate of 40% (2 out of 5 patients). The mean frequency of therapeutic intervention procedures with the use of balloon and Savary wire-guided dilations, incisional therapy, steroid injection and esophageal SEMS before ECM application was every 5.2 weeks, which reduced to every 8.4 weeks with the use of dilation alone after the ECM application. The mean number of therapeutic procedures pre and post ECM application were 4 and 2.8, respectively. With this new technique, we noted an absolute decrease in the frequency of the therapeutic procedure by 3.2 weeks and an absolute decrease in the mean number of interventions by 1.2. Our study presents a novel use of the ECM membrane for the treatment of RBES that may reduce both the frequency and the number of repeat interventions. Further prospective studies with a larger cohort and a longer-term follow up is required to evaluate the potential of this new technique.