Sp608 Successful Mucosal Transplantation from Stomach to Esophagus for Stricture Prevention after Widespread Circular Endoscopic Submucosal Dissection (ESD) For Early Esophageal Squamous Cell Carcinoma - Report of a First Case in Man with 1 1/2 Year Transplant Survival

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Secondary stricture formation is the major drawback for resections >3 cm or more than 75% of the esophageal circumference at esophageal ESD. In March 2011 we embarked on animal experiments regarding esophageal resection and re-transplantation of esophageal and gastric mucosal patches in pigs under an approved protocol (NLVL No: 33-42502-06/1151) for stricture prevention. CASE REPORT: A 72 y old man with swallowing difficulty (DG1); tabacco use of 20 py until >15 y ago. Prior rectal resection with sigma anus praeter for a T2 distal rectal cancer. EGD: Suspicion of early squamous cell cancer (Paris IIa; EUS UT1a, m, N0), >75% circum-ferential tumor spread within the cervical esophagus and upper sphincter area (17-25 cm aborally). Biopsy: SC HG-IEN. On April 13, 2011 we performed an EGD under general anesthesia with tracheal intubation with first tubular ESD over 10 cm from the lower hypopharynx through the UES from 17-27 cm followed by a 9x4 cm ESD in the gastric antrum. The healthy gastric specimen retrieved was cut longitudinally into 3 mucosal stripes that were attached to the denuded esophageal muscular layer by means of hemoclips. The stripes were gently pressed against the wall by a non-covered self-expanding metal stent with the intent to allow also a luminal nutrition of the specimen. The sphincter area of 1.5 cm length had to be spared. The esophageal specimen showed a non-invasive low horny early squamous cell cancer (pT1a G2 L-, V-) and curative resection (R0; invasion depth of lamina propria max. 150 microns). Stent removal was performed at day 20 and was cumbersome due to local mucosal hyperplasia. However, multiple islets of gastric mucosa had successfully grown at the esophageal resection site. The patient was discharged on day 24 and regularly seen as outpatient. We observed a stepwise circular spread out of the reddish layer over an area of 5-6 cm within the next 6 months. Stenosis was successfully prevented. Biopsy proved antral HP-negative mucosa. 1 1/2 years later the patient is free of complaints. This first case of a successful gastro-esophageal endoscopic mucosal transplant with one year follow-up after wide- spread ESD in the esophagus for an early squamous cell cancer opens a new perspective for systematic research in this field.