Esophageal Stricture Formation Research Articles

Predictors of stricture after endoscopic submucosal dissection of the esophagus and steroids application.

Endoscopic submucosal dissection (ESD) is a reliable method to resect early esophageal cancer. Esophageal stricture is one of the major complications after ESD of the esophagus. Steroid prophylaxis for esophageal strictures, particularly local injection of triamcinolone acetonide (TA), is a relatively effective method to prevent esophageal strictures. However, even with steroid prophylaxis, stenosis still occurs in up to 45% of patients. Predicting the risk of stenosis formation after local TA injection would enable additional interventions in risky patients. To identify the predictors of esophageal strictures after steroids application. Patients who underwent esophageal ESD and steroid prophylaxis and who were comprehensively assessed for lesion- and ESD-related factors at Southeast University Affiliated Zhongda Hospital between February 2018 and March 2023 were included in the study. The univariate and multivariate regression analyses were conducted to identify the predictors of stricture among patients undergoing steroid prophylaxis. A total of 120 patients were included in the analysis. In the oral prednisone and oral prednisone combined with local tretinoin injection groups, the stenosis rates were 44/53 (83.0%) and 56/67 (83.6%), respectively. Among them, univariate analysis showed that the lesion circumference (P = 0.01) and submucosal injection solution (P = 0.04) showed significant correlation with the risk of stenosis formation. Logistic regression analyses were then performed using predictors that were significant in the univariate analyses and combined with known predictors from previous reports, such as additional chemoradiotherapy and tumor location. We identified a lesion circumference < 5/6 (OR = 0.19; P = 0.02) and submucosal injection of sodium hyaluronate (OR = 0.15; P = 0.03) as independent predictors of on esophageal stricture formation. Steroid prophylaxis effectively prevents stenosis. Moreover, the lesion circumference and submucosal injection of sodium hyaluronate were independent predictors of esophageal strictures. Additional interventions should be considered in high-risk patients.

Mucous Membrane Pemphigoid: A Frustrating Disabling Disease in A 15-year-old Male

Mucous membrane pemphigoid (MMP) is a rare chronic autoimmune subepithelial blistering disease characterized by erosive lesions of mucous membranes and skin that typically results in scarring of at least some sites of involvement. A progressive disorder that may result in serious complications including blindness, loss of the airway, and esophageal stricture formation. Most patient experience reduced quality of life specifically with ocular symblepharon and laryngeal destruction. Case: We present a case of a 15-year-old male patient with 1 month-history of multiple tense bullae, difficulty to open the eyes, and hoarseness due to scar lesion in mucous membrane. The patient was reported to have Dermatology Life Quality Index (DLQI) of 15 which implied he had severe disability and decreased quality of life due to his illness. Patient also had symblepharone release operation done by ophthalmologist. A laryngeal reconstruction plan was also carried out by ENT doctor, but the patient couldn’t continue the treatment because of economic problem. Scarring of MMP is a significant complication in many cases. Mucous membrane pemphigoid could cause a lot of disability to the patient and decreased quality of life. Symblepharone release operation was done and laryngeal reconstruction plan was also carried out. Surgical intervention may not curable; however, it may be necessary for restoring function and improving quality of life.

Risk factors for total laryngectomy associated proximal esophageal stricture formation in head and neck cancer patients.

Development of esophageal strictures is common after the total laryngectomy of head and neck cancer patients. While endoscopic techniques like dilatation by balloon or Salvary bougies are well established, risk factors and pathophysiology for development of refractory strictures are less well understood. To evaluate risk factors associated with occurrence and recurrence of total-laryngectomy-associated esophageal strictures in head and neck cancer patients. We analyzed retrospectively a cohort of 170 head and neck squamous cell carcinoma patients, who underwent total laryngectomy between 2007 and 2017. The outcome measure was laryngectomy-associated proximal esophageal stricture needing an endoscopic dilatation by using a balloon or Savary dilators. Of the 170 patients in the cohort, 32 (18.8%) developed strictures. Mean time between surgery and first endoscopic intervention was 24.4 months. Significant predictive factors were age ≥ 65 (p=0.017), nodal status N> 1 (p=0.003), continued alcohol abuse after surgery (p=0.005) and diabetes mellitus (p=0.005). In a subgroup, 17 of 32 patients developed refractory strictures and needed more than three dilatations to relieve dysphagia. Postoperative mean (p=0.016) and maximum (p=0.015) C-reactive protein (CRP) were predictive for refractory strictures. Symptomatic strictures occurred in 18.8% of the cases. Age, nodal status N>1, continued alcohol abuse and diabetes mellitus were predictive factors. For refractory stenosis (>3 dilatations needed) mean and maximum postoperative CRP were predictive. This may indicate that systemic inflammatory response post-surgery is involved in the stricture formation process.

Application of polyglycolic acid sheets and basic fibroblast growth factor to prevent esophageal stricture after endoscopic submucosal dissection in pigs.

Endoscopic submucosal dissection (ESD) has been the first-line treatment for early-stage esophageal cancer. However, it often causes postoperative stricture in cases requiring wide dissection. Basic fibroblast growth factor (bFGF) reportedly has anti-scarring effects during cutaneous wound healing. We hypothesized that suppressing myofibroblast activation will prevent stricture after esophageal ESD. We resected a complete porcine esophagus circumference section by ESD. To investigate the preventive effect of bFGF on esophageal stricture formation after ESD, we endoscopically applied bFGF-soaked poly-glycolic acid (PGA) sheets onto the wound bed after ESD and fixed them by spraying fibrin glue (PGA + bFGF group), PGA sheets alone onto the wound bed and fixed them by spraying fibrin glue (PGA group), or nothing (control group). After removing the esophagus on day 22, we evaluated the mucosal constriction rate. Compared with those in the control group, esophageal stricture was significantly reduced in the PGA + bFGF group, and the areas stained with α-SMA and calponin-1 antibodies were significantly inhibited in the PGA + bFGF and PGA groups. The thickness of the fibrous layer in the PGA + bFGF group was uniform compared to that of the other groups. Thus, PGA + bFGF inhibited the development of unregulated fibroblasts in the acute phase, leading to uniform wound healing. Stenosis after esophageal ESD is related to fibrosis in the acute phase. Administration of PGA and bFGF suppresses myofibroblast activation in the acute phase, thereby preventing esophageal constriction in pigs.

Esophageal and Gastric Stricture Formation Following Corrosive Ingestion in Our Local Population

Corrosive substances are defined as chemicals which cause injury upon coming in contact with living tissues such as the skin, gastrointestinal tract, respiratory tract and eyes. These include acids, alkalis, oxidizing agents, hydrocarbons among others. Objective: To determine the frequency and difference in the frequency of upper gastrointestinal stricture formation following corrosive ingestion in the gastroenterology unit of Lady Reading Hospital, Peshawar. Methods: This cross- sectional study was held in the Gastroenterology unit of Lady Reading Hospital, Peshawar from 16th July, 2019 to 16th Jan, 2019. Detailed history was taken from the patient and the container of the chemical ingested was examined to find out the duration since ingestion, amount of chemical ingested, and the type of chemical ingested (acid or alkali). Results: Mean and SD for age was 35 ± 5.55. Mean and SDs for duration since ingestion. Mean and SDs for amount of corrosive ingestion was 24 ± 1.54. 50 (34.48%) patients were recorded in 10-25 years’ age group and 95 (65.51%) patients were recorded in 26-40 years’ age group. 97 (66.89%) patients were male, and 48 (33.10%) patients were female. 41 (28.27%) patients had acidic corrosion and 104 (71.72%) patients had alkali corrosion. As per frequencies and percentages for stricture formation, 57 (39.31%) patients had stricture formation. Conclusions: Although the mortality and morbidity of corrosive gastric injuries is high, the key to improve the survival is early identification of perforation, maintenance of nutrition and control of sepsis.

Prevention of stricture after semi-circumferential and whole circumferential esophageal endoscopic resection

: Stricture formation after esophageal endoscopic resection (ER) worsens a patient’s quality of life because it causes dysphagia and requires multiple endoscopic dilations. Numerous methods are available to prevent esophageal stricture formation after ER. For noncircumferential resections, much evidence indicates local steroid injection is the best choice and is therefore widely used in clinical practice. However, local steroid injection alone is insufficient to prevent stricture of whole circumferential resections. Accordingly, we should select oral steroid administration or combination therapy (oral steroid administration + local steroid injection) for such extensive resections. However, the stricture rate is significantly higher compared with noncircumferential resections despite these prevention methods. Steroid therapies, including local injection and oral administration, have the advantages of high effectiveness and low cost. However, concerns include the risk of steroid-related complications such as immunosuppression, diabetes onset/exacerbation, and fragility of the esophageal wall. Also, favorable outcomes of modified steroid methods such as local triamcinolone acetonide (TA) injection together with a polyglycolic acid sheet (PGA), TA-soaked PGA sheet together with a fully covered metal stent, and TA filling method have been reported. Innovative methods include tissue engineering approaches such as cell sheet transplantation and autologous mucosal transplantation. Despite the promise of these methods, further studies are required to establish their efficacies before widespread use in clinical practice.

A nomogram and risk classification system predicting esophageal stricture after endoscopic submucosal dissection of a large area for early esophageal cancer.

Esophageal stricture is a troublesome adverse effect of endoscopic submucosal dissection (ESD) for early esophageal cancer. However, risk factors of post-ESDesophagealstricture formation are incomprehensive. This study aimed to conduct a comprehensive analysis of independent risk factors and provide predictive tools. Patients who underwent ESD for early esophageal cancer between 2014 and 2021 at the Beijing Friendship Hospital, Capital Medical University, were recruited. A nomogram and risk classification system was established based on Cox proportional hazards analyses and validated using the concordance index (C-index), calibration curves, decision curve analysis (DCA), and Kaplan-Meier (K-M) curves. Stricture formed in 36 patients, while stricture was not observed in the remaining 112 patients. Operative time (odds ratio [OR]: 1.01; 95% confidence interval [CI]: 1.00-1.01; p < 0.01); lesions >3/4 circumferential range of esophagus (OR: 3.82; 95% CI: 1.90-7.66; p < 0.01), and tumor infiltration to the mucosal lamina propria (m2) or deeper (OR: 2.40; 95% CI: 1.24-4.66; p = 0.01) were independent predictive factors for post-ESD esophageal stricture. The nomogram and risk classification system was developed and validated with 0.79 C-index, good calibration curves, good DCA results, and good K-M curves. We developed a nomogram and risk stratification system to predict post-ESD esophageal stricture using three independent risk factors.

Prediction of Esophageal Stricture after Endoscopic Submucosal Dissection in Patients with Early Esophageal Cancer

BackgroundEndoscopic submucosal dissection (ESD) treatment of early esophageal cancer is effective and safe. It is currently the first-line treatment for early esophageal cancer. However, a common side effect is the development of esophageal strictures after ESD. This study was designed to identify the risk factors for esophageal stricture development and to predict its occurrence after ESD. MethodsIn this retrospective study, 150 consecutive patients with early esophageal cancer treated with ESD at Daping Hospital, Chongqing, were enrolled between January 2016 and December 2020. Data on patient demographics, esophageal tumor characteristics, procedure-related factors, and postoperative situations were collected. We identified independent risk factors of esophageal stricture formation using univariate analysis and multivariate logistic regression. The predictive probability was obtained after multivariate logistic analysis. In addition, patients were divided into six groups based on these risk factors and the rate of esophageal stricture in each group was analyzed. ResultsThe postoperative esophageal stricture rate was 14% (21/150). Tumor location (OR = 5.655, 95% CI: 1.245–25.691, P = 0.025) and circumferential resection range (OR = 16.113, 95% CI: 4.294–60.466, P < 0.001) are independent risk factors for the development of esophageal strictures. According to predictive probability analysis and the rates of stricture in six groups, we developed a possible flow chart to predict stricture formation. ConclusionsTumor location and circumferential resection range are reliable risk factors to predict the occurrence of esophageal strictures. Our prediction flow chart suggests that tumors with a circumferential resection range of 1/2–3/4 and located above the upper thoracic segment or a circumferential resection range of > 3/4 have a high risk of postoperative stricture. Thus, timely and effective preventive measures should be taken in these patients following ESD.

S2444 Acute Esophageal Necrosis and Stricture Formation: A Case Report and Literature Review

S2444 Acute Esophageal Necrosis and Stricture Formation: A Case Report and Literature Review

Esophageal Magnetic Anastomosis Device (EMAD) to Simplify and Improve Outcome of Thoracoscopic Repair for Esophageal Atresia with Tracheoesophageal Fistula: A Proof of Concept Study

BackgroundWe designed a new Esophageal Magnetic Anastomosis Device (EMAD) for thoracoscopic repair of esophageal atresia (EA) with tracheoesophageal fistula (TEF) without the need of handheld suturing or additional gastrostomy. MethodsSynthetic EA-TEF model: Spherical and tubular shaped rubber balloons and a term infant sized plastic doll were used. Medical students (n = 10) and surgical trainees (n = 10) were asked to perform thoracoscopic repair of an “EA” with a hand sutured anastomosis (HA) and with the EMAD. Euthanized animal model: The esophagus in 5 piglets (3–4 kg) was dissected and a thoracoscopic esophageal magnetic anastomosis (EMA) was performed. Bursting pressure (BP) and pulling force (PF): HA and EMA were created on ex vivo New Zealand white rabbit (2.5–3 kg) esophagi (n = 25 in each test series). BP and PF were measured and compared against each other. ResultsMedical students were unable to complete HA, but were successful with the EMAD in 11.1 ± 2.78 min. Surgical trainees completed EMA in 4.6 ± 2.06 min vs. HA 30.8 ± 4.29 min (p<0.001). The BP following a HA (14.1 ± 3.32 cmH2O) was close to the physiological intraluminal pressure reported in a neonatal esophagus (around 20 cmH2O), whereas the BP with the EMAD was extremely high (>90 cmH2O) (p<0.001). The PF of an EMA (1.8 ± 0.30 N) was closer to the safety limits of anastomotic tension reported in the literature (i.e. 0.75 N) compared with the HA (3.6 ± 0.43 N) (p<0.0001). ConclusionThe EMAD could simplify, shorten, and potentially improve the outcome of thoracoscopic repair for EA with TEF in the future. A high BS and a relative low PF following EMAD application may lower the risk of postoperative complications such as esophageal leakage and stricture formation.

Pirfenidone prevents esophageal stricture by inhibiting nucleotide binding oligomerization domain like receptor protein 3 inflammasome activation.

Esophageal injury often results in a scar, leading to refractory strictures. The NLRP3 inflammasome activates caspase-1, causing the maturation of interleukin (IL)-1β. Here, we aimed to investigate the preventive effect of pirfenidone (PFD), an antifibrotic drug, on esophageal stricture after ulcer healing and studied its mechanism by focusing on the activation of the NLRP3 inflammasome. Esophageal ulcers were induced in rats via the local application of acetic acid in the serosa. PFD was intraperitoneally administered to the rats 3days after ulcer induction. The effect of PFD on esophageal stricture after ulcer healing was assessed by esophagography on day 9. The protein levels of mature caspase-1 and IL-1β were assessed by western blotting. The ulcers fully developed 3days after induction and were almost scarred by day 9 with severe strictures. PFD promoted ulcer healing and attenuated fibrotic collagen in the submucosa by suppressing the increase in NLRP3, cleaved caspase-1, and mature IL-1β expression, improving stricture rate (PFD vs vehicle=55% vs 81%). Exogenous IL-1β abolished the therapeutic effects of PFD on ulcer healing and stricture formation. Furthermore, NLRP3 and caspase-1 inhibitors mimicked the effects of PFD on ulcer healing and stricture formation, with suppression of the increase in cleaved caspase-1 and mature IL-1β proteins and expression of fibrosis-related molecules including transforming growth factor (TGF)-β1. The NLRP3 inflammasome promotes esophageal stricture formation following ulcer healing, and PFD exerts potential prophylactic activity against strictures, possibly via the inhibition of the NLRP3/IL-1β/TGF-β1 axis.

Esophageal Dilatation in Patients with Esophageal Stricture Formation due to Corrosive Intake - Clinical Experience of Thoracic Surgery Department at A Tertiary Care Center

Objective: Assessment of the outcome of esophageal dilatation in patients with esophageal stricture formation due to corrosive intake experienced at a tertiary healthcare facility in order to devise a better management plan for such patients. Study design: Retrospective Study Study setting: Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. Study duration: January 2018-June 2021 Methodology: A total of 19 subjects who presented with esophageal stricture formation due to corrosive intake were taken as study subjects. The location of involved mucosa, number of dilatation sessions done, level of symptomatic relief and recurrence rates were assessed for these study subjects. Then the data was gathered and analyzed with the help of SPSS Version. 21. Results: This study comprising of 19 patients who had esophageal stricture formed due to corrosive intake and they underwent esophageal dilatation for it. The age range for the subjects came out to be 5-40 years (Mean= 2.89±8.81). Male to female ratio came out to be 7(36.8%) vs 12(63.2%) respectively. Among these study subjects, 15(78.9%) subjects gave history of an acid ingestion while only 4(21.1%) had a history of alkali ingestion. Majority of them showed relief in response to esophageal dilatation and with low recurrence rates. Conclusion: Esophageal dilatation with bougies is one of the safest, less invasive, and efficient method for the effective management of esophageal stenosis/ stricture formation after corrosive intake that needs to be emphasized specially in healthcare centers which lack specialized departments dealing with more invasive surgical procedure and facilities. Keywords: Esophagus, Dilatation, Corrosive, Stricture, Acid, Alkali

Prevention Effect of TGF-β Type I Receptor Kinase Inhibitor in Esophageal Stricture Formation after Corrosive Burn

Corrosive burns lead to progressive esophageal stricture and dysphagia. There are many trials to prevent esophageal stricture formation after corrosive burn. EW-7197 has been proven in several animal models of fibrosis to have antifibrotic and antiproliferative effect. This study aimed to assess the effects of EW-7197 on prevention for esophageal stricture formation after corrosive esophageal burn. An animal study was carried out, where the animals were divided into three groups: a healthy group, a control group (corrosive burn without EW-7197), and a treatment group (corrosive burn with EW-7197). Corrosive esophageal burns were induced using 30% NaOH on the lower esophagus. For 3 weeks, the control group received vehicle and the treatment group received 20 mg/kg/day EW-7197. Treatment efficacy was assessed by measuring the stenosis ratio by esophagogram with contrast media on day 21. Histologic staining was performed to evaluate the fibrosis area ratio, and Western blotting was performed to evaluate fibrotic markers. Among 20 rats that underwent surgery, 14 survived. Three in the treatment group died because of esophageal perforation, and three in the control group died due to their debilitating status. The esophageal stenosis ratio was significantly lower in the treatment group than in the control group (12.1 ± 9.5% and 42.2 ± 8.3%, respectively; p = 0.001). The histologic fibrosis area ratio was also significantly lower in the treatment group (12.5 ± 3.0% and 21.6 ± 2.1%, respectively; p = 0.001). The treatment group showed lower expressions of profibrogenic proteins such as TGF-β1, pSmad3, and α-SMA. EW-7197 may be a good alternative for the prevention esophageal stricture formation after corrosive burn.

Effect of two different pre-anaesthetic omeprazole protocols on gastroesophageal reflux incidence and pH in dogs.

Gastroesophageal reflux can occur during anaesthesia and may lead to esophagitis and occasionally oesophageal stricture formation. The aim of the study is to assess two omeprazole protocols on gastroesophageal reflux incidence and pH in anaesthetised dogs. Fifty-five dogs undergoing elective ovariectomy were randomly assigned to: omeprazole single dose 1mg/kg orally the evening before anaesthesia (20 dogs), omeprazole two doses 1mg/kg orally the evening and 3hours before anaesthesia (15 dogs), and control group that did not receive omeprazole (20 dogs). An oesophageal impedance/pH probe was used to measure gastroesophageal reflux incidence and pH during anaesthesia. Gastroesophageal reflux was observed in 55% (11/20) of control dogs, 55% (11/20) of dogs receiving omeprazole once and 47% (7/15) of dogs receiving omeprazole twice. The incidence was not statistically significant different between groups. Gastroesophageal reflux pH (mean ± sd) was higher in dogs receiving omeprazole twice (6.3 ± 1.5), when compared to either control dogs (3.8 ± 1.1) or dogs receiving omeprazole once (4.1 ± 1.5). Strongly acidic reflux (pH< 4) was observed in 7% (1/15) of dogs receiving omeprazole twice versus 55% (11/20) and 35% (7/20) of control dogs and dogs receiving omeprazole once, respectively. Omeprazole administered the evening and 3hours before anaesthesia increased gastroesophageal reflux pH and decreased the incidence of strongly acidic reflux in dogs. A single dose of omeprazole given the evening before anaesthesia had no effect on reflux pH.

Esophageal Tear with Pneumomediastinum Secondary to Esophageal Candidiasis in a Patient with Autoimmune Polyendocrinopathy-Candidiasis-Ectodermal Dystrophy (APECED)

Autoimmune Polyendocrinopathy-Candidiasis-Ectodermal Dystrophy (APECED) is a rare condition that diffusely affects many organ systems. Chronic mucocutaneous candidiasis is one of the features of APECED, which needs to be treated and monitored to prevent severe complications. This case demonstrates esophageal structuring and resultant esophageal perforation, in the setting of chronic mucocutaneous candidiasis. Learning Points • Chronic mucocutaneous candidiasis (CMC) can be present without overt esophageal thrush • CMC can result in esophageal lesions causing significant morbidity. • APECED patients with dysphagia should be assessed for chronic candida esophagitis and treated accordingly. • Patients with recurrent candida esophagitis should be considered for intermittent topical and systemic antifungal prophylactic therapy. • Esophageal perforation due to candidiasis is most often seen in the setting of immunocompromised states. Background Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare autosomal recessive disease caused by mutations of the AIRE (autoimmune regulator) genes [1, 2, 6, 7]. It is characterized by the clinical trial of chronic mucocutaneous candidiasis (CMC), hypoparathyroidism, and adrenal insufficiency [7]. APECED has been reported worldwide, but is more prevalent in some historically- isolated homogeneous populations in Finland (1/25000), Sardinia, and Iranian Jews (1/9000) [7]. APECED is also seen at a lower incidence in Norway, Sweden, Slovenia, Great Britain, Italy, Ireland, and North America [7]. Most patients have CMC from early childhood [2, 3]. Rarely, untreated esophageal candidiasis may lead to complications such as esophageal stricture, rupture and or fistula formation [4, 5].

Cordycepin prevents the esophageal stricture formation in the alkali-burn rat model by exerting anti-inflammatory and antifibrotic effects.

ABSTRACTPurposeTo investigate the efficacy of cordycepin, an adenosine analogue, on prevention of esophageal damage and stricture formation due to esophageal caustic burns in rat model comparing with prednisolone.MethodsCaustic esophageal burn was introduced by 37.5% of NaOH to distal esophagus. Thirty-two Wistar albino rats were divided in four groups: sham rats undergone laparotomy, treated with 0.9% NaCl; control rats injured with NaOH without cordycepin treatment; cordycepin group injured with NaOH, treated with 20 mg/kg cordycepin; prednisolone group injured with NaOH, treated with 1 mg/kg prednisolone for 28 days. Efficacy was assessed by histopathological and immunohistochemical analysis of esophageal tissues.ResultsCordycepin treatment significantly decreased inflammation, granulation tissue and fibrous tissue formation and prevented formation of esophageal strictures shown by histopathological damage score and stenosis indexes compared to control group (p < 0.01). These effects are relatively more substantial than prednisolone, probably based on attenuation of elevation of proinflammatory cytokines hypoxia-inducible factor 1-alpha (HIF-1?), tumor necrosis factor alpha (TNF-?), proliferative and fibrotic factor fibroblast growth factor 2 (FGF2) and angiogenic factor vascular endothelial growth factor A (VEGFA) (p < 0.05).ConclusionsThe findings suggest that cordycepin has a complex multifactorial healing process in alkali-burned tissue, more successful than prednisolone in preventing the formation of esophageal strictures and may be used as a therapeutic agent in the acute phase of esophageal alkali-burn.

Impact of topical budesonide on prevention of esophageal stricture after mucosal resection

EMR and endoscopic submucosal dissection (ESD) are treatment modalities for Barrett's esophagus involving high-grade dysplasia or early cancer. Injectional corticosteroid therapy decreases the risk of procedure-related esophageal stricture (ES) formation. Our aim was to assess the efficacy of topical budesonide on the rate of ES formation after EMR or ESD. Patients included prospectively from 3 tertiary endoscopy centers received 3 mg budesonide orally twice a day for 8 weeks after esophageal EMR or ESD of 50% or more of the esophageal circumference between January 1, 2014 and June 30, 2018. These patients were matched (1:3 ratio) retrospectively with a consecutive patient cohort who underwent EMR or ESD of 50% or more of the esophageal circumference without concomitant corticosteroid therapy. The primary endpoint was the presence of ES at the 12-week follow-up. Twenty-five patients (budesonide) were matched with 75 patients (no budesonide). Most underwent EMR for Barrett's esophagus with biopsy-proven high-grade dysplasia or suspected T1a cancer. Although most baseline characteristics did not differ significantly, patients in the budesonide cohort tended to have a higher proportion of circumferential EMR. The proportion of patients with ES was not significantly lower in the budesonide cohort (16% vs 28%). On logistic regression analysis, budesonide remained associated with a lower incidence of ES (P= .023); however, when controlling for baseline characteristics with a propensity score weighted logistic regression model, there was no significant effect on ES formation (P= .176). Topical budesonide might be associated with a reduction of ES after EMR or ESD; however, further studies are needed to verify our results.

Strategies for treating oesophageal diseases with stem cells.

There is a wide range of oesophageal diseases, the most general of which are inflammation, injury and tumours, and treatment methods are constantly being developed and updated. With an increasingly comprehensive understanding of stem cells and their characteristics of multilineage differentiation, self-renewal and homing as well as the combination of stem cells with regenerative medicine, tissue engineering and gene therapy, stem cells are playing an important role in the treatment of a variety of diseases. Mesenchymal stem cells have many advantages and are most commonly applied; however, most of these applications have been in experimental studies, with few related clinical trials for comparison. Therefore, the methods, positive significance and limitations of stem cells in the treatment of oesophageal diseases remain incompletely understood. Thus, the purpose of this paper is to review the current literature and summarize the efficacy of stem cells in the treatment of oesophageal diseases, including oesophageal ulceration, acute radiation-induced oesophageal injury, corrosive oesophageal injury, oesophageal stricture formation after endoscopic submucosal dissection and oesophageal reconstruction, as well as gene therapy for oesophageal cancer.

Sa1298 ENDOSCOPIC SUBMUCOSAL DISSECTION VERSUS ESOPHAGECTOMY FOR THE TREATMENT OF SUPERFICIAL ESOPHAGEAL LESIONS: A RETROSPECTIVE COMPARATIVE ANALYSIS

Dysplastic lesions associated with Barrett’s esophagus are commonly treated with endoscopic mucosal resection (EMR). Lesions refractory to EMR or with positive margins for intramucosal adenocarcinoma are commonly referred for esophagectomy. While typically curative, esophagectomy is associated with significant complications and morbidity. More recently, endoscopic submucosal dissection (ESD) has emerged as a recognized modality for dysplastic Barretts esophagus and non invasive adenocarcinoma, with high curative resection rates and low risks of complications. The aim of this study is to evaluate the comparative effectiveness of ESD versus esophagectomy for dysplastic Barrett’s esophageal lesions and non-invasive adenocarcinoma. This was a single-center retrospective study of adult patients that underwent ESD and surgical esophagectomy for the treatment of superficial esophageal lesions. Using the TNM staging classification, only T1aM0N0 lesions were included to ensure lesions were amenable to both treatment strategies. Baseline data was collected for age, gender, size of lesion, prior EMR, procedure times, and pathology. Cases with invasive cancers were excluded from the final analysis. Primary outcomes were procedure-associated adverse events and evidence of local recurrence. Secondary outcomes included adverse events and recurrence rates. Statistical analyses were performed using Student’s t-test or Fisher’s exact test with statistical significance defined as P<0.05. A total of 17 patients underwent ESD with 34 patients undergoing surgical esophagectomy at our institution. Baseline patient, lesion, and procedure characteristics are summarized in Table 1. Mean age, gender, and histologic pathology was not difference between ESD and esophagectomy. For ESD, en-bloc resection was achieved in 100% of patients with 4 (23.53%) patients having undergone previous resection attempts or treatment with radiofrequency ablation. A majority of patients in the esophagectomy group (71.88%) underwent minimally invasive Ivor Lewis procedures, with the other patients undergoing transhiatal (18.75%) or three-hole (9.38%) surgeries. Esophagectomy resulted in significantly longer hospitalization [8.58 ±6.25 vs 0.00 ±0.00; P<0.001] with more procedure-associated adverse events [61.76% vs 11.76%; P<0.001]. Post-procedure esophageal stricture formation was also higher for the esophagectomy group [41.18% vs 11.76%; P<0.050]. Both ESD and esophagectomy were curative with no cases of local recurrence in either group. In this retrospective study of dysplastic Barrett’s and T1aM0N0 esophageal lesions, ESD was associated with comparable curative resection rates to esophagectomy however with shorter length of hospital stay, fewer procedure related adverse events and less stricture formation.

A rare cause of dysphagia due to esophageal intramural pseudodiverticulosis: a case report and review of literature

BackgroundEsophageal intramural pseudodiverticulosis is an uncommon, idiopathic disorder characterized by multiple small outpouchings protruding from the esophageal lumen. Esophageal intramural pseudodiverticulosis is associated with conditions such as gastroesophageal reflux disease and diabetes mellitus, as well as emergent complications including pneumomediastinum. The most common presenting symptom is dysphagia with associated esophageal stricture formation. While the pathogenesis of EIP has yet to be determined, it is important to bring awareness to this unique disease with distinctive diagnostic findings and treatment options.Case presentationIn this case, we present a 62-year-old woman who suffered from dysphagia, an inability to tolerate a regular diet, and unintentional weight loss for several years prior to her diagnoses. She was diagnosed by esophagram and esophagogastroduodenoscopy to have esophageal intramural pseudodiverticulosis, complicated by severe stricture formation. Following treatment with sequential dilatation and maintenance H2-blocker therapy, she achieved significant symptomatic improvement.ConclusionsThis case highlights the importance of accurate identification and treatment of an uncommon cause of dysphagia, esophageal intramural pseudodiverticulosis. Treatment includes dilatational therapy, as successfully demonstrated in our patient. Furthermore, treatment is focused on optimizing medical management, as demonstrated in our patient with the addition of an H2-blocker for GERD, or addressing potentially serious underlying causes, such as carcinoma, with surgery.