Autologous buccal keratinocyte implantation for the prevention of stenosis after EMR of the esophagus

Sakurai, Tadashi; Miyazaki, Shukichi; Miyata, Go; Satoh, Susumu; Hori, Yoshio

doi:10.1016/j.gie.2006.12.062

Cited by 58 publications

(47 citation statements)

References 15 publications

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“…Experimental methods to prevent stricture formation after extensive EMR, including autologous buccal keratinocyte implantation and use of an extracellular scaffold matrix, show promising results in animal studies but are not applicable for clinical practice, yet. 36,37 Esophageal perforation is an infrequent complication of EMR. In our series, this occurred in 2 patients.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of EMR to completely remove Barrett's esophagus: experience in 41 patients

Gerke

Siddiqui²,

Nasr

et al. 2011

Gastrointestinal Endoscopy

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of EMR to completely remove Barrett's esophagus: experience in 41 patients

Gerke

Siddiqui²,

Nasr

et al. 2011

Gastrointestinal Endoscopy

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“…Transplantation of autologous epithelial cell sheets following hemicircumferential ESD resulted in better healing and reduced strictures in dogs survived for 4 weeks [27]. Injection of keratinocytes isolated from the buccal mucosa resulted in prevention of stricture formation at the site of injection following EEM in a swine model [32]. Extracellular matrix also has been reported to reduce strictures in dogs treated with circumferential EEM [33].…”

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confidence: 99%

Biodegradable esophageal stent placement does not prevent high-grade stricture formation after circumferential mucosal resection in a porcine model

et al. 2012

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Background Advanced esophageal dysplasia and early cancers have been treated traditionally with esophagectomy. Endoscopic esophageal mucosectomy (EEM) offers less-invasive therapy, but high-degree stricture formation limits its applicability. We hypothesized that placement of a biodegradable stent (BD-stent) immediately after circumferential EEM would prevent stricturing. Methods Ten pigs (five unstented controls, five BD-stent) were utilized. Under anesthesia, a flexible endoscope with a band ligator and snare was used to incise the mucosa approximately 20 cm proximal to the lower esophageal sphincter. A 10-cm, circumferential, mucosal segment was dissected and excised by using snare electrocautery. In the stented group, an 18-×120-mm, self-expanding, woven polydioxanone stent (ELLA-CS, Hradec-Kralove) was deployed. Weekly esophagograms evaluated for percent reduction in esophageal diameter, stricture length, and proximal esophageal dilation. Animals were euthanized when the stricture exceeded 80 % and were unable to gain weight (despite high-calorie liquid diet) or at 14 weeks. Results The control group rapidly developed esophageal strictures; no animal survived beyond the third week of evaluation. At 2 weeks post-EEM, the BD-stent group had a significant reduction in esophageal diameter (77.7 vs. 26.6 %, p < 0.001) and degree of proximal dilation (175 vs. 131 %, p = 0.04) compared with controls. Survival in the BD-stent group was significantly longer than in the control group (9.2 vs. 2.4 weeks, p = 0.01). However, all BD-stent animals ultimately developed clinically significant strictures (range, 4–14 weeks). Comparison between the maximum reduction in esophageal diameter and stricture length (immediately before euthanasia) demonstrated no differences between the groups. Conclusions Circumferential EEM results in severe stricture formation and clinical deterioration within 3 weeks. BD-stent placement significantly delays the time of clinical deterioration from 2.4 to 9.2 weeks, but does not affect the maximum reduction in esophageal diameter or proximal esophageal dilatation. The timing of stricture formation in the BD-stent group correlated with the loss radial force and stent disintegration.

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“…The promotion of re-epithelialization could greatly enhance the healing process. Importantly, it can also prevent stenosis of the artificial esophagus [30,31]. On the other hand, the mild inflammation found in the SIS-Cu group may delay the regain of body weight for the dogs.…”

Section: Discussionmentioning

confidence: 99%

Tissue engineered esophagus by copper—small intestinal submucosa graft for esophageal repair in a canine model

Tan

Wang

Chen

et al. 2014

Sci. China Life Sci.

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Acellular porcine small intestinal submucosa (SIS) has been used for esophagoplasty with success in a canine model. However, it did not lead to complete epithelialization. For better reconstruction, a cellular component is required. Moreover, promotion of angiogenesis with copper has been widely recognized by basic research as well as clinical studies. In this study, we have evaluated the feasibility and effectiveness of combined Cu and SIS (SIS-Cu patch) for the esophageal repair using a canine model. Eighteen male beagle dogs were subjected to surgical resection to produce cervical esophageal defects (5 cm in length, 180° in range). SIS with Cu (5 or 25 μmol L 1 copper) or without Cu was patched on the esophageal defects. Barium esophagram and histology exam were carried out to evaluate the effectiveness of the therapy. As shown, the SIS-Cu graft promoted re-epithelialization, re-vascularization and muscular regeneration. SIS-Cu patch is more effective than SIS alone for esophageal repair, and the SIS+25 μmol L 1 Cu group demonstrated additional advantages over the SIS+5 μmol L 1

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Autologous buccal keratinocyte implantation for the prevention of stenosis after EMR of the esophagus

Cited by 58 publications

References 15 publications

Efficacy and safety of EMR to completely remove Barrett's esophagus: experience in 41 patients

Efficacy and safety of EMR to completely remove Barrett's esophagus: experience in 41 patients

Biodegradable esophageal stent placement does not prevent high-grade stricture formation after circumferential mucosal resection in a porcine model

Tissue engineered esophagus by copper—small intestinal submucosa graft for esophageal repair in a canine model

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