Autologous esophageal mucosa with polyglycolic acid transplantation and temporary stent implantation can prevent stenosis after circumferential endoscopic submucosal dissection

Abstract

Background: This research aimed at investigating the safety and efficacy of autologous esophageal mucosa (AEM) with polyglycolic acid (PGA) transplantation and temporary stent implantation (TSI) in preventing esophageal stenosis (ES) after early esophageal cancer (EC) surgery.Methods: Between April 2019 and October 2020, patients scheduled for circumferential endoscopic submucosal dissection (ESD) were prospectively recruited. After ESD, autologous esophageal mucosal patches (MPs) were constructed on the absorbable PGA felt. Then, the felt was structured onto a covered metal mesh stent (CMMS) and attached to the ulcer surface. The stents were removed 6-8 weeks after the operation. The occurrence of ES and adverse events was observed and analyzed.Results: Data from 25 patients were analyzed. In total, 14 patients (56%) had no stenosis during an average follow-up of 10.2 months, and 11 patients (44%) suffered strictures at a mean interval of 63.73 days after the ESD procedure. Stent migration occurred in 2 patients. No other complications, including perforations, bleeding, or wound infections, occurred. The median of endoscopic balloon dilatation (EBD) sessions was 2.16 (range, 0-14). There showed a higher post-ESD stricture rate in patients with lesions located in the middle-lower esophagus (P<0.05). More transplanted MPs may reduce the occurrence of ES.Conclusions: AEM with PGA transplantation and TSI is a safe and effective approach of preventing ES and improving the life quality after circumferential ESD.

MFGE8 in exosomes derived from mesenchymal stem cells prevents esophageal stricture after endoscopic submucosal dissection in pigs

“…Tomonori et al reported a biodegradable esophageal stent for stricture prevention, while the long-term efficacy by 24 weeks was unsatisfactory due to the stricture recurrence as well as the complications such as esophagobronchial fistula [42]. Tissue engineering approaches including the autologous oral cell sheet transplantation, thigh skin-grafting, and cell sheet transplantation were also developed [43][44][45]. The incidence of stricture was reported to be 44% in patients received autologous esophageal mucosa treatment after circumferential ESD [44], but this technology is relatively expensive and laborintensive.…”

“…Tissue engineering approaches including the autologous oral cell sheet transplantation, thigh skin-grafting, and cell sheet transplantation were also developed [43][44][45]. The incidence of stricture was reported to be 44% in patients received autologous esophageal mucosa treatment after circumferential ESD [44], but this technology is relatively expensive and laborintensive. Autologous skin or esophageal mucosa grafting is an aggressive approach with relatively low patient compliance; recurrent esophageal stricture was found in 8 out of 9 patients (88.9%) during the average follow-up period of 24.7 days.…”

Prevention of Esophageal Stricture after Endoscopic Submucosal Dissection with an Autologous Esophageal Epithelial Cell Suspension: An Animal Study

“…However, oral cell suspension is less effective for whole circumferential ESD [22,23,25]. In recent years, both domestic and international researchers have attempted to prevent esophageal stricture by autologous mucosal transplantation to alleviate esophageal strictures [19,26,27]. In 2018, autogenous esophageal mucosa transplantation was conducted on nine patients with esophageal cancer who had undergone peri-circumferential ESD.…”

“…These studies have focused on extracellular matrix scaffolds, autologous cell suspensions, cell membrane sheets, autologous tissue transplants, etc. [17][18][19]. Autologous epidermal active cell transplantation regeneration technology is a method of transplanting a cell suspension to the wound surface to regenerate the epithelium uniformly and rapidly and avoid scar forma-tion; this approach has been applied in the treatment of burns and skin diseases and has exhibited excellent efficacy [20,21].…”

Advances in the application of regenerative medicine in prevention of post-endoscopic submucosal dissection for esophageal stenosis

“…Liu et al . [ 51 ] also reported the application of autologous esophageal mucosa transplantation to prevent esophageal stenosis after circumferential ESD. A total of 25 patients were enrolled and 14 of them did not develop stenosis, which suggested that autologous esophageal mucosa transplantation might be an effective solution to prevent post-ESD stenosis.…”