Endoscopic mucosal autograft for treating esophageal caustic strictures: preliminary human experience

Abstract

Esophageal caustic stricture is a stubborn disease and postoperative restenosis limits the clinical efficacy of endoscopic dilation. Autologous mucosal grafts have been successfully applied in the treatment of urethral stricture and in the prevention of stricture after extensive mucosal resection. We aimed to use mucosal autografting performed endoscopically to treat refractory esophageal stricture. METHODS : Three patients with intractable corrosive esophageal stricture were treated endoscopically by combining dilation with autologous mucosal transplantation. RESULTS : All procedures were successful with no severe complications. Mucosal regeneration was shown at the transplanted segments. One patient was able to maintain a normal diet with complete remission after 1 year of follow-up. Intraluminal stenosis and dysphagia were significantly improved in another two patients. CONCLUSIONS : Mucosal autografting can achieve esophageal re-epithelialization, inhibit undesired fibrosis, prevent restenosis, and promote functional regeneration.

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

“…Specifically, the advantages come from the convenience and safety of the harvesting process and absence of immunogenicity. [ 45 , 47 , 86 ] Although the transplantation process may be time consuming, a novel device has been developed to shorten the procedures. [ 87 ] The presence of sheets as cells’ carrier guarantees the even distribution and longer preservation over the surface of ulcers.…”

Use of tunnel endoscopy for diagnosis of obscure submucosal esophageal adenocarcinoma: A case report and review of the literature with emphasis on causes of esophageal stenosis

“…Meanwhile, dysphagia is the most common symptom which urges patients to seek medical treatment. Benign esophageal strictures can occur following peptic strictures[8], eosinophilic esophagitis[9], achalasia[10], pill-injury esophageal strictures[11], caustic strictures[12], anastomotic strictures[13], Crohn's disease-associated esophageal stricture[14], IgG4-related esophagitis[15], radiation-induced esophageal strictures[16], esophageal intramural pseudodiverticulosis[17], or epidermolysis bullosa[18] (Table 1). It is generally known that a malignant esophageal stricture refers to esophageal cancer.…”

Concerns about transplantation of autologous esophageal mucosa to prevent stricture after circumferential endoscopic submucosal dissection

“…Would the large defect of normal mucosa induce undesired stricture formation or extended hospitalization? In our study, 6 each mucosal autograft was performed at an interval of several months, accompanied with esophageal stricture dilation, and several refractory caustic strictures were cured.…”

“…According to our findings on mucosal autograft for esophageal caustic strictures, the symptoms of benign stricture symptoms can be cured. 6 More improvements should be done in the authors' esophageal mucosa transplantation.…”

“…First, after the mucosal patch grafts were fixed by clips, fibrin tissue glue was sprayed, 6 which could provide extra fixation and prevent mucosal crimping. In this situation, it is unclear whether the addition of a metal mesh stent was further needed to fix the graft.…”