Transplantation of epidermal cell sheets by endoscopic balloon dilatation to avoid esophageal re-strictures: initial experience in a porcine model

Kobayashi, Shinichiro; Kanai, Nobuo; Tanaka, Nobuyuki; Maeda, Masanori; Hosoi, Takahiro; Fukai, Fumio; Eguchi, Susumu; Yamato, Masayuki

doi:10.1055/s-0042-116145

Cited by 19 publications

(10 citation statements)

References 27 publications

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“…First, the ESD ulcer might be too large to demonstrate the effect of cell sheet transplantation. We performed a large, 4-5 cm long circumferential ESD, but the artificial ulceration was shorter and more hemi-circumferential than those in previous reports [19][20][21]. We attached six to eight-cell sheets per ESD ulcer, and this number was insufficient to prevent long stricture.…”

Section: Discussionmentioning

confidence: 98%

Allogeneic epithelial cell sheet transplantation for preventing esophageal stricture after circumferential ESD in a porcine model: preliminary results

Lee

Shim

et al. 2021

Scandinavian Journal of Gastroenterology

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Objectives: Circumferential endoscopic submucosal dissection (ESD) for large lesions induces severe stricture, requiring subsequent treatment. We aimed to evaluate the efficacy of allogeneic epithelial cell sheet transplantation in preventing esophageal stricture after circumferential ESD in a porcine model. Materials and methods: A total of 15 conventional pigs underwent a 4 cm long circumferential ESD in the mid-esophagus. Out of these animals, 11 were immediately subjected to allogeneic oral mucosal cell sheet transplantation at the resection site, whereas four pigs underwent circumferential ESD only. We performed upper endoscopy 1 and 2 weeks after ESD and assessed the degree of esophageal stricture and histologic characteristics. Results: Dysphagia scores and weight change ratios recorded 1 and 2 weeks after ESD did not differ between the two groups. The stricture rate 2 weeks after ESD was 100% in the control group and 90.9% in the cell sheet group (p ¼ 1.000). The median mucosal constriction rates of the control and cell sheet groups were 73.5% (range 63.0-80.0%) and 53.8% (37.5-73.3%, p ¼ .018), respectively. With regard to microscopic measurements, the length of re-epithelialization was greater in the cell sheet group than in the control group (2,495 mm vs. 369 mm, p ¼ .008). Median fibrosis thickness and degree of muscle damage were not significantly different between groups. Conclusions: Although allogeneic epithelial cell sheet transplantation showed greater re-epithelialization and less mucosal constriction of post-ESD ulcers, it was not sufficiently effective in preventing post-ESD stricture.

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Section: Discussionmentioning

confidence: 98%

Allogeneic epithelial cell sheet transplantation for preventing esophageal stricture after circumferential ESD in a porcine model: preliminary results

Lee

Shim

et al. 2021

Scandinavian Journal of Gastroenterology

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“…In an animal model, Kobayashi et al. [ 92 ] reported that even intractable anastomotic stricture occurs at the stage of repair of mucosal laceration after EBD. In this study, transplanting epidermal cell sheets to the laceration site after EBD could reduce the extent of stricture.…”

Section: Future Perspectivesmentioning

confidence: 99%

Esophageal regenerative therapy using cell sheet technology

Ohki

Yamamoto

2020

Regenerative Therapy

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We have been conducting research on esophageal regenerative therapy using cell sheet technology. In particular, in the endoscopic field, we have pushed forward clinical research on endoscopic transplantation of cultured autologous oral mucosal epithelial cell sheets to esophageal ulcer after endoscopic submucosal dissection (ESD). We started research in this direction using animal models in 2004 and performed clinical research in 2012 in collaboration with Nagasaki University and Karolinska Institute. Although in full-circumferential cases it was difficult to prevent esophageal stricture after ESD, there were no complications and stricture could be suppressed. The cell sheet technology is still in its infancy. However, we are convinced that it has a high potential for application in various areas of gastrointestinal science. In this review, we focus on the pre-clinical and clinical trial results obtained and on the theoretical aspects of (1) stricture prevention, (2) esophageal tissue engineering research, and (3) endoscopic transplantation, and review the esophageal regenerative therapy by cell sheet technology.

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“…The incidence of stricture was 10%. They have also succeeded in developing a logistics system and new devices to collect materials from clinics, transport them to the remote cell proceeding center, and return the cultured AOMECs for endoscopic transplantation [ 96 , 97 , 98 , 99 ].…”

Section: Regenerative Medicinementioning

confidence: 99%

Prevention of Stricture after Endoscopic Submucosal Dissection for Superficial Esophageal Cancer: A Review of the Literature

Hikichi

Nakamura

Takasumi

et al. 2020

JCM

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Endoscopic resection has been the standard treatment for intramucosal esophageal cancers (ECs) because of the low risk of lymph node metastases in the lesions. In recent years, endoscopic submucosal dissection (ESD), which can resect large ECs, has been performed. However, the risk of esophageal stricture after ESD is high when the mucosal defect caused by the treatment exceeds 3/4 of the circumference of the lumen. Despite the subsequent high risk of luminal stricture, ESD has been performed even in cases of circumferential EC. In such cases, it is necessary to take measures to prevent stricture. Therefore, in this review, we aimed to clarify the current status of stricture prevention methods after esophageal ESD based on previous literature. Although various prophylactic methods have been reported to have stricture-preventing effects, steroid injection therapy and oral steroid administration are mainstream. However, in cases of circumferential EC, both steroid injection therapy and oral steroid administration cannot effectively prevent luminal stricture. To solve this issue, clinical applications, such as tissue shielding methods with polyglycolic acid sheet, autologous oral mucosal epithelial sheet transplantation, and stent placement, have been developed. However, effective prophylaxis of post-ESD mucosal defects of the esophagus is still unclear. Therefore, further studies in this research field are needed.

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Transplantation of epidermal cell sheets by endoscopic balloon dilatation to avoid esophageal re-strictures: initial experience in a porcine model

Cited by 19 publications

References 27 publications

Allogeneic epithelial cell sheet transplantation for preventing esophageal stricture after circumferential ESD in a porcine model: preliminary results

Allogeneic epithelial cell sheet transplantation for preventing esophageal stricture after circumferential ESD in a porcine model: preliminary results

Esophageal regenerative therapy using cell sheet technology

Prevention of Stricture after Endoscopic Submucosal Dissection for Superficial Esophageal Cancer: A Review of the Literature

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