Mucosal loss as a critical factor in esophageal stricture formation after mucosal resection: a pilot experiment in a porcine model

Liu, Bing-Rong; Liú, Dan; Yang, Wenyi; Hai, Shi; Cao, Zhiru; He, Dawei; Zhang, Xuehui; Yang, Shi; Zhou, Yangyang; Chen, Yong; He, Dedong; Zhao, Lina; Yuan, Yulian; Li, Deliang

doi:10.1007/s00464-019-06793-z

Cited by 11 publications

(8 citation statements)

References 28 publications

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“…Zhang et al [ 56 ] reported that the cautery time was longer, and the local thermal damage was more serious after active bleeding, which was considered to be possibly correlated with post-ESD stricture. Liu et al [ 51 ] suggested that direct relatedness of esophageal stricture formation to the loss of the submucosa and instead of damage to it and shared the view that mucosal loss was a key mechanism for the occurrence of esophageal stricture following ESD in the new study. In addition, it was mentioned that the occurrence of stricture may be different in different study populations influenced by host factors, such as environmental factors, single-nucleotide polymorphisms, and other habits such as dietary routine, etc.…”

Section: Discussionmentioning

confidence: 83%

“…The traditional theories consider esophageal stricture as a consequence of esophageal wall damage followed by scar tissue development and contraction of the secondary tissue. [ 51 ] Some researchers suggested that withering of the muscularis propria and fibrosis of the submucosa were key factors in postoperative stricture after ESD. [ 49 , 52 ] Honda et al [ 53 ] reported that withering of the muscularis propria during the wound healing process was associated with stricture after esophageal EMR in a dog model.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors of postoperative stricture after endoscopic submucosal dissection for superficial esophageal neoplasms

Lin

Lin²,

Gong³

2021

Medicine

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Background: As larger-sized superficial esophageal neoplasms became candidates for endoscopic submucosal dissection (ESD), post-ESD esophageal stricture has inevitably developed into a significant complication during long-term follow-up. Method: The PubMed, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Web of Science, as well as China National Knowledge Infrastructure, the Wanfang Database, and the Chinese Biomedical Literature Database, were searched to identify all the appropriate studies published from January 2000 through October 2019. For risk factor assessment between postoperative stricture and control groups, pooled odds ratios (OR) and weighted mean differences (WMD) estimation was done. All meta-analytical procedures were conducted by using Stata version 15.1 software. Results: The results showed that 11 studies with 2248 patients (284 structure cases and 1964 controls) were eligible for this meta-analysis. Statistical results indicated 6 substantial risk factors: lesion characteristics involving the upper third of the esophagus (OR 1.51, [1.02–2.25]), macroscopic type of IIa/IIc (OR 2.76, [1.55–4.92]), tumor depth of invasion above m1 (OR 7.47, [3.31–16.86]), and m2 (OR 12.67, [4.00–40.10]), longitudinal length (WMD 13.75 mm, [7.76–19.74]), circumferential diameter (WMD 10.87 mm, [8.13–13.60]), and circumferential range >3/4 (OR 38.17, [9.94–146.52]). Each additional 10% of the circumferential range increased the risk of stricture by 149% (OR 9282.46, [978.14–88089.35]). Conclusions: Six risk factors were assessed to have a key role in the elevated risk levels of post-ESD esophageal stricture. The results can help doctors identify patients with increased risk and thus can guide management of the adequate period of surveillance after ESD and take available approaches of stricture prevention.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Risk factors of postoperative stricture after endoscopic submucosal dissection for superficial esophageal neoplasms

Lin

Lin²,

Gong³

2021

Medicine

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“…This is the first study in which we observed the dynamics of We found no significant difference in the mucosal thickening diameter between the AE and control groups. Liu et al 19 cited mucosal deficiency as one contributing factor in scar stenosis of post-esophageal ESD ulcers and stated that the larger the mucosal deficiency, the more likely it was to become stenotic. Unlike peripheral ESD ulcers, the EMRC ulcer created in this study was a local ulcer with a partial mucosal defect.…”

Section: Discussionmentioning

confidence: 99%

“…There are two reasons for assessing epithelialization 1 week after surgery. First, existing studies have reported mild to severe stenosis 14 days after ESD 19,20 . Euthanasia was considered when the oral intake of the pigs deteriorated significantly, but the experiment could be carried out as scheduled within 1 week after the operation so we could detect signs of slight stenosis.…”

Section: Methodsmentioning

confidence: 99%

“…First, existing studies have reported mild to severe stenosis 14 days after ESD. 19,20 Euthanasia was considered when the oral intake of the pigs deteriorated significantly, but the experiment could be carried out as scheduled within 1 week after the operation so we could detect signs of slight stenosis. Second, Ota et al stated that ulcer healing after esophageal EMR/ESD is as short as 21 days.…”

Section: Transplantation Of Ae Cells Into Porcine Esophageal Ulcersmentioning

confidence: 99%

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A potential preventive method for scar stenosis after esophageal endoscopic mucosal resection using human amniotic epithelial cells in a porcine model

et al. 2022

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Objectives The current methods employed for esophageal endoscopic mucosal resection (EMR) involve the risk of adverse postprocedural complications. Therefore, this study aimed to develop a new method to prevent stenosis following a resection procedure using human amniotic epithelial cells in a porcine model. Methods With the consent of a woman who underwent a cesarean section, amniotic epithelial cells were isolated from the amniotic membrane of the delivered placenta. Six swine were used for this study. Under general anesthesia, four EMRs using cap‐fitted microscope ulcers were performed on each porcine esophagus. Of the four ulcers, the two on the oral side were treated by injecting human amniotic epithelial (AE group) cells, and the remaining two on the anal side were left untreated (control group). One week after the procedure, the swine were sacrificed, and the ulcers were evaluated. The epithelialization rate was calculated by dividing the length of the epithelialized portion of each section by the length of the ulcer, which was determined using an optical microscope. Moreover, the mucosal thickening in each section was measured in terms of diameter. Results The epithelialization rate was significantly higher in the AE group than in the control group. Mucosal thickening was not significantly different between the groups. Conclusions Transplanting amniotic epithelial cells into the ulcer promoted ulcer epithelialization. Amniotic epithelial cell transplantation is a potential method for the management of ulcer scar stenosis following esophageal endoscopic submucosal dissection.

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3D printing of melatonin-loaded esophageal stents for treatment of corrosive esophagitis

Yuan,

Liu,

et al. 2024

Applied Materials Today

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Mucosal loss as a critical factor in esophageal stricture formation after mucosal resection: a pilot experiment in a porcine model

Cited by 11 publications

References 28 publications

Risk factors of postoperative stricture after endoscopic submucosal dissection for superficial esophageal neoplasms

Risk factors of postoperative stricture after endoscopic submucosal dissection for superficial esophageal neoplasms

A potential preventive method for scar stenosis after esophageal endoscopic mucosal resection using human amniotic epithelial cells in a porcine model

3D printing of melatonin-loaded esophageal stents for treatment of corrosive esophagitis

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