Widespread Endoscopic Mucosal Resection of the Esophagus with Strategies for Stricture Prevention: A Preclinical Study

Rajan, Elizabeth; Gostout, C. J.; Feitoza, Arnaldo B.; Herman, Lori J.; Knipschield, Mary A.; Burgart, Lawrence J.; Chung, S; Cotton, Peter B.; Hawes, Robert H.; Kalloo, Anthony N.; Kantsevoy, Sergey V.; Pasricha, Pankaj J.

doi:10.1055/s-2005-870531

Cited by 61 publications

(60 citation statements)

References 9 publications

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“…Such a disparity may impair the effectiveness of ELSI. In addition, serious procedure-related complications such as bleeding or esophageal perforation were sometimes reported (9,10). Thus, more effective and safer treatment for the prevention of esophageal stricture after ESD has been required.…”

Section: Introductionmentioning

confidence: 99%

A Phase III study of oral steroid administration versus local steroid injection therapy for the prevention of esophageal stricture after endoscopic submucosal dissection (JCOG1217, Steroid EESD P3)

Tanaka¹,

Eba²,

Mizusawa³

et al. 2015

Jpn. J. Clin. Oncol.

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A randomized Phase III trial commenced in Japan in September 2014. Endoscopic local steroid injection has been commonly used and considered acceptable as the current standard treatment for the prevention of esophageal stricture after endoscopic submucosal dissection for superficial esophageal cancer. The purpose of this study is to confirm the superiority of prophylactic oral steroid administration following endoscopic submucosal dissection in terms of stricture-free survival over endoscopic local steroid injection for patients with superficial esophageal cancer. A total of 360 patients will be accrued from 35 Japanese institutions within 2.5 years. The primary endpoint is stricture-free survival, and the secondary endpoints are the number of endoscopic balloon dilations for 12 weeks after endoscopic submucosal dissection, adverse events, serious adverse events and the proportion of patients with dysphagia score ≤1 at 12 weeks after endoscopic submucosal dissection. This trial has been registered in the UMIN Clinical Trials Registry as UMIN000015064

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Section: Introductionmentioning

confidence: 99%

A Phase III study of oral steroid administration versus local steroid injection therapy for the prevention of esophageal stricture after endoscopic submucosal dissection (JCOG1217, Steroid EESD P3)

Tanaka¹,

Eba²,

Mizusawa³

et al. 2015

Jpn. J. Clin. Oncol.

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“…On the other hand, there is no clear evidence that steroid administration has an anti-inflammatory and protective effect on the esophagus after corrosive esophagitis or EMR/ESD [12][13][14] . Second, as a regenerative approach, the use of an autologous keratinocyte sheet 15) or xenogenic extracellular matrix 12,16) that can prevent stricture after esophageal EMR has been reported. The purpose of this treatment was to closely approximate the native structure of the healing tissue for the prevention of esophageal stricture.…”

Section: Macroscopic Appearance and Histological Findingsmentioning

confidence: 99%

“…A preventive strategy for stricture should be a primary focus when severe esophagitis or ulcers are treated. There are 2 main approaches for the prevention of esophageal stricture: anti-inflammatory therapy and regenerative medicine 12) . First, anti-inflammatory therapy includes the use of a regime in which there is a sufficient period of non-feeding, and the administration of antibiotics and proton-pump inhibitors reduces the effects of gastric acid.…”

Section: Macroscopic Appearance and Histological Findingsmentioning

confidence: 99%

The mechanism of esophageal stricture after endoscopic resection: Histological and biomechanical evaluation in a canine model

Honda

Kobayashi

Nakayama

et al. 2017

Ann. Cancer Res. Therap.

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Background and study aims: Benign esophageal stricture has major deleterious effects on a patient's quality of life and is often refractory. This study aims were to prepare the animal model and to investigate the mechanism of esophageal stricture in the view point of histological and biomechanical evaluation. Material and method: Nine beagle dogs were enrolled in this study. Under general anesthesia, circumferential endoscopic submucosal dissection was carried out 5 cm length in thoracic esophagus for preparing stricture models. The process of stricture formation was evaluated by the endoscopic observation and histological findings. Immunohistochemical staining was performed for collagen I or collagen III. In the biomechanical evaluation, rectangular-shaped specimens were obtained from the esophageal samples. The failure load and linear stiffness were measured using a tensile tester and compared healed tissue with normal. Results: The dogs developed severe stricture. The macroscopic appearance showed a deep ulcer formation and severe mucosal constriction. No esophageal glands or muscularis mucosae were evident, and instead, they were replaced with condensed granulation tissue that were composed type I and III collagen fibers. The inner circular muscular layer of the muscularis propria showed partial atrophy and fibrosis in the center of the lesion. The failure load and linear stiffness were significantly decreased in the healed tissue. Conclusion:The cause of benign esophageal stricture might have been the biomechanical deterioration that was caused the change of the collagen components in the submucosal layers or atrophic changes of inner circular muscles.

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“…These strictures are often responsive to dilation. To date, animal studies have not identified that prophylactic balloon dilation, esophageal stenting, or deep mural steroid injections prevent the formation of strictures [44] .…”

Section: Emr Complicationsmentioning

confidence: 99%

“…Upper GI tract perforation can be managed conservatively with the combination of clipping, nasogastric tube suction, and broad-spectrum antibiotics [43] . Patients are at an increased risk of developing strictures if circumferential resections of the esophagus or gastric pylorus are performed [29,44,45] . These strictures are often responsive to dilation.…”

Section: Emr Complicationsmentioning

confidence: 99%

Endoscopic mucosal resection in the upper gastrointestinal tract

Ahmadi¹,

Draganov²

2008

WJG

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Endoscopic mucosal resection (EMR) is a technique used to locally excise lesions confined to the mucosa. Its main role is the treatment of advanced dysplasia and early gastrointestinal cancers. EMR was originally described as a therapy for early gastric cancer. Recently its use has expanded as a therapeutic option for ampullary masses, colorectal cancer, and large colorectal polyps. In the Western world, the predominant indication for EMR in the upper gastrointestinal tract is the staging and treatment of advance dysplasia and early neoplasia in Barrett's esophagus. This review will describe the basis, indications, techniques, and complications of EMR, and its role in the management of Barrett's esophagus.

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Widespread Endoscopic Mucosal Resection of the Esophagus with Strategies for Stricture Prevention: A Preclinical Study

Cited by 61 publications

References 9 publications

A Phase III study of oral steroid administration versus local steroid injection therapy for the prevention of esophageal stricture after endoscopic submucosal dissection (JCOG1217, Steroid EESD P3)

A Phase III study of oral steroid administration versus local steroid injection therapy for the prevention of esophageal stricture after endoscopic submucosal dissection (JCOG1217, Steroid EESD P3)

The mechanism of esophageal stricture after endoscopic resection: Histological and biomechanical evaluation in a canine model

Endoscopic mucosal resection in the upper gastrointestinal tract

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