CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(11): E1698-E1706
DOI: 10.1055/a-1261-3103
Original article

Stenting to prevent esophageal stricture after circumferential endoscopic submucosal dissection: an experimental study

Jan Martinek
1  Institute for Clinical and Experimental Medicine, Hepatogastroenterology, Prague, Czech Republic
2  Czech Academy of Sciences, Institute of Animal Physiology and Genetics, PIGMOD, Libechov, Czech Republic
3  University of Ostrava Faculty of Medicine, Department of Clinic Subjects, Ostrava, Czech Republic
4  Charles University, First Faculty of Medicine, Institute of Physiology, Prague, Czech Republic
,
Radek Dolezel
2  Czech Academy of Sciences, Institute of Animal Physiology and Genetics, PIGMOD, Libechov, Czech Republic
6  Charles University, Department of Surgery, 2nd Faculty of Medicine Central Military Hospital, Prague, Czech Republic.
,
Bara Walterova
2  Czech Academy of Sciences, Institute of Animal Physiology and Genetics, PIGMOD, Libechov, Czech Republic
,
Marek Kollar
2  Czech Academy of Sciences, Institute of Animal Physiology and Genetics, PIGMOD, Libechov, Czech Republic
4  Charles University, First Faculty of Medicine, Institute of Physiology, Prague, Czech Republic
5  Institute for Clinical and Experimental Medicine, Clinical and Transplant Pathology Centre, Prague, Czech Republic
,
Stefan Juhas
2  Czech Academy of Sciences, Institute of Animal Physiology and Genetics, PIGMOD, Libechov, Czech Republic
,
Jana Juhasova
2  Czech Academy of Sciences, Institute of Animal Physiology and Genetics, PIGMOD, Libechov, Czech Republic
,
Zuzana Vackova
1  Institute for Clinical and Experimental Medicine, Hepatogastroenterology, Prague, Czech Republic
4  Charles University, First Faculty of Medicine, Institute of Physiology, Prague, Czech Republic
,
Rastislav Hustak
1  Institute for Clinical and Experimental Medicine, Hepatogastroenterology, Prague, Czech Republic
,
Jakub Erben
7  Technical University of Liberec, Faculty of Textile Engineering, Department of Nonwovens and Nanofibrous Materials, Liberec, Czech Republic
› Author Affiliations
  

Abstract

Background and study aims Circular ESD (CESD) is a treatment option for patients with extensive early esophageal cancer. Its major drawback is the development of a stricture. Stenting may represent an attractive prevention strategy. We designed an experimental study to assess the effect of stents covered with acellular biomatrix (AB) and a drug-eluting stent.

Materials and methods Thirty-five 35 pigs underwent CESD and were randomized into six groups: G1 (control), G2 (SEMS), G3 (SEMS + AB), G4 (SEMS + AB + steroid-eluting layer), G5 (biodegradable stent [BD]), G6 (BD + AB). SEMS were placed alongside the post-CESD defect, fixed and removed after 21 days. The main outcomes were stricture development, severity, and histopathology.

Results Pigs with BD stents (G5, 6) experienced severe inflammation and hypergranulation without biodegradation, therefore, these groups were closed prematurely. Significant strictures developed in 29 of 30 pigs (96.7 %). The most severe stricture developed in G2 and G4 (narrowest diameter (mm) 8.5 ± 3, 3 (G2) and 8.6 ± 2.1 (G4) vs. 17 ± 7.3 (G1) and 13.5 ± 8.3 (G3); P < 0.01. Signs of re-epithelization were present in 67 % and 71 % in G1 and G2 and in 100 % in G3 and G4. The most robust re-epithelization layer was present in G4. The inflammation was the most severe in G1 (mean score 2.3) and least severe in G4 (0.4).

Conclusions Stenting did not effectively prevent development of post-CESD esophageal stricture. SEMS with AB resulted in improved re-epithelization and decreased stricture severity. Steroid-eluting SEMS suppressed inflammation. BD stents seem inappropriate for this indication.



Publication History

Received: 10 December 2019

Accepted: 11 May 2020

Publication Date:
22 October 2020 (online)

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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