Autologous skin-grafting surgery with novel continuous liquid infusion stent for prevention of esophageal stenosis after complete circular endoscopic submucosal tunnel dissection

We usually prevent postoperative esophageal stenosis with autologous skin-grafting surgery for complete circular endoscopic submucosal tunnel dissection (ccESTD) [1] [2]. However, the survival rate of skin grafts and the prevention of stenosis still need to be improved. Therefore, we used a novel liquid infusion stent for the prevention of esophageal stenosis after ccESTD.

A 67-year-old man diagnosed with wholly circumferential superficial esophageal neoplasm, 27–36 cm from the incisors, underwent double-tunnel ccESTD in our hospital. To fill the long circular artificial ulcer in the esophagus, a novel continuous liquid infusion stent (patent CN 218010622 U) with a 15×8 cm skin graft was used, as described below.

The skin graft was harvested from the right outer thigh of the patient, and the oversleeve-like skin graft was sewn onto the novel continuous liquid infusion stent ([Fig. 1]). The skin graft with novel continuous liquid infusion stent was placed at the esophageal artificial ulcer. A naso-stent tube attached to the stent was drawn from the nostrils ([Fig. 2]). A unidirectional valve at the tail of the stent and sustained-release drug storage capsule were designed for temporary storage of liquid ([Fig. 3]). To test the slow-release function of the stent, methylene blue solution was administered through the naso-stent tube ([Fig. 4], [Video 1]). Recombinant human epidermal growth factor (rhEGF) solution (100 000 IU) was pumped through the naso-stent tube every 2 days until the stent was removed after 4 weeks. There was no sign of stenosis after 8 weeks, and the main part of the skin graft survived ([Fig. 5]).

Fig. 1 The oversleeve-like skin graft was sewn onto the novel continuous liquid infusion stent.

Fig. 2 The naso-stent tube attached to the stent was drawn from the nostrils.

Fig. 3 A unidirectional valve at the tail of the stent and sustained-release drug storage capsule were designed for temporary storage of liquid.

Fig. 4 To test the slow-release function of the stent, methylene blue solution was administered through the naso-stent tube.

Autologous skin-grafting surgery with novel continuous liquid infusion stent for the prevention of esophageal stenosis after complete circular endoscopic submucosal tunnel dissection.Video 1

Fig. 5 The main part of the skin graft survived after 8 weeks.

To the best of our knowledge, this is the first report of autologous skin-grafting surgery with novel rhEGF infusion stent for prevention of post-ccESTD esophageal stenosis. However, more cases are required to determine the long-term efficacy of this technique in preventing postoperative esophageal stenosis.

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• References

• 1 Chai N, Zhang W, Linghu E. et al. Autologous skin-grafting surgery for the prevention of esophageal stenosis after complete circular endoscopic submucosal tunnel dissection. Am J Gastroenterol 2018; 113: 938
• 2 Chai N, Zou J, Linghu E. et al. Autologous skin-grafting surgery to prevent esophageal stenosis after complete circular endoscopic submucosal tunnel dissection for superficial esophageal neoplasms. Am J Gastroenterol 2019; 114: 822-825