Commercially available biological mesh does not prevent stricture after esophageal mucosectomy

Background and study aims: Endoscopic mucosal resection (EMR) offers a minimally invasive therapy for advanced esophageal dysplasia and early cancers but stricture formation limits its applicability. We aimed at assessing the efficacy of placement of a commercially available biological mesh for preventing stricture formation following esophageal EMR.

Methods: 25 swine were submitted to circumferential esophageal EMR with 10-cm extent and divided in five groups: one group with EMR only (control); one receiving an uncovered stent (stent-only group); and three groups receiving a stent covered with one of three extracellular matrices, namely small intestine submucosa (SIS group), acellular dermal matrix (ADM group), or urinary bladder matrix (UBM group). Stricture formation was evaluated with weekly esophagograms.

Results: The stent-only group had significantly less stricture formation and survival was extended compared with controls (4.8 vs. 2.4 weeks). Compared with stenting only, the addition of a biological mesh did not reduce stricture formation: percent reductions in esophageal diameter for the groups were SIS 86 %, ADM 94 %, and UBM 94 %, compared with 82 % in the stent-only group.

Conclusions: Placement of commercially available biological meshes did not alter remodeling sufficiently to prevent stricture formation after esophageal EMR.

• References

• 1 Pech O, Ell C. Endoscopic therapy of Barrett’s esophagus. Curr Opin Gastroenterol 2009; 25: 405-411
• 2 Fleischer DE, Sharma VK. Endoscopic ablation of Barrett’s esophagus using the Halo system. Dig Dis 2008; 26: 280-284 Epub 2009 Jan 30
• 3 Vieth M, Ell C, Gossner L et al. Histological analysis of endoscopic resection specimens from 326 patients with Barrett’s esophagus and early neoplasia. Endoscopy 2004; 36: 776-781
• 4 Rhee PH, Friedman CD, Ridge JA et al. The use of processed allograft dermal matrix for intraoral resurfacing: an alternative to split-thickness skin grafts. Arch Otolaryngol Head Neck Surg 1998; 124: 1201-1204
• 5 Nahabedian MY. Acellular dermal matrices in primary breast reconstruction: principles, concepts, and indications. Plast Reconstr Surg 2012; 130 : 44S-53S
• 6 Silverman RP. Acellular dermal matrix in abdominal wall reconstruction. Aesthet Surg J 2011; 31 : 24S-9S
• 7 Badylak S, Meurling S, Chen M et al. Resorbable bioscaffold for esophageal repair in a dog model. J Pediatr Surg 2000; 35: 1097-1103
• 8 Nieponice A, McGrath K, Qureshi I et al. An extracellular matrix scaffold for esophageal stricture prevention after circumferential EMR. Gastrointest Endosc 2009; 69: 289-296
• 9 Cobb MA, Badylak SF, Janas W et al. Histology after dural grafting with small intestinal submucosa. Surg Neurol 1996; 46: 389-393
• 10 Pauli EM, Schomisch SJ, Furlan JP et al. Biodegradable esophageal stent placement does not prevent high-grade stricture formation after circumferential mucosal resection in a porcine model. Surg Endosc 2012; 26: 3500-3508