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Deployment of carboxymethyl cellulose sheets to prevent esophageal stricture after full circumferential endoscopic submucosal dissection: A porcine model
Author(s) -
Tang Jian,
Ye Shufang,
Ji Xueliang,
Liu Feng,
Li Zhaoshen
Publication year - 2018
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.13070
Subject(s) - medicine , endoscopic submucosal dissection , carboxymethyl cellulose , esophageal stricture , dissection (medical) , software deployment , radiology , surgery , esophagus , sodium , chemistry , organic chemistry , operating system , computer science
Background and Aim Esophageal stricture is a serious adverse event secondary to extensive endoscopic submucosal dissection ( ESD ). The present study aimed to investigate the efficacy of carboxymethyl cellulose ( CMC ) sheets for the prevention of esophageal stricture after full circumferential ESD in an animal model. Methods Fourteen porcine models were randomized into a control group ( n = 7) and a CMC group ( n = 7). Five‐centimeter‐long circumferential esophageal ESD was carried out at a distance of 40 to 45 cm from the incisors in all models. In the CMC group, CMC sheets were placed over the mucosal defect completely after ESD , whereas the control group underwent routine ESD only. Endoscopic examination was conducted after the first and second week post‐ ESD . Esophageal specimens were harvested during post‐mortem and were evaluated for macroscopic and histological appearance. Blood serum levels of four pro‐inflammatory or profibrotic cytokines were measured quantitatively. Results The CMC group had better food tolerability during the second week post‐ ESD . The CMC group showed a significantly lower esophageal mucosal stricture rate compared to the control group. Histological assessments showed less fibrosis in the submucosal layer, milder damage to the muscularis propria, and enhanced re‐epithelization in the CMC group. Serum transforming growth factor beta 1 levels were significantly lower in the CMC group post‐ ESD . Conclusion Deployment of CMC sheets on the mucosal defect appears to be a promising method for preventing esophageal strictures after extensive ESD .