Endoscopy 2005; 37(11): 1111-1115
DOI: 10.1055/s-2005-870531
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

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

E.  Rajan1 , C.  Gostout1 , A.  Feitoza1 , L.  Herman1 , M.  Knipschield1 , L.  Burgart2 , S.  Chung3 , P.  Cotton4 , R.  Hawes4 , A.  Kalloo5 , S.  Kantsevoy5 , P.  Pasricha6
  • 1Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
  • 2Division of Anatomic Pathology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
  • 3Division of Gastroenterology and Hepatology, The Chinese University of Hong Kong, Hong Kong, China
  • 4Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina, USA
  • 5Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
  • 6Division of Gastroenterology and Hepatology, The University of Texas Medical Branch, Galveston, Texas, USA
Weitere Informationen

Publikationsverlauf

Submitted 9 May 2005

Accepted after revision 15 August 2005

Publikationsdatum:
10. November 2005 (online)

Background and Study Aims: Circumferential endoscopic mucosal resection of the esophagus is complicated by stricture formation. Prophylactic measures for avoiding such strictures have not been well studied. The aim of this preclinical study was to assess strategies for prevention of esophageal strictures in a porcine model following widespread endoscopic mucosal resection (EMR).
Methods: A total of 18 60-kg pigs were included in the study. The roles of strip width (group 1), prophylactic steroids (group 2), and prophylactic stents (group 3) in the prevention of post-mucosectomy strictures were studied. Six animals were included in each group. Esophageal mucosal resection was achieved using a novel widespread EMR technique previously described by our group. Animals in group 1 underwent partial (50 % circumference) mucosal resection without prophylactic measures, while animals in the other two groups underwent circumferential mucosal resection. Animals in group 2 received 80 mg of triamcinolone injected directly into the exposed submucosal tissue (20 mg injection in four quadrants). Animals in group 3 received esophageal metal stents coated with small-intestine submucosa (SIS) that were deployed immediately post-resection. Animals were kept alive for 1 month.
Results: Partial and circumferential widespread EMRs were achieved in all animals. There were no procedural complications. Repeat endoscopy at 1 month showed no strictures in group 1. Only four animals were studied in group 2, owing to the high complication rate (periesophageal abscess in all animals) with one early death. Three of the surviving animals developed mild to tight strictures. In group 3, all animals developed tight strictures; however, there was early stent migration in four animals and premature stent removal in two animals because of persistent vomiting.
Conclusions: Partial widespread EMR of the esophagus heals without stricture formation and does not require prophylactic intervention. The use of deep mural steroid injection following a circumferential resection does not appear to prevent strictures and may result in serious adverse events. Short-term use of esophageal stents is inadequate for stricture prevention. However, better results may be anticipated with longer term (at least 6 weeks) stent use.

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E. Rajan, MD

Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation

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