Aims:
To evaluate the effect of metallic or biodegradable (BD) stents covered with or without
non-cellular matrix (Matrix, Xe-Derma) in preventing of esophageal stricture after
circumferential endoscopic submucosal dissection (CESD) in experimental pigs.
Methods:
Pigs were randomized into 6 groups: A. control – CESD only (n = 6); B. CESD + systemic
corticosteroids (SC) (n = 6); C. CESD + Self-Expandable Metal Stent (SEMS, WallFlex)
+ SC (n = 8); D. CESD + SEMS + Matrix + SC (n = 8); E. CESD + BD stent (ELLA-CS) +
SC (n = 3); F. CESD + BD stent + Matrix + SC (n = 2).
Results:
A total of 33 pigs underwent CESD in the mid esophagus. All pigs with BD stent experienced
macroscopic inflammation, massive hyper-granulation and food stagnation inside the
stent while stent biodegradation did not occur. Except one animal from group B significant
strictures developed in all pigs (groups A and B) in 12.9 ± 0.1 days after CESD and
in 13.9 ± 1.4 days after SEMS extraction (groups C and D). The longest strictures
were observed in the group A (2.7 ± 1.3 cm) and the shortest in SEMS groups (C, D)
(1.5 ± 0.8 cm and 1.6 ± 1.1 cm). The narrowest strictures occurred in groups A and
C (Ø= 2.71 ± 0.99 mm and 2.8 ± 1.18 mm) vs. groups B and D (Ø= 4.46 ± 1.31 mm and
4.33 ± 2.45 mm).
Conclusions:
None of the tested methods resulted in the effective prevention of post-CESD esophageal
stricture. The SEMS coverage with non-cellular matrix from porcine dermis resulted
in reduced severity of stenosis and improved healing quality. The BD stent is inappropriate
in this indication.
Acknowledgement:
Supported by the Ministry of Health, Project Reg. No. 16 – 27653A, the National Sustainability
Program I, project No. LO1609 (Czech Ministry of Education), and RVO: 67985904.
