Deployment of carboxymethyl cellulose sheets to prevent esophageal stricture after full circumferential endoscopic submucosal dissection: A porcine model

作者：Jian, Tang; Shufang, Ye; Xueliang, Ji; Feng, Liu; Zhaoshen, Li

来源：Digestive Endoscopy, 2018, 30(5): 608-615.

DOI：10.1111/den.13070

<jats:sec><jats:title>Background and Aim</jats:title><jats:p>Esophageal stricture is a serious adverse event secondary to extensive endoscopic submucosal dissection (<jats:styled-content style="fixed-case">ESD</jats:styled-content>). The present study aimed to investigate the efficacy of carboxymethyl cellulose (<jats:styled-content style="fixed-case">CMC</jats:styled-content>) sheets for the prevention of esophageal stricture after full circumferential <jats:styled-content style="fixed-case">ESD</jats:styled-content> in an animal model.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Fourteen porcine models were randomized into a control group (<jats:italic>n</jats:italic> = 7) and a <jats:styled-content style="fixed-case">CMC</jats:styled-content> group (<jats:italic>n</jats:italic> = 7). Five‐centimeter‐long circumferential esophageal <jats:styled-content style="fixed-case">ESD</jats:styled-content> was carried out at a distance of 40 to 45 cm from the incisors in all models. In the <jats:styled-content style="fixed-case">CMC</jats:styled-content> group, <jats:styled-content style="fixed-case">CMC</jats:styled-content> sheets were placed over the mucosal defect completely after <jats:styled-content style="fixed-case">ESD</jats:styled-content>, whereas the control group underwent routine <jats:styled-content style="fixed-case">ESD</jats:styled-content> only. Endoscopic examination was conducted after the first and second week post‐<jats:styled-content style="fixed-case">ESD</jats:styled-content>. 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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The <jats:styled-content style="fixed-case">CMC</jats:styled-content> group had better food tolerability during the second week post‐<jats:styled-content style="fixed-case">ESD</jats:styled-content>. The <jats:styled-content style="fixed-case">CMC</jats:styled-content> 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 <jats:styled-content style="fixed-case">CMC</jats:styled-content> group. Serum transforming growth factor beta 1 levels were significantly lower in the <jats:styled-content style="fixed-case">CMC</jats:styled-content> group post‐<jats:styled-content style="fixed-case">ESD</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Deployment of <jats:styled-content style="fixed-case">CMC</jats:styled-content> sheets on the mucosal defect appears to be a promising method for preventing esophageal strictures after extensive <jats:styled-content style="fixed-case">ESD</jats:styled-content>.</jats:p></jats:sec>

• 出版日期2018-9
• 单位中国人民解放军第二军医大学