Stenting to prevent esophageal stricture after circumferential endoscopic submucosal dissection: an experimental study
| Autor: | Jakub Erben, Stefan Juhas, Jana Juhasova, Marek Kollar, Rastislav Hustak, Bara Walterova, Radek Dolezel, Zuzana Vackova, Jan Martinek |
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| Rok vydání: | 2020 |
| Předmět: |
Original article
medicine.medical_specialty business.industry medicine.medical_treatment Stent Treatment options Endoscopic submucosal dissection Esophageal cancer medicine.disease Severe inflammation Surgery Esophageal stricture medicine lcsh:Diseases of the digestive system. Gastroenterology Pharmacology (medical) Histopathology lcsh:RC799-869 business |
| Zdroj: | Endoscopy International Open Endoscopy International Open, Vol 08, Iss 11, Pp E1698-E1706 (2020) |
| ISSN: | 2196-9736 2364-3722 |
| DOI: | 10.1055/a-1261-3103 |
| Popis: | Background and study aims Circular ESD (CESD) is a treatment option for patients with extensive early esophageal cancer. Its major drawback is the development of a stricture. Stenting may represent an attractive prevention strategy. We designed an experimental study to assess the effect of stents covered with acellular biomatrix (AB) and a drug-eluting stent. Materials and methods Thirty-five 35 pigs underwent CESD and were randomized into six groups: G1 (control), G2 (SEMS), G3 (SEMS + AB), G4 (SEMS + AB + steroid-eluting layer), G5 (biodegradable stent [BD]), G6 (BD + AB). SEMS were placed alongside the post-CESD defect, fixed and removed after 21 days. The main outcomes were stricture development, severity, and histopathology. Results Pigs with BD stents (G5, 6) experienced severe inflammation and hypergranulation without biodegradation, therefore, these groups were closed prematurely. Significant strictures developed in 29 of 30 pigs (96.7 %). The most severe stricture developed in G2 and G4 (narrowest diameter (mm) 8.5 ± 3, 3 (G2) and 8.6 ± 2.1 (G4) vs. 17 ± 7.3 (G1) and 13.5 ± 8.3 (G3); P Conclusions Stenting did not effectively prevent development of post-CESD esophageal stricture. SEMS with AB resulted in improved re-epithelization and decreased stricture severity. Steroid-eluting SEMS suppressed inflammation. BD stents seem inappropriate for this indication. |
| Databáze: | OpenAIRE |
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