Post written by Siyu Sun MD, PhD, and Ye Han MD, PhD, from the Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China.

Esophageal stenosis is closely associated with quasi-circumferential endoscopic submucosal dissection (ESD). We examined whether post-ESD esophageal stricture can be prevented by grafting an acellular dermal matrix (ADM) membrane in a large animal model.

Patients undergoing extensive near-circumferential ESD will develop strictures in up to 90% of cases. Traditional treatments may either have a long treatment period or potentially put patients at risk of severe adverse events. Thus, stricture formation after extended esophageal ESD remains challenging. As the most promising strategy for regeneration medicine, tissue engineering has attracted a great deal of attention since it first appeared in the 1980s. It has been shown to promote tissue remodeling in different wound healing processes and is currently being investigated in clinical trials in several fields. We were enlightened by studies showing that ADM can repair oral mucosal defects and wondered if it could be applied to endoscopic field.

Figure 1. Placement of the acellular dermal matrix (ADM) graft. A, The semicircumferential defect. B, The ADM is grasped with endoscopic forceps. C, The ADM is placed over the ulcer. D-F, The ADM sheet is attached at the site of the defect with metal clips.

This is the first study in which ADM grafts have been successfully placed in the digestive tract with metal clips. The local effect of the ADM provided a favorable environment for ulcer healing. This study has shown the effectiveness of ADM graft implantation for the prevention of postoperative esophageal stricture after semi-circumferential ESD. Early epithelialization, minimization of the associated inflammatory response, and organized tissue remodeling are thought to be the mechanisms by which ADM implantation promotes ulcer healing. In our study, the metal clip was used for the endoscopic suture of biologic scaffolds and esophageal wound to evaluate its curative effect. Heterogeneous acellular dermal matrix can be used in the field of endoscopy, and it is feasible and effective. Next we need to further explore the repair of artificial ulceration after nearly-circumferential ESD for fixation of the ADM in the mucosal defect. A new endoscopic puncture-suture device may be designed to attach biologic scaffolds to the nearly circumferential mucosal defect. We must plan future studies to verify its feasibility and try to apply the results of animal experiments to clinical practice.

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