Post written by Dennis Yang, MD, from the Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA.

Endoscopic submucosal dissection (ESD) has become an increasingly endorsed technique for the management of superficial neoplasia in the esophagus. The main limitation with ESD in the esophagus is the high rate of stricture formation. The aim of this multicenter study was to evaluate the safety and efficacy of a novel self-assembling peptide (SAP) gel for stricture prevention after esophageal ESD.

Esophageal stricture formation is very common after wide-field endoscopic resection. No single effective prophylaxis therapy for stricture prevention has been established. Stricture formation is associated with high morbidity, need for repeated procedures and health care resource use, and poor quality of life.

A total of 43 patients underwent ESD with mucosal defects more than 50% of the esophageal circumference. SAP gel was applied to the mucosal defect after ESD. At follow-up, the overall rate of stricture formation was 21%.

When stratified based on the extent of the mucosal defect, stricture formation developed in 80% of those who had circumferential ESD, but only in 19% in those with at least 75% involvement. The stricture rate was low at 6% for those patients who had a mucosal defect extending between 50% and 75% of the circumference.

Future prospective studies comparing SAP gel with other prophylactic measures are needed to corroborate these initial findings.

Patient flowchart. ESD, Endoscopic submucosal dissection.

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