Endoscopy 2019; 51(04): S79
DOI: 10.1055/s-0039-1681401
ESGE Days 2019 oral presentations
Friday, April 5, 2019 17:00 – 18:30: ESD esophagus Congress Hall
Georg Thieme Verlag KG Stuttgart · New York

NON-CELLULAR MATRIX FROM PORCINE DERMIS IN PREVENTION OF ESOPHAGEAL STRICTURE AFTER CIRCUMFERENTIAL ENDOSCOPIC SUBMUCOSAL DISSECTION – AN EXPERIMENTAL STUDY

R Dolezel
1   Laboratory of Cell Regeneration and Plasticity, PIGMOD, Institute of Animal Physiology and Genetics CAS, v.v.i., Libechov, Czech Republic
2   Department of Surgery, 2nd Faculty of Medicine, Charles University and Central Military Hospital, Prague, Czech Republic
,
B Walterova
1   Laboratory of Cell Regeneration and Plasticity, PIGMOD, Institute of Animal Physiology and Genetics CAS, v.v.i., Libechov, Czech Republic
3   Third Faculty of Medicine, Charles University, Prague, Czech Republic
,
Z Vackova
4   Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
,
S Juhas
1   Laboratory of Cell Regeneration and Plasticity, PIGMOD, Institute of Animal Physiology and Genetics CAS, v.v.i., Libechov, Czech Republic
,
J Juhasova
1   Laboratory of Cell Regeneration and Plasticity, PIGMOD, Institute of Animal Physiology and Genetics CAS, v.v.i., Libechov, Czech Republic
,
M Kollar
5   Department of Clinical and Transplant Pathology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
,
J Klima
1   Laboratory of Cell Regeneration and Plasticity, PIGMOD, Institute of Animal Physiology and Genetics CAS, v.v.i., Libechov, Czech Republic
,
J Martinek
1   Laboratory of Cell Regeneration and Plasticity, PIGMOD, Institute of Animal Physiology and Genetics CAS, v.v.i., Libechov, Czech Republic
4   Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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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.