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Stricture prevention after extended circumferential endoscopic mucosal resection by injecting autologous keratinocytes in the sheep esophagus

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Abstract

Background

During the past decades, endoscopic mucosal resection (EMR) has been developed to treat early intramucosal esophageal cancers and dysplastic Barrett’s esophagus. The primary drawback of this method is severe postsurgical esophageal stricture formation. The purpose of this preclinical study was to assess strategies for prevention of this major complication by injecting autologous keratinocytes in the EMR mucosal defect in the sheep model.

Methods

Circumferential, 6-cm–long EMRs were performed in the esophagus of nine sheep. Autologous keratinocytes were harvested 2 weeks before EMR and cultured. Circumferential resection consisted of two opposite hemicircumferential mucosectomies allowing a widespread resection of 24 cm2. Immediately after EMR, autologous keratinocytes were endoscopically injected in the mucosal defect. Animals were sacrificed after 6 months.

Results

Circumferential EMRs were successfully performed in all animals. There were no intra- or postoperative complications. None of the animals developed strictures. All animals were sacrificed at 6 months as planned. Histological examinations showed fibrotic changes in 10 % (range 0–25 %) of the circumferential muscularis propria interna layer and 7.2 % (range 0–25 %) in the muscularis propria externa layer at the midportion of the EMR. No circumferential transmural fibrosis was identified.

Conclusions

Prevention of stricture formation after extensive (6-cm long) circumferential EMR of the sheep esophagus can be achieved by injecting autologous keratinocytes into the wound of the resected mucosal segment.

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Disclosures

Drs. Barbara F. Zuercher, Mercy George, Anette Escher, Elsa Piotet, Christos Ikonomidis, and Snezana Blant Andrejevic have no conflicts of interest or financial ties to disclose. The senior author Philippe Monnier will hold a financial relationship with the Storz Company, if the device reaches the market. For the present study, full intellectual independence of the authors was guaranteed.

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Authors and Affiliations

  1. Head and Neck Surgery, Department of Oto-Rhino-Laryngology, University Hospital (CHUV), Lausanne, Switzerland

    Barbara F. Zuercher, Mercy George, Anette Escher, Elsa Piotet, Christos Ikonomidis & Philippe Monnier

  2. Institute of Pathology, University Hospital (CHUV), Lausanne, Switzerland

    Snezana Blant Andrejevic

  3. Head and Neck Surgery, Department of Oto-Rhino-Laryngology, Inselspital, University of Bern, 3010, Bern, Switzerland

    Barbara F. Zuercher

Authors
  1. Barbara F. Zuercher
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  2. Mercy George
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  3. Anette Escher
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  4. Elsa Piotet
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  5. Christos Ikonomidis
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  6. Snezana Blant Andrejevic
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  7. Philippe Monnier
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Correspondence to Barbara F. Zuercher.

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Zuercher, B.F., George, M., Escher, A. et al. Stricture prevention after extended circumferential endoscopic mucosal resection by injecting autologous keratinocytes in the sheep esophagus. Surg Endosc 27, 1022–1028 (2013). https://doi.org/10.1007/s00464-012-2509-8

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  • DOI: https://doi.org/10.1007/s00464-012-2509-8

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