Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan; Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan.
Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan.
Gastroenterology. 2012 Sep;143(3):582-588.e2. doi: 10.1053/j.gastro.2012.04.050. Epub 2012 May 3.
BACKGROUND & AIMS: The use of esophageal endoscopic submucosal dissection (ESD) to remove superficial esophageal neoplasms is gradually becoming more common in Japan. However, large-scale esophageal ESD often requires subsequent multiple balloon dilations to prevent postoperative esophageal stricture. We investigated the safety and efficacy of endoscopic transplantation of tissue-engineered autologous oral mucosal epithelial cell sheets in preventing formation of strictures after ESD.
We performed an open-label, single-arm, single-institute study. We collected specimens of oral mucosal tissue from 9 patients with superficial esophageal neoplasms. Epithelial cell sheets were fabricated ex vivo by culturing isolated cells for 16 days on temperature-responsive cell culture surfaces. After a reduction in temperature, these sheets were endoscopically transplanted directly to the ulcer surfaces of patients who had just undergone ESD. All patients were monitored by endoscopy once a week until epithelialization was complete.
Autologous cell sheets were successfully transplanted to ulcer surfaces using an endoscope. Complete re-epithelialization occurred within a median time of 3.5 weeks. No patients experienced dysphagia, stricture, or other complications following the procedure, except for one patient who had a full circumferential ulceration that expanded to the esophagogastric junction.
Sutureless, endoscopic transplantation of carrier-free cell sheets composed of autologous oral mucosal epithelial cells safely and effectively promotes re-epithelialization of the esophagus after ESD. Patients in this study did not experience any serious complications. This procedure might be used to prevent stricture formation following ESD and improve patients' quality of life. Further study will be needed to show that stricture formation can be prevented.
在日本，使用食管内镜黏膜下剥离术（ESD）切除食管浅表性肿瘤的情况越来越普遍。然而，大规模的食管 ESD 通常需要随后进行多次球囊扩张，以预防术后食管狭窄。我们研究了内镜移植组织工程化自体口腔黏膜上皮细胞片在预防 ESD 后狭窄形成方面的安全性和有效性。
我们进行了一项开放标签、单臂、单中心研究。我们从 9 名患有食管浅表性肿瘤的患者中采集口腔黏膜组织标本。通过在温度响应细胞培养表面上培养分离的细胞 16 天，体外制造上皮细胞片。降低温度后，将这些细胞片直接内镜移植到刚刚接受 ESD 的患者的溃疡表面上。所有患者在完成上皮化之前每周通过内镜进行一次监测。
使用内镜成功地将自体细胞片移植到溃疡表面上。中位时间为 3.5 周时，完全再上皮化发生。除了一名患者发生全周溃疡扩展到食管胃交界的情况外，所有患者在手术后均未出现吞咽困难、狭窄或其他并发症。
无缝线、内镜移植由自体口腔黏膜上皮细胞组成的无载体细胞片安全有效地促进 ESD 后食管的再上皮化。本研究中的患者未出现任何严重并发症。该方法可能用于预防 ESD 后狭窄形成并提高患者的生活质量。需要进一步的研究来证明可以预防狭窄形成。
