Wang Hua, Shuai Qun, Tang Jian, Long Dan, Xu Chen, Liu Feng, Li Zhao-Shen
Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Department of Gastroenterology, Second Hospital of Longyan, Longyan, China.
Dig Dis. 2019;37(2):87-92. doi: 10.1159/000492216. Epub 2018 Nov 14.
Endoscopic submucosal dissection (ESD) is widely used in the treatment of early esophageal cancer. However, the incidence of postoperative esophageal stricture is relatively high, especially after full circumferential ESD. Previous studies have shown that thymosin β4 (Tβ4) has anti-fibrotic activity and prevents scar formation. In this study, we investigated the safety and therapeutic effect of Tβ4 injection in preventing esophageal stricture after circumferential ESD in a porcine model.
A total of 8 Bama pigs underwent esophageal circumferential ESD under anesthesia (n = 4 for experimental and control group). Local injection of Tβ4 gel was administered in the experimental group. Follow-up endoscopy was conducted, and balloon dilation (EBD) was performed to prevent the occurrence of esophageal stricture.
Esophageal stricture developed after circumferential ESD in all pigs. Local Tβ4 gel injection has shortened resolution of the stricture (p = 0.012) and was associated with a lesser number of EBD sessions (p = 0.002). The severity of esophageal stricture was milder in the experimental group (p = 0.046 vs. control group). No adverse events occurred in the study.
Local Tβ4 gel injection appeared to be safe and effective for the prevention of esophageal stricture after circumferential ESD in a porcine model.
内镜黏膜下剥离术（ESD）广泛应用于早期食管癌的治疗。然而，术后食管狭窄的发生率相对较高，尤其是全周ESD术后。既往研究表明，胸腺素β4（Tβ4）具有抗纤维化活性并可预防瘢痕形成。在本研究中，我们在猪模型中探究了注射Tβ4预防全周ESD术后食管狭窄的安全性和治疗效果。
共8只巴马猪在麻醉下接受食管全周ESD（实验组和对照组各4只）。实验组局部注射Tβ4凝胶。进行随访内镜检查，并实施球囊扩张（EBD）以预防食管狭窄的发生。
所有猪在全周ESD术后均发生食管狭窄。局部注射Tβ4凝胶缩短了狭窄的消退时间（p = 0.012），且与较少的EBD次数相关（p = 0.002）。实验组食管狭窄的严重程度较轻（与对照组相比，p = 0.046）。研究中未发生不良事件。
在猪模型中，局部注射Tβ4凝胶预防全周ESD术后食管狭窄似乎是安全有效的。
