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内镜下环形黏膜下剥离术后置入支架预防食管狭窄的实验研究

Stenting to prevent esophageal stricture after circumferential endoscopic submucosal dissection: an experimental study.

作者信息

Martinek Jan, Dolezel Radek, Walterova Bara, Kollar Marek, Juhas Stefan, Juhasova Jana, Vackova Zuzana, Hustak Rastislav, Erben Jakub

机构信息

Institute for Clinical and Experimental Medicine, Hepatogastroenterology, Prague, Czech Republic.

Czech Academy of Sciences, Institute of Animal Physiology and Genetics, PIGMOD, Libechov, Czech Republic.

出版信息

Endosc Int Open. 2020 Nov;8(11):E1698-E1706. doi: 10.1055/a-1261-3103. Epub 2020 Oct 22.

Abstract

Circular ESD (CESD) is a treatment option for patients with extensive early esophageal cancer. Its major drawback is the development of a stricture. Stenting may represent an attractive prevention strategy. We designed an experimental study to assess the effect of stents covered with acellular biomatrix (AB) and a drug-eluting stent. Thirty-five 35 pigs underwent CESD and were randomized into six groups: G1 (control), G2 (SEMS), G3 (SEMS + AB), G4 (SEMS + AB + steroid-eluting layer), G5 (biodegradable stent [BD]), G6 (BD + AB). SEMS were placed alongside the post-CESD defect, fixed and removed after 21 days. The main outcomes were stricture development, severity, and histopathology. Pigs with BD stents (G5, 6) experienced severe inflammation and hypergranulation without biodegradation, therefore, these groups were closed prematurely. Significant strictures developed in 29 of 30 pigs (96.7 %). The most severe stricture developed in G2 and G4 (narrowest diameter (mm) 8.5 ± 3, 3 (G2) and 8.6 ± 2.1 (G4) vs. 17 ± 7.3 (G1) and 13.5 ± 8.3 (G3);  < 0.01. Signs of re-epithelization were present in 67 % and 71 % in G1 and G2 and in 100 % in G3 and G4. The most robust re-epithelization layer was present in G4. The inflammation was the most severe in G1 (mean score 2.3) and least severe in G4 (0.4). Stenting did not effectively prevent development of post-CESD esophageal stricture. SEMS with AB resulted in improved re-epithelization and decreased stricture severity. Steroid-eluting SEMS suppressed inflammation. BD stents seem inappropriate for this indication.

摘要

环形内镜黏膜下剥离术(CESD)是广泛早期食管癌患者的一种治疗选择。其主要缺点是会形成狭窄。置入支架可能是一种有吸引力的预防策略。我们设计了一项实验研究来评估覆盖脱细胞生物基质(AB)的支架和药物洗脱支架的效果。35头猪接受了CESD,并被随机分为六组:G1(对照组)、G2(自膨式金属支架[SEMS]组)、G3(SEMS+AB组)、G4(SEMS+AB+类固醇洗脱层组)、G5(可降解支架[BD]组)、G6(BD+AB组)。将SEMS放置在CESD术后缺损处,21天后固定并取出。主要观察指标为狭窄的发生、严重程度和组织病理学。使用BD支架的猪(G5、6组)出现严重炎症和过度肉芽组织增生,且未发生降解,因此,这两组提前结束实验。30头猪中有29头(96.7%)出现了明显的狭窄。G2组和G4组出现了最严重的狭窄(最窄直径(mm):G2组为8.5±3、3,G4组为8.6±2.1,而G1组为17±7.3,G3组为13.5±8.3;P<0.01)。G1组和G2组分别有67%和71%出现了再上皮化迹象,G3组和G4组为100%。G4组出现了最强大的再上皮化层。G1组炎症最严重(平均评分2.3),G4组炎症最轻微(0.4)。置入支架未能有效预防CESD术后食管狭窄的发生。带有AB的SEMS可改善再上皮化并降低狭窄严重程度。类固醇洗脱SEMS可抑制炎症。BD支架似乎不适用于该适应证。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/309f/7581471/d488f8dabb7c/10-1055-a-1261-3103-i1790ei1.jpg

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