Liu Yong, Li Zhengqi, Dou Lizhou, Zhang Yueming, He Shun, Zhu Jiqing, Ke Yan, Liu Xudong, Liu Yumeng, Ng Hoiloi, Wang Guiqi
Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ann Transl Med. 2021 Apr;9(7):546. doi: 10.21037/atm-20-6987.
This research aimed at investigating the safety and efficacy of autologous esophageal mucosa (AEM) with polyglycolic acid (PGA) transplantation and temporary stent implantation (TSI) in preventing esophageal stenosis (ES) after early esophageal cancer (EC) surgery.
Between April 2019 and October 2020, patients scheduled for circumferential endoscopic submucosal dissection (ESD) were prospectively recruited. After ESD, autologous esophageal mucosal patches (MPs) were constructed on the absorbable PGA felt. Then, the felt was structured onto a covered metal mesh stent (CMMS) and attached to the ulcer surface. The stents were removed 6-8 weeks after the operation. The occurrence of ES and adverse events was observed and analyzed.
Data from 25 patients were analyzed. In total, 14 patients (56%) had no stenosis during an average follow-up of 10.2 months, and 11 patients (44%) suffered strictures at a mean interval of 63.73 days after the ESD procedure. Stent migration occurred in 2 patients. No other complications, including perforations, bleeding, or wound infections, occurred. The median of endoscopic balloon dilatation (EBD) sessions was 2.16 (range, 0-14). There showed a higher post-ESD stricture rate in patients with lesions located in the middle-lower esophagus (P<0.05). More transplanted MPs may reduce the occurrence of ES.
AEM with PGA transplantation and TSI is a safe and effective approach of preventing ES and improving the life quality after circumferential ESD.
本研究旨在探讨自体食管黏膜（AEM）联合聚乙醇酸（PGA）移植及临时支架植入（TSI）在早期食管癌（EC）手术后预防食管狭窄（ES）的安全性和有效性。
2019年4月至2020年10月，前瞻性招募计划接受环周内镜黏膜下剥离术（ESD）的患者。ESD术后，在可吸收的PGA毡片上构建自体食管黏膜补片（MPs）。然后，将毡片构建在覆膜金属网支架（CMMS）上并附着于溃疡表面。术后6 - 8周取出支架。观察并分析ES的发生情况及不良事件。
分析了25例患者的数据。平均随访10.2个月，共有14例患者（56%）无狭窄，11例患者（44%）在ESD术后平均63.73天出现狭窄。2例患者发生支架移位。未发生其他并发症，包括穿孔、出血或伤口感染。内镜下球囊扩张（EBD）次数的中位数为2.16（范围0 - 14）。病变位于食管中下段的患者ESD术后狭窄率较高（P<0.05）。更多的移植MPs可能会减少ES的发生。
AEM联合PGA移植及TSI是预防ES及提高环周ESD术后生活质量的一种安全有效的方法。
