Lin LiLin, Chen SuYu, Huang Rui, Chen JianHua, Lin Juan, Shi Hong
Department of Endoscopy Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian Branch of Fudan University Shanghai Cancer Center, Fuzhou, Fujian, China.
PLoS One. 2025 Sep 11;20(9):e0331618. doi: 10.1371/journal.pone.0331618. eCollection 2025.
Esophageal endoscopic submucosal dissection (ESD) a more challenging procedure. Numerous studies have explored submucosal injection materials from diverse perspectives. However, there is no consensus yet, and further exploration is still required. This study aimed to evaluate the efficacy of a novel submucosal filler, acetylcysteine, which is commonly used in respiratory medicine, when applied for the first time in ESD procedure of the porcine esophagus.
A self-controlled survival study was carried out on porcine model. In each pig, the novel submucosal filler was injected in one part of the esophagus (Experimental group; Group E), while normal saline was injected in another part (Control group; Group C) during the ESD procedure. Additionally, one pig received a submucosal injection of normal saline as a negative control to observe baseline daily movements and pathology following ESD. One month post- ESD, endoscopic and pathological evaluations were conducted to assess wound healing and other vital organs, allowing for a comprehensive assessment of the long - term impact and efficacy of the filler in this novel application context.
The dissection time per unit area in Group E was notably shorter than in Group C (3.79 ± 1.38 minutes vs. 5.79 ± 1.22 minutes; P = 0.004). Group E also required a smaller volume of submucosal filler per unit area than Group C (3.48 ± 1.07 ml vs. 7.48 ± 3.96 ml; P = 0.039). However, There were no significant differences between Group E and Group C regarding the complication rate and thickness of the submucosal layer in the ESD specimens. Pathological evaluation of wound healing and other vital organs demonstrated comparable results in Group E and Group C.
This novel submucosal filler can expedite the ESD process without increasing the incidence of complications.
食管内镜黏膜下剥离术（ESD）是一项更具挑战性的手术。众多研究已从不同角度探索了黏膜下注射材料。然而，尚未达成共识，仍需进一步探索。本研究旨在评估一种新型黏膜下填充剂——乙酰半胱氨酸（常用于呼吸医学领域）首次应用于猪食管ESD手术时的疗效。
在猪模型上进行了一项自身对照的生存研究。在每头猪的ESD手术过程中，在食管的一部分注射新型黏膜下填充剂（实验组；E组），而在另一部分注射生理盐水（对照组；C组）。此外，一头猪接受黏膜下注射生理盐水作为阴性对照，以观察ESD术后的基线日常活动和病理情况。ESD术后1个月，进行内镜和病理评估，以评估伤口愈合情况及其他重要器官，从而全面评估该填充剂在这一新型应用环境中的长期影响和疗效。
E组每单位面积的剥离时间明显短于C组（3.79±1.38分钟对5.79±1.22分钟；P = 0.004）。E组每单位面积所需的黏膜下填充剂体积也比C组小（3.48±1.07毫升对7.48±3.96毫升；P = 0.039）。然而，E组和C组在ESD标本的并发症发生率和黏膜下层厚度方面无显著差异。伤口愈合及其他重要器官的病理评估显示，E组和C组结果相当。
这种新型黏膜下填充剂可加快ESD手术进程，且不增加并发症发生率。
