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01-02-2020

Mucosal loss as a critical factor in esophageal stricture formation after mucosal resection: a pilot experiment in a porcine model

Authors: Bing-Rong Liu, Dan Liu, Wenyi Yang, Saif Ullah, Zhen Cao, Dezhi He, Xuehui Zhang, Yang Shi, Yangyang Zhou, Yong Chen, Donghai He, Lixia Zhao, Yulian Yuan, Deliang Li

Published in: Surgical Endoscopy | Issue 2/2020

Abstract

Background and aim

Esophageal stricture is a major complication of large areas endoscopic submucosal dissection (ESD). Until now, the critical mechanism of esophageal stricture remains unclear. We examined the role of mucosal loss versus submucosal damage in esophageal stricture formation after mucosal resection using a porcine model.

Materials and methods

Twelve swine were randomly divided into two groups, each of 6. In each group, two 5-cm-long submucosal tunnels were made to involve 1/3rd of the widths of the anterior and posterior esophageal circumference. The entire mucosal roofs of both tunnels were resected in group A. In group B, the tunnel roof mucosa was incised longitudinally along the length of the tunnel, but without excision of any mucosa. Stricture formation was evaluated by endoscopy after 1, 2, and 4 weeks, respectively. Anatomical and histological examinations were performed after euthanasia.

Results

Healing observed on endoscopy in both groups after 1 week. Group A (mucosa resected) developed mild-to-severe esophageal stricture, dysphagia, and weight loss. In contrast, no esophageal stricture was evident in group B (mucosa incisions without resection) after 2 and 4 weeks, respectively. Macroscopic examination showed severe esophageal stricture and shortening of esophagus in only group A. Inflammation and fibrous hyperplasia of the submucosal layer was observed on histological examination in both groups.

Conclusion

The extent of loss of esophageal mucosa appears to be a critical factor for esophageal stricture. Inflammation followed by fibrosis may contribute to alteration in compliance of the esophagus but is not the main mechanism of postresection stricture.

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Title: Mucosal loss as a critical factor in esophageal stricture formation after mucosal resection: a pilot experiment in a porcine model
Authors: Bing-Rong Liu
Dan Liu
Wenyi Yang
Saif Ullah
Zhen Cao
Dezhi He
Xuehui Zhang
Yang Shi
Yangyang Zhou
Yong Chen
Donghai He
Lixia Zhao
Yulian Yuan
Deliang Li
Publication date: 01-02-2020
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 2/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-06793-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Mucosal loss as a critical factor in esophageal stricture formation after mucosal resection: a pilot experiment in a porcine model

Abstract

Background and aim

Materials and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background and aim

Materials and methods

Results

Conclusion

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