title: Prevention of esophageal stricture after endoscopic submucosal dissection using tissue-engineered cell sheets.
abstract: OBJECTIVE
  The use of esophageal endoscopic submucosal dissection (ESD) to remove superficial esophageal neoplasms is gradually becoming more common in Japan. However, large-scale esophageal ESD often requires subsequent multiple balloon dilations to prevent postoperative esophageal stricture. We investigated the safety and efficacy of endoscopic transplantation of tissue-engineered autologous oral mucosal epithelial cell sheets in preventing formation of strictures after ESD.
  
  
  METHODS
  We performed an open-label, single-arm, single-institute study. We collected specimens of oral mucosal tissue from 9 patients with superficial esophageal neoplasms. Epithelial cell sheets were fabricated ex vivo by culturing isolated cells for 16 days on temperature-responsive cell culture surfaces. After a reduction in temperature, these sheets were endoscopically transplanted directly to the ulcer surfaces of patients who had just undergone ESD. All patients were monitored by endoscopy once a week until epithelialization was complete.
  
  
  RESULTS
  Autologous cell sheets were successfully transplanted to ulcer surfaces using an endoscope. Complete re-epithelialization occurred within a median time of 3.5 weeks. No patients experienced dysphagia, stricture, or other complications following the procedure, except for one patient who had a full circumferential ulceration that expanded to the esophagogastric junction.
  
  
  CONCLUSIONS
  Sutureless, endoscopic transplantation of carrier-free cell sheets composed of autologous oral mucosal epithelial cells safely and effectively promotes re-epithelialization of the esophagus after ESD. Patients in this study did not experience any serious complications. This procedure might be used to prevent stricture formation following ESD and improve patients' quality of life. Further study will be needed to show that stricture formation can be prevented.
authors.affiliation: Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan; Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ohki
authors.affiliation: Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yamato
authors.affiliation: Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Masaho
authors.initials: M
authors.lastname: Ota
authors.affiliation: Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Takagi
authors.affiliation: Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan; Graduate School of Science and Engineering, Waseda University, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Murakami
authors.affiliation: Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan; Graduate School of Science and Engineering, Waseda University, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Kondo
authors.affiliation: Department of Oral and Maxillofacial Surgery, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Sasaki
authors.affiliation: Graduate School of Science and Engineering, Waseda University, Tokyo, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Namiki
authors.affiliation: Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: tokano@abmes.twmu.ac.jp.
authors.forename: Teruo
authors.initials: T
authors.lastname: Okano
authors.affiliation: Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002478:Cells, Cultured; D004210:Dissection / Q000009:adverse effects* / Q000379:methods; D004847:Epithelial Cells / Q000637:transplantation*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology / Q000517:prevention & control*; D004945:Esophagoscopy / Q000009:adverse effects*; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D013997:Time Factors; D023822:Tissue Engineering; D054457:Tissue Scaffolds; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014456:Ulcer / Q000473:pathology / Q000601:surgery; D014945:Wound Healing