Commercially available biological mesh does not prevent stricture after esophageal mucosectomy.
OBJECTIVE
Endoscopic mucosal resection (EMR) offers a minimally invasive therapy for advanced esophageal dysplasia and early cancers but stricture formation limits its applicability. We aimed at assessing the efficacy of placement of a commercially available biological mesh for preventing stricture formation following esophageal EMR.


METHODS
25 swine were submitted to circumferential esophageal EMR with 10-cm extent and divided in five groups: one group with EMR only (control); one receiving an uncovered stent (stent-only group); and three groups receiving a stent covered with one of three extracellular matrices, namely small intestine submucosa (SIS group), acellular dermal matrix (ADM group), or urinary bladder matrix (UBM group). Stricture formation was evaluated with weekly esophagograms.


RESULTS
The stent-only group had significantly less stricture formation and survival was extended compared with controls (4.8 vs. 2.4 weeks). Compared with stenting only, the addition of a biological mesh did not reduce stricture formation: percent reductions in esophageal diameter for the groups were SIS 86 %, ADM 94 %, and UBM 94 %, compared with 82 % in the stent-only group.


CONCLUSIONS
Placement of commercially available biological meshes did not alter remodeling sufficiently to prevent stricture formation after esophageal EMR.
Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Steve J
SJ
Schomisch
Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Liming
L
Yu
Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Yuhsin
Y
Wu
Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Eric M
EM
Pauli
Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Cassandra
C
Cipriano
Division of Gastroenterology, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Amitabh
A
Chak
Miraca Life Sciences Inc, Irving, Texas, USA.
Richard H
RH
Lash
Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Jeffrey L
JL
Ponsky
Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Jeffrey M
JM
Marks
D062088:Acellular Dermis; D000818:Animals; D004940:Esophageal Stenosis / Q000209:etiology / Q000517:prevention & control*; D004945:Esophagoscopy; D004947:Esophagus / Q000601:surgery*; D005109:Extracellular Matrix; D009092:Mucous Membrane / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D015607:Stents; D013526:Surgical Mesh; D013552:Swine; D016896:Treatment Outcome