title: Amniotic membrane grafts for the prevention of esophageal stricture after circumferential endoscopic submucosal dissection.
abstract: OBJECTIVE
  The prevention of esophageal strictures following circumferential mucosal resection remains a major clinical challenge. Human amniotic membrane (AM) is an easily available material, which is widely used in ophthalmology due to its wound healing, anti-inflammatory and anti-fibrotic properties. We studied the effect of AM grafts in the prevention of esophageal stricture after endoscopic submucosal dissection (ESD) in a swine model.
  
  
  METHODS
  In this prospective, randomized controlled trial, 20 swine underwent a 5 cm-long circumferential ESD of the lower esophagus. In the AM Group (n = 10), amniotic membrane grafts were placed on esophageal stents; a subgroup of 5 swine (AM 1 group) was sacrificed on day 14, whereas the other 5 animals (AM 2 group) were kept alive. The esophageal stent (ES) group (n = 5) had ES placement alone after ESD. Another 5 animals served as a control group with only ESD.
  
  
  RESULTS
  The prevalence of symptomatic strictures at day 14 was significantly reduced in the AM group and ES groups vs. the control group (33%, 40% and 100%, respectively, p = 0.03); mean esophageal diameter was 5.8±3.6 mm, 6.8±3.3 mm, and 2.6±1.7 mm for AM, ES, and control groups, respectively. Median (range) esophageal fibrosis thickness was 0.87 mm (0.78-1.72), 1.19 mm (0.28-1.95), and 1.65 mm (0.7-1.79) for AM 1, ES, and control groups, respectively. All animals had developed esophageal strictures by day 35.
  
  
  CONCLUSIONS
  The anti-fibrotic effect of AM on esophageal wound healing after ESD delayed the development of esophageal stricture in our model. However, this benefit was of limited duration in the conditions of our study.
authors.affiliation: Department of Gastroenterology, Cochin Hospital, Paris, France; Faculté Paris Descartes, Paris, France.
authors.forename: Maximilien
authors.initials: M
authors.lastname: Barret
authors.affiliation: Department of Gastroenterology, Cochin Hospital, Paris, France; Faculté Paris Descartes, Paris, France.
authors.forename: Carlos Alberto
authors.initials: CA
authors.lastname: Pratico
authors.affiliation: Department of Gastroenterology, Cochin Hospital, Paris, France; Faculté Paris Descartes, Paris, France.
authors.forename: Marine
authors.initials: M
authors.lastname: Camus
authors.affiliation: Faculté Paris Descartes, Paris, France; Department of Pathology, Cochin Hospital, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Beuvon
authors.affiliation: Human Tissue Bank, Saint-Louis Hospital, Paris, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Jarraya
authors.affiliation: Faculté Paris Descartes, Paris, France; Department of Immunology and EA 1833, Cochin Hospital, Paris, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Nicco
authors.affiliation: Department of Gastroenterology, Cochin Hospital, Paris, France.
authors.forename: Luigi
authors.initials: L
authors.lastname: Mangialavori
authors.affiliation: Department of Gastroenterology, Cochin Hospital, Paris, France; Faculté Paris Descartes, Paris, France.
authors.forename: Stanislas
authors.initials: S
authors.lastname: Chaussade
authors.affiliation: Faculté Paris Descartes, Paris, France; Department of Immunology and EA 1833, Cochin Hospital, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Batteux
authors.affiliation: Department of Gastroenterology, Cochin Hospital, Paris, France; Faculté Paris Descartes, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Prat
mesh_terms: D000650:Amnion / Q000637:transplantation*; D000818:Animals; D004210:Dissection / Q000009:adverse effects; D004940:Esophageal Stenosis / Q000473:pathology / Q000517:prevention & control*; D004945:Esophagoscopy / Q000009:adverse effects; D004947:Esophagus / Q000473:pathology* / Q000601:surgery; D006801:Humans; D018384:Oxidative Stress; D011183:Postoperative Complications / Q000517:prevention & control*; D011897:Random Allocation; D013552:Swine; D019737:Transplants / Q000473:pathology*; D014945:Wound Healing