title: Bio-sheet graft therapy for artificial gastric ulcer after endoscopic submucosal dissection: an animal feasibility study.
abstract: BACKGROUND
  Various bio-sheet grafts have been attempted either to accelerate healing of artificial ulcers or to prevent adverse events after endoscopic submucosal dissection (ESD), but neither prospective nor mechanistic studies were available.
  
  
  OBJECTIVE
  To evaluate the substantial effect of a bio-sheet graft on artificial ulcer healing and its feasibility as an endoscopic treatment modality.
  
  
  METHODS
  Preclinical, in vivo animal experiment and proof-of-concept study.
  
  
  METHODS
  Animal laboratory.
  
  
  METHODS
  Three mini-pigs, Sus scrofa, mean age 14 months.
  
  
  METHODS
  Multiple ulcers sized 2.5 cm in diameter were generated by ESD in 3 mini-pigs and were assigned randomly into the following 3 groups; control group, bio-sheet group, or combination (bio-sheet plus drug) group. Bio-sheet grafts or bio-sheet plus drug combinations were applied on the artificial ulcers immediately after the ESD.
  
  
  METHODS
  Feasibility and efficacy of endoscopic bio-sheet graft therapy for the management of artificial ulcers and the evaluation of healing conditions based on histology changes in the remaining gastric bed tissues harvested from the stomachs.
  
  
  RESULTS
  Thirty-three ESD specimens were obtained. On an image analysis of the ratio of healed area in the remaining gastric bed tissue compared with the matched dissected gastric mucosa, the control group showed the most significant improvement in healing activity among the 3 groups (P < .05), whereas the severity of inflammation in the remaining ulcer tissue was significantly attenuated in bio-sheet and combination groups (P < .05).
  
  
  CONCLUSIONS
  Animal model.
  
  
  CONCLUSIONS
  Although the bio-sheet grafts provided physical protection from gastric acid attack as reflected in the attenuated inflammation on the ulcer beds, unexpected delayed ulcer healing was noted in the bio-sheet graft group because of its physical hindrance of the healing process.
authors.affiliation: Digestive Disease Center, CHA University, Seongnam, Republic of Korea.
authors.forename: Chang-Il
authors.initials: CI
authors.lastname: Kwon
authors.affiliation: Department of Pathology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
authors.forename: Gwangil
authors.initials: G
authors.lastname: Kim
authors.affiliation: Digestive Disease Center, CHA University, Seongnam, Republic of Korea.
authors.forename: Kwang Hyun
authors.initials: KH
authors.lastname: Ko
authors.affiliation: Division of Gastroenterology & Hepatology, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Cheonan Hospital, Cheonan, Republic of Korea.
authors.forename: Yunho
authors.initials: Y
authors.lastname: Jung
authors.affiliation: Division of Gastroenterology & Hepatology, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Cheonan Hospital, Cheonan, Republic of Korea.
authors.forename: Il-Kwun
authors.initials: IK
authors.lastname: Chung
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea.
authors.forename: Seok
authors.initials: S
authors.lastname: Jeong
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea.
authors.forename: Don Haeng
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Digestive Disease Center, CHA University, Seongnam, Republic of Korea.
authors.forename: Sung Pyo
authors.initials: SP
authors.lastname: Hong
authors.affiliation: Digestive Disease Center, CHA University, Seongnam, Republic of Korea.
authors.forename: Ki Baik
authors.initials: KB
authors.lastname: Hahm
mesh_terms: D000818:Animals; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001672:Biocompatible Materials / Q000627:therapeutic use*; D003094:Collagen / Q000627:therapeutic use*; D004210:Dissection / Q000009:adverse effects; D005240:Feasibility Studies; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy; D023421:Models, Animal; D011897:Random Allocation; D013276:Stomach Ulcer / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D034421:Sus scrofa; D014945:Wound Healing
chemical_list: D000897:Anti-Ulcer Agents; D001672:Biocompatible Materials; D003094:Collagen