title: Acellular dermal matrix for esophageal stricture prevention after endoscopic submucosal dissection in a porcine model.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) is considered an effective treatment for early esophageal cancer and precancerous lesions. Esophageal stenosis is closely associated with quasi-circumferential ESD. We examined whether post-ESD esophageal stricture can be prevented by grafting an acellular dermal matrix (ADM) membrane.
  
  
  METHODS
  Fourteen Bama miniature pigs were randomly divided into an ADM group (n = 7) and a control group (n = 7). Semicircumferential ESD was performed at the distal esophagus in all animals, and in the ADM group an ADM patch graft was placed at the resection site and secured innovatively with metal clips. Animals in the control group underwent ESD only. Endoscopy was performed at 3 days, 1 week, 2 weeks, and 4 weeks post-ESD, and fluoroscopy was performed at 4 weeks for assessment of the degree of stenosis, after which the remodeled esophageal tissues were excised for histologic analysis.
  
  
  RESULTS
  No animals in the ADM group developed clinically significant esophageal stenosis, whereas 42.8% (3/7) in the control group did. The degree of stenosis was severe in the control group (39.8% vs 17.2%, respectively; P = .01). Animals in the ADM group had less feeding difficulty and lost less weight (-.9 kg vs -4.1 kg, respectively; P = .007). Histologically, complete mucosal epithelium, slight local inflammation, and organized collagenous fibers were observed in the ADM group.
  
  
  CONCLUSIONS
  ADM patch graft appears, after short-term observation, to be a potentially useful new treatment strategy for prevention of esophageal stricture after ESD. A metal clip fixation technique is effective for endoscopic graft attachment.
authors.affiliation: Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Han
authors.affiliation: Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China.
authors.forename: Jintao
authors.initials: J
authors.lastname: Guo
authors.affiliation: Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China.
authors.forename: Siyu
authors.initials: S
authors.lastname: Sun
authors.affiliation: Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China.
authors.forename: Weichao
authors.initials: W
authors.lastname: Wu
authors.affiliation: Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Wang
authors.affiliation: Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Ge
authors.affiliation: Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Liu
authors.affiliation: Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China.
authors.forename: Guoxin
authors.initials: G
authors.lastname: Wang
authors.affiliation: Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China.
authors.forename: Shupeng
authors.initials: S
authors.lastname: Wang
mesh_terms: D062088:Acellular Dermis; D000818:Animals; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects; D016099:Endoscopy, Gastrointestinal; D000071041:Esophageal Mucosa / Q000000981:diagnostic imaging / Q000473:pathology; D004940:Esophageal Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D004947:Esophagus / Q000601:surgery*; D005471:Fluoroscopy; D011897:Random Allocation; D013552:Swine