A Small Intestinal Submucosa For Esophageal Stricture Prevention After Endoscopic Submucosal Dissection

Background: Endoscopic submucosal dissection(ESD)is an effective treatment for early esophageal cancer.However,ESD is likely to cause severe esophageal stenosis,affecting the prognosis and lifespan of patients.Small intestinal submucosa(SIS)is an ideal extracellular matrix(ECM)material.It has high biocompatibility,biomechanical properties and high safety.Objective: Effect of small intestinal submucosa prevention of postoperative stenosis in patients with ESD is discussed.Methods: Nine hybrid pigs were selected to conduct with ESD after the intubation anesthesia.The small intestinal extracellular matrixes of three pigs were placed on the esophageal injury after ESD with stent under the endoscope,marked as SIS group.The stents were placed on the wound of another three pigs,marked as the stent group.The rest three pigs were control group.Endoscopy was performed at the second and the fourth weeks,respectively.Pathological evaluation was performed at the eighth week.Results: After laury sodium sulfate acellular method and enzymic digestion method,hematoxylin and eosin stain detected successful removal of cells.The pig small intestine extracellular matrix was prepared.After the nine hybrid pigs underwent circumferential esophageal ESD,the six pigs in the stent group and the control group had different degrees of mucosal stenosis two weeks after the operation.Three of them were unable to tolerate oral feeding,and conducted with early euthanasia.Endoscopic examination at the second and the fourth weeks showed that the stent group and the control group ESD postoperative wound had inflammation and incomplete epithelial formation.SIS was conducted with endoscopy at the second and the fourth weeks.It was found that the inflammatory reaction after ESD operation was less,and the epithelial tissue was gradually formed.Also,the degree of esophageal stenosis was lower than that of the stent group and the control group.The pathological specimens at the fourth week showed that the mucosal inflammation of the small intestinal submucosa group was less,and the degree of stenosis was lower than the stent group and the control group.Conclusions: In this study,we successfully prepared the small intestinal extracellular matrix of pig with biocompatibility.The occurrence of esophageal stenosis was effectively prevented by placing the matrix on the wound of ESD operation.This study provides a new idea for clinical prevention of esophageal stenosis after ESD,and lays a solid foundation for the preparation and clinical application of tissue engineering biomaterials.