Background and study aims Circular ESD (CESD) is a treatment option for patients with extensive early esophageal cancer. Its major drawback is the development of a stricture. Stenting may represent an attractive prevention strategy. We designed an experimental study to assess the effect of stents covered with acellular biomatrix (AB) and a drug-eluting stent. Materials and methods Thirty-five 35 pigs underwent CESD and were randomized into six groups: G1 (control), G2 (SEMS), G3 (SEMS + AB), G4 (SEMS + AB + steroid-eluting layer), G5 (biodegradable stent [BD]), G6 (BD + AB). SEMS were placed alongside the post-CESD defect, fixed and removed after 21 days. The main outcomes were stricture development, severity, and histopathology. Results Pigs with BD stents (G5, 6) experienced severe inflammation and hypergranulation without biodegradation, therefore, these groups were closed prematurely. Significant strictures developed in 29 of 30 pigs (96.7 %). The most severe stricture developed in G2 and G4 (narrowest diameter (mm) 8.5 ± 3, 3 (G2) and 8.6 ± 2.1 (G4) vs. 17 ± 7.3 (G1) and 13.5 ± 8.3 (G3); P < 0.01. Signs of re-epithelization were present in 67 % and 71 % in G1 and G2 and in 100 % in G3 and G4. The most robust re-epithelization layer was present in G4. The inflammation was the most severe in G1 (mean score 2.3) and least severe in G4 (0.4). Conclusions Stenting did not effectively prevent development of post-CESD esophageal stricture. SEMS with AB resulted in improved re-epithelization and decreased stricture severity. Steroid-eluting SEMS suppressed inflammation. BD stents seem inappropriate for this indication.

Charles University 1st Faculty of Medicine Institute of Physiology Prague Czech Republic

Charles University Department of Surgery 2nd Faculty of Medicine Central Military Hospital Prague Czech Republic

Czech Academy of Sciences Institute of Animal Physiology and Genetics PIGMOD Libechov Czech Republic

Institute for Clinical and Experimental Medicine Clinical and Transplant Pathology Centre Prague Czech Republic

Institute for Clinical and Experimental Medicine Hepatogastroenterology Prague Czech Republic

Technical University of Liberec Faculty of Textile Engineering Department of Nonwovens and Nanofibrous Materials Liberec Czech Republic

University of Ostrava Faculty of Medicine Department of Clinic Subjects Ostrava Czech Republic

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Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T et al.Endoscopic submucosal issection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015;47:829–854. PubMed

Miwata T, Oka S, Tanaka S et al.Risk factors for esophageal stenosis after entire circumferential endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Surg Endosc. 2016;30:4049–4056. PubMed

Martínek J, Juhas S, Dolezel R et al.Prevention of esophageal strictures after circumferential endoscopic submucosal dissection. Minerva Chir. 2018;73:394–409. PubMed

Oliveira J F, Moura E G, Bernardo W M et al.Prevention of esophageal stricture after endoscopic submucosal dissection: a systematic review and meta-analysis. Surg Endosc. 2016;30:2779–2791. PubMed

Wen J, Lu Z, Yang Y et al.Preventing stricture formation by covered esophageal stent placement after endoscopic submucosal dissection for early esophageal cancer. Dig Dis Sci. 2014;59:658–663. PubMed

Pauli E M, Schomisch S J, Furlan J P et al.Biodegradable esophageal stent placement does not prevent high-grade stricture formation after circumferential mucosal resection in a porcine model. Surg Endosc. 2012;26:3500–3508. PubMed PMC

Zajicek R, Mandys V, Mestak O et al.Human keratinocyte growth and differentiation on acellular porcine dermal matrix in relation to wound healing potential. Sci World J. 2012;2012:727352. PubMed PMC

Matoušková E, Mestak O. The effect of different biologic and biosynthetic wound covers on keratinocyte growth, stratification and differentiation in vitro. J Tissue Eng. 2014;5:2.041731414554966E15. PubMed PMC

Zajicek R, Matouskova E, Broz L et al.New biological temporary skin cover Xe-Derma (®) in the treatment of superficial scald burns in children. Burns. 2011;37:333–337. PubMed

Fischer A, Bausch D, Baier P et al.Risk of biodegradable stent-induced hypergranulation causing re-stenosis of a gastric conduit after esophageal resection. Endoscopy. 2012;44:E125–126. PubMed

Saito Y, Tanaka T, Andoh A et al.Novel biodegradable stents for benign esophageal strictures following endoscopic submucosal dissection. Dig Dis Sci. 2008;53:330–333. PubMed

Shi Q, Ju H, Yao L Q et al.Risk factors for postoperative stricture after endoscopic submucosal dissection for superficial esophageal carcinoma. Endoscopy. 2014;46:640–644. PubMed

Yamaguchi N, Isomoto H, Nakayama T et al.Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest Endosc. 2011;73:1115–1121. PubMed

Shoji H, Yamaguchi N, Isomoto H et al.Oral prednisolone and triamcinolone injection for gastric stricture after endoscopic submucosal dissection. Ann Transl Med. 2014;2:22. PubMed PMC

Hashimoto S, Kobayashi M, Takeuchi M et al.The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection. Gastrointest Endosc. 2011;74:1389–1393. PubMed

Takahashi H, Arimura Y, Okahara S et al.A randomized controlled trial of endoscopic steroid injection for prophylaxis of esophageal stenoses after extensive endoscopic submucosal dissection. BMC Gastroenterol. 2015;15:1. PubMed PMC

Hashimoto S, Mizuno K I, Takahashi K et al.Evaluating the effect of injecting triamcinolone acetonide in two sessions for preventing esophageal stricture after endoscopic submucosal dissection. Endosc Int Open. 2019;7:E764–E770. PubMed PMC

Martinek J. How to prevent post-ESD esophageal stricture. Endosc Int Open. 2019;7:E771–E773. PubMed PMC

Ye L P, Zheng H H, Mao X L et al.Complete circular endoscopic resection using submucosal tunnel technique combined with esophageal stent placement for circumferential superficial esophageal lesions. Surg Endosc. 2016;30:1078–1085. PubMed

Han Y, Guo J, Sun S et al.Acellular dermal matrix for esophageal stricture prevention after endoscopic submucosal dissection in a porcine model. Gastrointest Endosc. 2017;86:1160–1167. PubMed

Schomisch S J, Yu L, Wu Y et al.Commercially available biological mesh does not prevent stricture after esophageal mucosectomy. Endoscopy. 2014;46:144–148. PubMed PMC

Barret M, Pratico C A, Camus M et al.Amniotic membrane grafts for the prevention of esophageal stricture after circumferential endoscopic submucosal dissection. PLoS One. 2014;9:e100236. PubMed PMC

Li L, Linghu E, Chai N. Efficacy of triamcinolone-soaked polyglycolic acid sheet plus fully covered metal stent for preventing stricture formation after large esophageal endoscopic submucosal dissection. Dis Esophagus. 2019;32 doi: 10.1093/dote/doy121. PubMed DOI