Transplantation of Mucosa From Stomach to Esophagus to Prevent Stricture After Circumferential Endoscopic Submucosal Dissection of Early Squamous Cell (original) (raw)

Gastroenterology, 2014

Abstract

ABSTRACT Background and aims ESD in the esophagus is an expert technique for 'en bloc' resection of mucosal cancers >2cm in size. Secondary stricture formation is the major drawback. Since march 2011 we had been performing animal experiments concerning esophageal ESD and retransplantation of esophageal and gastric mucosal patches in pigs. We report on the first clinical case in man with longterm FU. Clinical case and description of technology 72 y old male p; early esophageal SCC (17.5-25cm, cervical esophagus to hypopharynx; Paris IIa; >75% circumferential; EUS UT1a, m, N0). Discussion in tumor board/with patient. On April 13, 2011 as compassionate use at first tubular esophageal ESD 17-27cm aborally followed by a 9×4-6 cm gastric ESD in the antrum (video). Attachment of 3 gastric mucosal stripes to the denuded esophageal muscular layer by hemoclips, secured by a non-covered SEMS to allow luminal and vascular nutrition of the specimen. Sphincter area of 1.5cm spared. Specimen: low horny early SCC (pT1a, G2, L-, V-, R0; invasion to lp <150mc; low risk). Stent removal at day 20, multiple islets of gastric mucosa with stepwise circular spread out over 5-6cm within the next 6 month and successful prevention of stenosis. In contrast, the 1-1.5cm non-transplant covered segment in the sphincter area showed a tendency to stricture formation requiring repetitive dilations. Conclusions The so far unique case of successful endoscopic gastro-esophageal mucosal transplantation for stricture prevention after wide-spread ESD in the esophagus opens a new perspective for systematic research in this field.

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