Prevention Of Autologous Esophageal Epithelial Cell Suspension On Esophageal Stricture After Endoscopic Submucosal Dissection

Objective:To investigate the efficacy of autologous esophageal epithelial cell suspension in prevention of esophageal stenosis after endoscopic submucosal dissection（ESD）.Methods:12 pigs underwent circumferential ESD and were randomized into four groups:G1（control）,G2（esophageal stent）,G3（autologous esophageal epithelial cell suspension）,G4（autologous esophageal epithelial cell suspension+esophageal stent）.Health observation and fasting were carried out before ESD.Under general anesthesia,circumferential ESD was performed at 35-40cm of esophagus,and corresponding intervention was carried out.The basic state of each group of pigs was observed after ESD,and the esophageal stricture was evaluated by endoscopy every week.The esophageal stents were removed 3 weeks after ESD,and the animals were sacrificed 4 weeks after ESD or when the animals were unable to eat fluid,and the specimens were evaluated pathologically.Results:At 4 weeks after ESD,weight loss was found in all four groups.The weight loss in G1 was（8.5±1.2）kg,which was more than that in the other three groups[（5.2±0.7）kg（G2）,（3.5±1.2）kg（G3）and（3.0±0.8）kg（G4）,p<0.05].The dysphagia scores of G1,G2,G3 and G4 were 2.3±0.6,2.3±0.6,1.3±0.6,1.6±0.6,1.6±0.6 in the 28^th day after ESD.However,there was no significant difference among all groups.By gross specimen measurement,it was found that the esophageal mucosal stenosis rates of the four groups were（77.7±2.9）%（G1）,（74.2±1.9）%（G2）,（69.2±3.8）%（G3）and（65.9±1.9）%（G4）.The rate of esophageal mucosal stenosis in G1 was the highest(G1 vs.G3,P=0.005;G1 vs.G4,P=0.001.At 4 weeks after operation,the total length of regenerated epithelium in each group was（4.408±1.980）mm（G1）,（8.319±0.857）mm（G2）,（11.801±2.455）mm（G3）and（12.353±1.111）mm（G4）,there was no significant difference between G3 and G4（p=0.706）.Pairwise comparison among each group showed that the degree of re-epithelialization in G1was the lowest after 4 weeks after ESD,followed by G2,and the wound healing was the best in G3 and G4.The maximum vertical thickness of wound fibrous layer in each group was（2.546±0.389）mm（G1）,（2.136±0.231）mm（G2）,（1.126±0.211）mm（G3）and（1.131±0.438）mm（G4）;there was no significant difference between G1 and G2,as well as G3 and G4（G1 vs.G3,P=0.170;G1 vs.G4,P=0.986）.Pairwise comparison among the other groups,p<0.05,the difference between groups was statistically significant,so it can be considered that the degree of wound fibrosis in G1 and G2 is significantly higher.Conclusion:Autologous esophageal epithelial cell suspension can promote re-epithelialization and reduce fibrosis,thus reducing the degree of esophageal stricture,which provides a promising strategy for the prevention of esophageal stricture after ESD.