Prevention of esophageal stricture after circumferential endoscopic submucosal dissection using a modified self-assembling peptide.

Abstract

Circumferential endoscopic resection (ER) of the esophageal mucosa could find its place in the treatment of dysplastic Barrett's esophagus or extensive squamous cell neoplasia. However, the occurrence of esophageal strictures remains a major complication after ER exceeding 75% of the circumference. The aim of this study was to assess the effect of a modified, pH = 2, self-assembling peptide matrix (4[Arg-Ala-Asp-Ala]) (SAP) on the development of esophageal stricture after circumferential ER in a swine model. We performed a circumferential ER in 35 swine under general anesthesia. Five animals were included in the control group, 11 animals received the SAP matrix immediately after the resection, and 11 received the SAP matrix associated to a local steroid immediately after the resection. Follow-up endoscopy and esophagogram were performed before slaughter and necropsy at day 14. Eight treated animals were kept alive until day 28. At day 14, 27% of the animals in the SAP group developed a symptomatic stricture versus 100% in the control group (P = 0.008) and 50% in the SAP-triamcinolone group (P = 0.11). Application of an SAP matrix after circumferential ER in the swine allowed a significant reduction of the incidence of symptomatic stricture at day 14. Adding triamcinolone brought no significant improvement.

• Authors: Sarra Oumrani, Maximilien Barret, Frédéric Beuvon, Carole Nicco, Charlotte Chêne, Frédéric Batteux, Frédéric Prat
• Journal: Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus (Dis Esophagus) Vol. 34 Issue 8 (Aug 10 2021) ISSN: 1442-2050 [Electronic] United States
• PMID: 33480395 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: [email protected].

Chemical References

• Peptides

Topics

• Animals
• Barrett Esophagus
• Endoscopic Mucosal Resection (adverse effects)
• Esophageal Mucosa
• Esophageal Neoplasms (surgery)
• Esophageal Stenosis (etiology, prevention & control)
• Peptides
• Swine