Topic Highlight
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World J Gastroenterol. Nov 7, 2014; 20(41): 15098-15109
Published online Nov 7, 2014. doi: 10.3748/wjg.v20.i41.15098
Prevention of esophageal strictures after endoscopic submucosal dissection
Shinichiro Kobayashi, Nobuo Kanai, Takeshi Ohki, Ryo Takagi, Naoyuki Yamaguchi, Hajime Isomoto, Yoshiyuki Kasai, Takahiro Hosoi, Kazuhiko Nakao, Susumu Eguchi, Masakazu Yamamoto, Masayuki Yamato, Teruo Okano
Shinichiro Kobayashi, Nobuo Kanai, Takeshi Ohki, Ryo Takagi, Naoyuki Yamaguchi, Yoshiyuki Kasai, Takahiro Hosoi, Masayuki Yamato, Teruo Okano, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
Shinichiro Kobayashi, Susumu Eguchi, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8102, Japan
Nobuo Kanai, Takeshi Ohki, Masakazu Yamamoto, Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
Naoyuki Yamaguchi, Hajime Isomoto, Kazuhiko Nakao, Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8102, Japan
Yoshiyuki Kasai, Graduate School of Advanced Science and Engineering, Life Science and Medical Bioscience, Waseda University, Tokyo 162-8480, Japan
Takahiro Hosoi, Department of Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Tokyo University of Science, Chiba 278-8501, Japan
Author contributions: Kobayashi S designed and wrote the introductory editorial for the Highlight Topic “Prevention of esophageal strictures after endoscopic submucosal dissection”; Yamato M and Eguchi S confirmed and edited the entire content of the main body of text; Yamaguchi N, Isomoto H and Nakao K provided suggestions and edited the content, figure, and table for the subsection “ANTI-INFLAMMATORY APPROACHES” in this article; Kanai N, Ohki T and Yamamoto M provided suggestions and edited the content and figures for the subsection “Transplanting autologous oral epithelial mucosal cell sheets into the artificial ulcer sites after ESD” in this article; Takagi R, Yamaguchi N, Kasai Y and Hosoi T provided suggestions and edited the content and figure for the subsection “Preparing autologous oral mucosal epithelial cell sheets for clinical application” in this article; Okano T supervised total research projects related to the manuscript and approved the final submission of this article.
Supported by The Creation of Innovation Centers for Advanced Interdisciplinary Research Areas Program that was part of the Project for Developing Innovation Systems by the Cell Sheet Tissue Engineering Center from the Ministry of Education, Culture, Sports, Science and Technology, Japan
Correspondence to: Teruo Okano, PhD, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. tokano@abmes.twmu.ac.jp
Telephone: +81-3-53679945  Fax: +81-3-33596046
Received: November 29, 2013
Revised: April 29, 2014
Accepted: May 19, 2014
Published online: November 7, 2014
Processing time: 346 Days and 9.3 Hours
Abstract

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have recently been accepted as less invasive methods for treating patients with early esophageal cancers such as squamous cell carcinoma and dysplasia of Barrett’s esophagus. However, the large defects in the esophageal mucosa often cause severe esophageal strictures, which dramatically reduce the patient’s quality of life. Although preventive endoscopic balloon dilatation can reduce dysphagia and the frequency of dilatation, other approaches are necessary to prevent esophageal strictures after ESD. This review describes several strategies for preventing esophageal strictures after ESD, with a particular focus on anti-inflammatory and tissue engineering approaches. The local injection of triamcinolone acetonide and other systemic steroid therapies are frequently used to prevent esophageal strictures after ESD. Tissue engineering approaches for preventing esophageal strictures have recently been applied in basic research studies. Scaffolds with temporary stents have been applied in five cases, and this technique has been shown to be safe and is anticipated to prevent esophageal strictures. Fabricated autologous oral mucosal epithelial cell sheets to cover the defective mucosa similarly to how commercially available skin products fabricated from epidermal cells are used for skin defects or in cases of intractable ulcers. Fabricated autologous oral-mucosal-epithelial cell sheets have already been shown to be safe.

Keywords: Endoscopic submucosal dissection, Esophageal stricture, Systemic steroid therapy, Autologous oral mucosal epithelial cell sheet

Core tip: Esophageal strictures after extensive endoscopic submucosal dissection (ESD) reduce quality of life. Endoscopic local injections and the oral administration of steroids are safe and effective for preventing esophageal strictures. In addition, several tissue engineering therapies have been used in attempts to overcome severe esophageal strictures. Cell-based tissue engineering therapy with fabricated autologous oral mucosal epithelial cell sheets has been used to prevent esophageal strictures after ESD in nine patients. This therapy has been shown to be safe and may be widely used in the future.