1108

THE USE OF A SELF-ASSEMBLING PEPTIDE GEL TO PREVENT ESOPHAGEAL STENOSIS DEVELOPMENT AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION: A U.S. MULTICENTER PROSPECTIVE STUDY

Date
May 21, 2024

Background: Esophageal stenosis is a potential risk after endoscopic submucosal dissection (ESD), with incidence ranging from 70-90% among those with mucosal defects involving more than three-quarters of the circumference of the esophagus. Application of a self-assembling peptide (SAP) gel after circumferential ESD in a porcine model has been shown to reduce occurrence of stenosis. We aimed to evaluate the use of this SAP gel for stenosis prevention after esophageal ESD in humans.
Methods: Multicenter prospective study of patients who underwent esophageal ESD between March 2022 to September 2023. Patients were included if they underwent esophageal ESD with mucosal defects involving ≥ 50% of the circumference. SAP gel (Purastat, 3D-Matrix, Tokyo, Japan) was applied immediately following ESD. Esophageal stenosis was defined as cases in which an ordinary-sized 9.8 mm endoscope could not pass through the esophagus and/or symptoms of dysphagia with any narrowing of the esophageal lumen on follow-up. Very high-risk cases were defined as those with mucosal defects involving ≥75% of the circumference.
Results: A total of 35 patients (median age 72.5 years; 80% male) underwent ESD with mucosal defects ≥ 50% of the circumference of the esophagus (Table 1). Most lesions (33/35; 94.3%) were in the distal esophagus/gastroesophageal junction. Median lesion and resected specimen size were 30 (interquartile range [IQR]: 21-40) mm and 50 (IQR: 40-55) mm, respectively. Median mucosal defect longitudinal length was 50 (IQR: 40-60) mm. Overall, esophageal stenosis occurred in 7 out of the 35 patients (20%) at repeat endoscopy (median 2 months; IQR: 1-5). Stenosis occurred in 33.3% (6/18) of the very high-risk cases: 4/4 (100%) among those with mucosal defects involving the entire circumference; and 14.3% (2/14) of those involving between <100% and ≥75%. Characteristics of patients with esophageal stenosis and their management are shown in Table 2. All cases were adequately managed endoscopically with resolution of stenosis and/or symptoms. Three patients (8.6%) developed post-procedural bleeding, of which 2 required repeat endoscopy and 1 was managed expectantly.
Conclusions: The novel SAP gel has been suggested to accelerate mucosal healing by promoting re-epithelialization. In this multicenter prospective study, the rate of esophageal stenosis in very high-risk patients was lower than expected based on the literature. Application of the SAP gel immediately after esophageal ESD may reduce the overall risk of stenosis development in patients with mucosal defects involving more than half of the circumference of the esophagus. Future larger comparative studies are needed to corroborate these initial findings.

Tracks

Related Products

Thumbnail for OUTCOMES OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR SUPERFICIAL ESOPHAGEAL SQUAMOUS NEOPLASMS: A MULTICENTER NORTH AMERICAN EXPERIENCE
OUTCOMES OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR SUPERFICIAL ESOPHAGEAL SQUAMOUS NEOPLASMS: A MULTICENTER NORTH AMERICAN EXPERIENCE
BACKGROUND: Endoscopic submucosal dissection (ESD) is a widely accepted treatment option for superficial esophageal squamous neoplasms (SSN) in Asia and is supported by US society guidelines…
Thumbnail for MULTICENTER STUDY EVALUATING LEARNING CURVES AND COMPETENCE IN COLORECTAL ENDOSCOPIC MUCOSAL RESECTION (C-EMR) AMONG ADVANCED ENDOSCOPY TRAINEES USING AN EMR STANDARDIZED ASSESSMENT TOOL (EMR-STAT): INTERIM ANALYSIS
MULTICENTER STUDY EVALUATING LEARNING CURVES AND COMPETENCE IN COLORECTAL ENDOSCOPIC MUCOSAL RESECTION (C-EMR) AMONG ADVANCED ENDOSCOPY TRAINEES USING AN EMR STANDARDIZED ASSESSMENT TOOL (EMR-STAT): INTERIM ANALYSIS
Training in interventional endoscopy is offered by interventional endoscopy fellowship programs (IEFPs) not accredited by the ACGME. The number of these programs has increased exponentially with a concurrent increase in the breadth and complexity of these procedures…
Thumbnail for OUTCOMES OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR PREVIOUSLY ATTEMPTED COLORECTAL LESIONS: AN INTERNATIONAL MULTICENTER EXPERIENCE
OUTCOMES OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR PREVIOUSLY ATTEMPTED COLORECTAL LESIONS: AN INTERNATIONAL MULTICENTER EXPERIENCE
BACKGROUND: The most common complication after endoscopic mucosal resection (EMR) is delayed bleeding (DB), especially in the proximal colon…
Thumbnail for CLINICAL OUTCOMES OF PERORAL ENDOSCOPIC MYOTOMY (POEM) IN PATIENTS WITH SPASTIC ESOPHAGEAL MOTILITY DISORDERS ON CHRONIC OPIOID USE: A MULTICENTER STUDY
CLINICAL OUTCOMES OF PERORAL ENDOSCOPIC MYOTOMY (POEM) IN PATIENTS WITH SPASTIC ESOPHAGEAL MOTILITY DISORDERS ON CHRONIC OPIOID USE: A MULTICENTER STUDY
BACKGROUND: Video analysis has emerged as a potentially strategy for performance assessment of specialized techniques where local expertise and mentorship are limited…