Video: Gastric to Esophageal Mucosal Transplantation
In the April issue of Gastroenterology, researchers report transplantation of mucosa from a patient’s stomach to esophagus, to prevent stricture formation after circumferential endoscopic mucosal dissection of early-stage esophageal cancer.
Endoscopic submucosal resection and dissection are used to remove areas of dysplasia and cancer from the esophagus. However, stricture formation is a major drawback for resections of more than 60% of the esophageal circumference.
In the issue’s “Gastroenterology in Motion section,” Juergen Hochberger et al. describe transplanting mucosa from a patient’s stomach to esophagus after endoscopic submucosal dissection for early squamous cell cancer of the cervical esophagus.
A video from the authors shows the circumferential spread of the lesion in the cervical esophagus through the sphincter area into the hypopharynx.
Marking of the upper and lower resection field is followed by submucosal injection of hydroxyethylic starch, with subsequent circumferential caudal and cervical incision.
A tubular caudocranial resection is performed using a 1.5-mm Flushknife and the esophageal specimen is set free, dropping down toward the stomach to be retrieved.
A dissection is performed in the gastric antrum and the specimen is cut into 3 slices. These are attached to the muscular layer of the denuded area in the cervical esophagus by means of clips and a noncovered metal stent.
Hochberger et al. report that within 5 months of the procedure, the area of mucosal transplant had grown nearly circumferentially in the cervical esophagus. Biopsies confirmed the presence of gastric antral mucosa. The patient has been followed for more than 32 months without complaints.
The authors conclude that gastro–esophageal mucosal transplantation provides a new approach for preventing stricture formation following widespread endoscopic submucosal resection or submucosal dissection, and provides excellent long-term results.