New technique improves ulcer healing after esophageal ESD

Ohki T et al. (2006) Treatment of oesophageal ulcerations using endoscopic transplantation of tissue-engineered autologous oral mucosal epithelial cell sheets in a canine model. Gut 55: 1704–1710

Endoscopic submucosal dissection (ESD) can remove large esophageal lesions in one procedure, but epithelial loss creates an ulcer. Ulcer healing can cause esophageal scarring and stenosis, which requires repeated balloon dilation or stenting and impairs patients' quality of life. Ohki and colleagues report that ESD combined with transplantation of autologous cell sheets derived from buccal epithelium markedly improved ulcer healing in a canine model.

Ohki and colleagues treated six male, 1-year-old dogs with ESD, to create an ulcer 5 cm long and half the internal circumference of the distal esophagus. Three controls received ESD only; in the other three dogs ESD was immediately followed by transplantation of two 24 mm² epithelial cell sheets per ulcer, cultured from a previously harvested 10 mm² buccal epithelial cell biopsy. Cell sheets were attached to the wound with 10 min of gentle pressure from the endoscope, without sutures or clips.

The cultured cell sheets were thinner than native epithelium, but possessed histologic features of normal esophageal epithelium. By 8 days after treatment, transplanted epithelium covered most of the ulceration. By 4 weeks after transplantation, the wounds were completely covered with an intact, mature epithelium that resembled normal esophageal epithelium, whereas the wounds of control animals were still healing.

Ohki and colleagues now plan to use their technique to treat patients with early esophageal carcinoma. They note that their technique could broaden the applicability of ESD to other conditions, such as Barrett's esophagus.