Preventive effect of autologous esophageal mucosal flap tip-twisting grafting combined with covered metal stent placement on stenosis after peripheral endoscopic esophageal mucosal dissection in pigs
WANG Limin
WANG Xin
LI Jian
LI Lei
Abstract：Objective To explore the preventive effect of autologous esophageal mucosal flap tip-twisting grafting combined with covered metal stent placement on stenosis after peripheral endoscopic esophageal mucosal dissection(ESD)in pigs.Methods Nine Bama minipigs were selected and randomly divided into the ESD group,stent group,and muco-sal flap+stent group,with three pigs in each group.The peri-esophageal ESD was performed alone in the ESD group,peri-esophageal ESD was performed in the stent group followed by laminar metal stenting in the stent group,and autologous oe-sophageal mucosal flap tip-twist transplantation combined with laminar metal stenting was performed in the mucosal flap+stent group after peri-esophageal ESD.Small pigs were executed 3 weeks after surgery,and the isolated esophagus was dissected to obtain the length of esophageal stenosis and the diameter of the narrowest part of the esophagus,and the in-trinsic damage(MP)grading of the scarred area of the isolated esophageal tissues in the anterior,posterior,left,and right walls of the esophageal tissues was evaluated.The levels of serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),IL-1β,and transforming growth factor-β1(TGF-β1)were detected.Results The esophageal stenosis length was as follows:mucosal flap+stent group<stent group and ESD group(P<0.05),and the difference in the diameter of the narrowest esophagus among the three groups was not statistically significant(P>0.05).The difference in MP grading among the three groups was statistically significant(Z=-6.222,P<0.05),with the mucosal flap+stent group having a lower MP grading.The weight loss rate in the mucosal flap+stent group was lower than those in the stent group and ESD group(both P<0.05),and the difference between the stent group and the ESD group was not statistically significant(P>0.05).There were no statistically significant differences in the preoperative serum TNF-α,IL-6,IL-1β,or TGF-β1 lev-els between groups(all P>0.05);serum TNF-α,IL-6,IL-1β,and TGF-β1 levels were lower in the mucosal flap+stent group at 7 d after surgery than in the stent group and the ESD group(all P<0.05).Conclusion Autologous esophageal mucosal flap tip-twisting grafting combined with covered metal stent placement can effectively prevent esophageal stenosis after total peripheral esophageal ESD,and its effect is better than that of ESD alone or combined covered metal stent placement.
Keywords：esophageal stenosisendoscopic mucosal dissectionautologous esophageal mucosal flap tip-twisting graftingcovered metal stent placement
Publication Date：2025-04-25
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 68-72 )