Eduard Jonas1,2, Sebastian Sjöqvist3, Peter Elbe1,2, Nobuo Kanai4, Jenny Enger5, Stephan L Haas1, Ammar Mohkles-Barakat1, Teruo Okano4, Ryo Takagi4, Takeshi Ohki4,6, Masakazu Yamamoto6, Makoto Kondo7, Katrin Markland5, Mei Ling Lim3, Masayuki Yamato4, Magnus Nilsson1,2, Johan Permert2,8, Pontus Blomberg5,9, J-Matthias Löhr1,2. 1. Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden. 2. Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden. 3. Advanced Centre for Translational Regenerative Medicine (ACTREM), Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden. 4. Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan. 5. Vecura, Clinical Research Centre, Karolinska University Hospital, Stockholm, Sweden. 6. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 7. Centre for Haematology and Regenerative Medicine (HERM), Karolinska Institutet, Stockholm, Sweden. 8. Innovation Office, Karolinska University Hospital, Stockholm, Sweden. 9. Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
Abstract
BACKGROUND AND OBJECTIVE: Endoscopic mucosal dissection (ESD) is a treatment option for oesophagus tumours localized to the mucosa enabling en bloc removal of large lesions. The resulting larger mucosal defects have resulted in an increase in the occurrence of post-treatment strictures. Transplantation of autologous cell sheets, cultured from oral mucosa, has been shown to prevent post-ESD strictures. The aim of the study was to assess the efficacy and safety of cell sheet transplantation after oesophageal ESD in a Western patient population where reflux-associated pre-malignant and malignant conditions predominate. METHODS: Patients with Barrett's oesophagus associated high-grade dysplasia or early adenocarcinoma where ESD entailed a resection >3 cm in length and ≥75% of the circumference were eligible for treatment under hospital exemption. Cell sheets were cultured from buccal mucosa according to Good Manufacturing Practice and were endoscopically applied to the post-ESD defect directly after resection. Patients were followed with weekly endoscopy examinations, including confocal laser microscopy, for a total of four weeks. RESULTS: Five patients were treated. ESD was extensive with resections being circumferential in three patients and 9-10 cm in length in two. The number of transplanted cell sheets ranged from two to six. Three patients developed strictures requiring two to five dilatation sessions. CONCLUSIONS: Cell sheet transplantation shows to be safe and feasible in a Western population. Results suggest that transplantation has a protective effect on the mucosal defect after ESD, decreasing both the risk for and extent of stricture formation.
BACKGROUND AND OBJECTIVE: Endoscopic mucosal dissection (ESD) is a treatment option for oesophagus tumours localized to the mucosa enabling en bloc removal of large lesions. The resulting larger mucosal defects have resulted in an increase in the occurrence of post-treatment strictures. Transplantation of autologous cell sheets, cultured from oral mucosa, has been shown to prevent post-ESD strictures. The aim of the study was to assess the efficacy and safety of cell sheet transplantation after oesophageal ESD in a Western patient population where reflux-associated pre-malignant and malignant conditions predominate. METHODS:Patients with Barrett's oesophagus associated high-grade dysplasia or early adenocarcinoma where ESD entailed a resection >3 cm in length and ≥75% of the circumference were eligible for treatment under hospital exemption. Cell sheets were cultured from buccal mucosa according to Good Manufacturing Practice and were endoscopically applied to the post-ESD defect directly after resection. Patients were followed with weekly endoscopy examinations, including confocal laser microscopy, for a total of four weeks. RESULTS: Five patients were treated. ESD was extensive with resections being circumferential in three patients and 9-10 cm in length in two. The number of transplanted cell sheets ranged from two to six. Three patients developed strictures requiring two to five dilatation sessions. CONCLUSIONS: Cell sheet transplantation shows to be safe and feasible in a Western population. Results suggest that transplantation has a protective effect on the mucosal defect after ESD, decreasing both the risk for and extent of stricture formation.
Authors: H Takahashi; Y Arimura; S Okahara; S Uchida; S Ishigaki; H Tsukagoshi; Y Shinomura; M Hosokawa Journal: Endoscopy Date: 2011-01-13 Impact factor: 10.093
Authors: Jessica M Leers; Steven R DeMeester; Arzu Oezcelik; Nancy Klipfel; Shahin Ayazi; Emmanuele Abate; Jörg Zehetner; John C Lipham; Linda Chan; Jeffrey A Hagen; Tom R DeMeester Journal: Ann Surg Date: 2011-02 Impact factor: 12.969
Authors: Anand P Tamhankar; Jeffrey H Peters; Giussepe Portale; Chih-Cheng Hsieh; Jeffrey A Hagen; Cedric G Bremner; Tom R DeMeester Journal: J Gastrointest Surg Date: 2004-11 Impact factor: 3.452
Authors: Stephen F Badylak; Toshitaka Hoppo; Alejandro Nieponice; Thomas W Gilbert; Jon M Davison; Blair A Jobe Journal: Tissue Eng Part A Date: 2011-03-28 Impact factor: 3.845