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首页> 外文期刊>BMC Gastroenterology >Different healing process of esophageal large mucosal defects by endoscopic mucosal dissection between with and without steroid injection in an animal model
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Different healing process of esophageal large mucosal defects by endoscopic mucosal dissection between with and without steroid injection in an animal model

机译：在有和没有类固醇注射的动物模型中，通过内镜下黏膜剥离术对食管大黏膜缺损的不同愈合过程

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Background Stricture formation is one of the major complications after endoscopic removal of large superficial squamous cell neoplasms of the esophagus, and local steroid injections have been adopted to prevent it. However, fundamental pathological alterations related to them have not been well analyzed so far. The aim of this study was to analyze the time course of the healing process of esophageal large mucosal defects resulting in stricture formation and its modification by local steroid injection, using an animal model. Methods Esophageal circumferential mucosal defects were created by endoscopic mucosal dissection (ESD) for four pigs. One pig was sacrificed five minutes after the ESD, and other two pigs were followed-up on endoscopy and sacrificed at the time of one week and three weeks after the ESD, respectively. The remaining one pig was followed-up on endoscopy with five times of local steroid injection and sacrificed at the time of eight weeks after the ESD. The esophageal tissues of all pigs were subjected to pathological analyses. Results For the pigs without steroid injection, the esophageal stricture was completed around three weeks after the ESD on both endoscopy and esophagography. Histopathological examination of the esophageal tissues revealed that spindle-shaped α-smooth muscle actin (SMA)-positive myofibroblasts arranged in a parallel fashion and extending horizontally were identified at the ulcer bed one week after the ESD, and increased contributing to formation of the stenotic luminal ridge covered with the regenerated epithelium three weeks after the ESD. The proper muscle layer of the stricture site was thinned with some myocytes which seemingly showed transition to the myofibroblast layer. By contrast, for the pig with steroid injection, esophageal stricture formation was not evident with limited appearance of the spindle-shaped myofibroblasts, instead, appearance of stellate or polygocal SMA-positive stromal cells arranged haphazardly in the persistent granulation tissue of the ulcer site. Conclusions Proliferation of spindle-shaped myofibroblasts arranged in a parallel fashion is likely to play an important role in stricture formation after circumferential mucosal defects by esophageal ESD, which may be related to the thinning of the proper muscle layer in the healing course of the defects. Local steroid injection seems to be effective to prevent the stricture through the modification of this process.
机译：背景技术内镜下切除食管的大型浅层鳞状细胞瘤后，狭窄的形成是主要并发症之一，并已采用局部类固醇注射来预防。然而，到目前为止，与它们相关的基本病理改变尚未得到很好的分析。这项研究的目的是使用动物模型分析食管大粘膜缺损愈合过程的时程，导致狭窄形成并通过局部类固醇注射对其进行修饰。方法采用内镜下黏膜剥离术（ESD）对4只猪进行食管周围黏膜缺损。 ESD后五分钟处死一只猪，对其他两只猪进行内窥镜检查，分别在ESD后一星期和三周时处死。其余的一头猪在内窥镜检查中进行五次局部类固醇注射，并在ESD后八周时处死。所有猪的食道组织均进行了病理分析。结果对于未注射类固醇的猪，内镜和食管造影检查均在ESD后三周左右完成了食管狭窄。食管组织的组织病理学检查显示，在ESD后1周，在溃疡床上发现了呈平行排列并水平延伸的纺锤形α-平滑肌肌动蛋白（SMA）阳性成肌纤维细胞，并增加了狭窄的形成ESD后三周，腔覆盖有再生上皮。狭窄部位的适当肌肉层被一些肌细胞减薄了，这似乎表明它已转变为成肌纤维细胞层。相比之下，对于注射类固醇的猪来说，食管狭窄的形成并不明显，纺锤形的成肌纤维细胞的外观有限，而是在溃疡部位的持续肉芽组织中无规则地排列了星状或多目标SMA阳性基质细胞。结论食管ESD引起的梭形肌成纤维细胞的增殖可能在周围粘膜缺损后狭窄形成狭窄的过程中起重要作用，这可能与缺陷愈合过程中适当的肌肉层变薄有关。局部类固醇注射似乎通过改变这一过程可有效防止狭窄。

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