Autologous buccal keratinocyte implantation for the prevention of stenosis after EMR of the esophagus

BackgroundEMR is a minimally invasive and well-accepted therapy for early esophageal cancer. However, extensive or circumferential EMR induces stricture formation. Cultured skin is now clinically applicable by using the technology of regenerative medicine. Esophageal mucosa also consists of keratinocytes, the same as with skin. We, therefore, hypothesized that, by applying the technology of regenerative medicine, the stricture occurring in the esophagus after EMR on broad lesions could be prevented.ObjectiveThe aim of this study was to evaluate, in a swine model, the effect of autologous keratinocyte implantation at the site after EMR to prevent stricture.DesignWith the pig under general anesthesia, EMR was carried out by using the cap technique. Two separate areas were resected by EMR. One area was left as a control. For the other area, autologous buccal keratinocytes were injected endoscopically.Main Outcome MeasurementsThe outcome, after 2 weeks, was evaluated by endoscopy, macroscopy, and histology.ResultsAt 2 weeks after EMR, scar formation and stricture were observed in the control lesion. However, in the keratinocyte implanted lesion, the lesion was covered with an epithelium and the luminal surface of the lesion was flat, without ulceration.ConclusionsThese results showed the feasibility of performing autologous keratinocyte implantation after EMR and the effect for early reepithelialization.