The use of a self-assembling peptide gel for stricture prevention in the esophagus after endoscopic submucosal dissection: a U.S. multicenter prospective study (with video).

Background and Aims: Postoperative stricture is a serious common adverse event after extensive endoscopic submucosal dissection (ESD) in the esophagus. Self-assembling peptide (SAP) gel has been shown to promote tissue healing and re-epithelialization. The aim of this study was to evaluate the effect of the SAP gel for esophageal stricture prevention after ESD.
Methods: This was a multicenter prospective study of patients who underwent esophageal ESD followed by SAP gel application between March 2022 and December 2023. Patients were included if the ESD mucosal defect involved ≥50% of the circumference of the esophagus. High-risk cases were defined as mucosal defects ≥75% of the circumference. Stricture was defined as the inability to pass an endoscope ≥8.9 mm in diameter or a narrow-caliber lumen in a patient with symptoms.
Results: A total of 43 patients (median age, 71 years; 81.4% male) underwent ESD (median resected specimen size, 50 mm) during the study period. SAP gel (median, 3 mL) was successfully applied in all cases (median time, 4 minutes). In aggregate, stricture occurred in 20.9% (9 of 43) of the cases. Stricture developed in 30.8% of the high-risk cases: 80% (4 of 5) after circumferential ESD and 19% (4 of 21) in those with defects ≥75% but <100% of the circumference. All cases of stricture resolved with endoscopic treatment. Three cases (6.9%) of postoperative bleeding occurred and were adequately managed endoscopically.
Conclusions: We show that SAP gel application was easy, quick, and associated with a relatively low stricture rate comparable to other prophylactic methods. Additional comparative studies are needed to corroborate these preliminary findings.
Competing Interests: Disclosure D. Yang: consultant for Olympus, Fujifilm, Boston Scientific, Medtronic, 3D-Matrix, Microtech, and Neptune Medical; and research grants from Microtech and 3D-Matrix. M. K. Hasan: consultant for Boston Scientific, Olympus, Neptune Medical, and Microtech. M. Gabr: consultant for Boston Scientific, Olympus, ConMed, 3D-Matrix, Fujifilm, and Adaptiv Endo. S. Jawaid: consultant for Lumendi, Creo Medical, and ConMed. M. Othman: consultant for Olympus, Boston Scientific, Creo Medical, Apollo Endosurgery, Lumendi, AbbVie, and Nestle; and research support from Boston Scientific, ConMed, Lucid Diagnostic, AbbVie, and Nestle. M. J. Rojas De Leon: Consultant for Boston Scientific. N. Sharma: consultant for Boston Scientific, Medtronic, Steris, and Olympus. P. V. Draganov: consultant for Olympus, Fujifilm, Boston Scientific, Medtronic, Microtech, Cook Medical, and 3D-Matrix. All other authors disclosed no financial relationships. The study was supported by a research grant from 3D-Matrix. 3D-Matrix was not involved in the design of the study, its conduct, analysis, or interpretation of study results. None of the authors participated in the development of the self-assembling peptide gel or benefit from its sales.
(Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)