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J Thorac Cardiovasc Surg 2008;136:1336-1342
© 2008 The American Association for Thoracic Surgery

General Thoracic Surgery

Prevention of stricture development after corrosive esophageal burn with a modified esophageal stent in dogs

Jing-Hai Zhou, MD, Yao-Guang Jiang, MD*, Ru-Wen Wang, MD, Shi-Zhi Fan, MD, Tai-Qian Gong, PhD, Qun-You Tan, PhD, Zheng Ma, PhD, Yun-Ping Zhao, PhD, Bo Deng, MD

Department of Thoracic Surgery, Daping Hospital, Third Military Medical University, Chongqing, China

Received for publication August 18, 2007; revisions received December 8, 2007; accepted for publication February 12, 2008.

* Address for reprints: Yao-Guang Jiang, MD, Department of Thoracic Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China. (Email: zhzhlu1993{at}yahoo.com.cn).

Objective: We sought to test the feasibility and technical ease of a newly designed nitinol–based modified esophageal stent and its effects on preventing postcaustic stricture in mongrel dogs and to try to explain the result at the molecular level.

Methods: Twenty-four dogs were included in this controlled study. Stenosis index (wall thickness/intraluminal diameter), pathologic features, hydroxyproline quantities, esophageal compliance, and biomechanics were compared between the injured but unstented and stented dogs. Transforming growth factor β1, Sma/Mad (Smad)3, and Smad7 mRNA expression and protein levels in esophageal tissue were detected by means of reverse transcriptase–polymerase chain reaction and Western blotting, respectively.

Results: The modified esophageal stent was able to be placed and retrieved successfully and conveniently and was not only intact but there was also no macroscopic esophageal mucosal injury after the stent removal 4 months later. In comparison with the injured but unstented group, esophageal compliance, biomechanics, and the stenosis index were significantly better in the stented group. Histopathologic study revealed that collagen bundles were thinner and its orientation tended toward a regular and parallel pattern. Transforming growth factor β1 and Smad3 mRNA expression and protein levels increased and Smad7 mRNA expression and protein levels decreased significantly in esophageal tissue in the stented group. These variables showed no statistically significant difference 2 months after stent removal.

Conclusions: The modified esophageal stent might be a promising stent in preventing stricture formation after corrosive esophageal burns clinically.

Abbreviations and Acronyms MES = modified esophageal stent; PCR = polymerase chain reaction; TGF-β1 = transforming growth factor β1






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