An Inflatable Device for Esophageal ESD Using Cell Sheet Engineering

Introduction: Large endoscopic submucosal dissection (ESD) of superficial esophageal cancers often requires subsequent of balloon dilation operations to prevent post-operative esophageal constriction. We therefore have previously developed a novel method to transplant oral mucosal epithelial cell sheets using cell sheet engineering to promote wound healing after ESD (Gut, 1704-1720, 2006). Although we have demonstrated the successful transplantation of two cell sheets, it has remained difficult to transplant cell sheets to the entire surface of esophageal ulcerative wound site using our previous. We therefore develop a novel device for the endoscopic delivery and transplantation of cell sheets. Methods: Oral mucosal epithelial cell sheets (24mm×24mm) from beagle dogs were harvested by simply reducing the temperature 2 weeks after seeding oral mucosal epithelial cells on temperature-responsive dishes. Using a novel inflatable device a carrier of the engineered tissues, four individual cell sheets were then simultaneously transplanted to an artificial circumferential esophageal ulceration of a deceased pig (n=5). Results: An inflatable balloon was attached to the exterior of standard EEMR-tube with an outer cylindricalcover. For transplantation, the device was carefully moved to the ulcer site by endoscopy. Ten minutes after transplantation we macroscopically confirmed complete circumferential transplantation of oral mucosal cell sheets. Iodine staining indicated that the all of the cell sheets were successfully attached to the esophageal ulcer. Histological results also confirmed that the epithelial cell sheets were attached to the remnant submucosal layers. Conclusions: Our results show that this novel balloon device completely enables to the simultaneous, controlled transplantation of several tissue engineered cell sheets by endoscopy. This ability to simply cover circumferential esophageal ulcerations with a single procedure creates new a potential treatment in endoscopic treatment of Barrett’s esophagus with high grade dysplasia, using ESD in conjunction with cell sheet engineering.

Session: Podium Presentation

Program Number: S067