E0189 - Using the Matrix: Efficacy of Extracellular Matrix in Treatment Algorithm for Recurrent Benign Esophageal Stricture Therapy

Deepa Kumarjiguda, DO¹, Nihit Shah, MD¹, Bradley D. Confer, DO², Harshit S. Khara, MD, FACG^1
1Geisinger Health System, Danville, PA; ²Geisinger Medical Center, Danville, PA

Introduction: Recurrent benign esophageal stricture (RBES) is caused by chronic inflammation from GERD, radiation, or surgery. Despite various therapeutic options including dilation, incision, steroid injection, and self-expandable metal stents, efficacy of these interventions remains suboptimal ranging between 20% to 63.6%.

Methods: We designed a proof-of-concept endoscopic technique that utilizes a biodegradable scaffold membrane composed of extracellular matrix (ECM) as part of our stricture management algorithm to stimulate site specific tissue repair.

Results: Ten patients, mean age 61 years (38-80) with 6 females:4 males, presented with four types of RBES (40% peptic, 30% anastomotic, 20% post Zenker’s septotomy and 10% fistula-related) were recruited to undergo ECM placement as part of their stricture management algorithm (Table 1). Mean follow up duration was 811 days (42-1726).
In patients with post Zenker’s septotomy strictures, there was 100% complete resolution of symptoms at two months with no further interventions required.
In peptic strictures, the average therapy interval was extended from 6.5 weeks to 9.3 weeks after ECM therapy, leading to 17% reduction in treatment frequency following ECM.
There was no change in therapy frequency in patients with post-surgical anastomotic esophageal strictures or fistula-related stenosis. The mean number of procedures required was reduced by 30% for peptic strictures and by 38% for anastomotic strictures.

Discussion: Our novel technique demonstrates that the utilization of ECM membrane as part of the treatment algorithm of RBES reduces both the frequency and the number of repeat interventions in select patients. Post septotomy and peptic strictures responded the best to ECM therapy in conjunction with other modalities compared to anastomotic strictures. Further larger prospective studies are required for increased understanding of ECM therapy response in various disease states.


Disclosures:


Deepa Kumarjiguda, DO¹, Nihit Shah, MD¹, Bradley D. Confer, DO², Harshit S. Khara, MD, FACG¹. E0189 - Using the Matrix: Efficacy of Extracellular Matrix in Treatment Algorithm for Recurrent Benign Esophageal Stricture Therapy, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.