Where There Is Fat There Is Fibrosis: Elucidating the Mechanisms of Creeping Fat-Driven Stricture Formation

Abstract Background and Aims Creeping fat, the wrapping of mesenteric fat around the bowel wall, is a typical feature of Crohn’s disease, and is associated with stricture formation and bowel obstruction. How creeping fat forms is unknown, and we interrogated potential mechanisms using novel intestinal tissue and cell interaction systems. Methods Tissues from normal, ulcerative colitis, non-strictured and strictured Crohn’s disease intestinal specimens were obtained. Fresh and decellularized tissue, mesenteric fat explants, primary human adipocytes, pre-adipocytes, muscularis propria cells, and native extracellular matrix were used in multiple ex vivo and in vitro systems involving cell growth, differentiation and migration, proteomics, and integrin expression. Results Crohn’s disease muscularis propria cells produced an extracellular matrix scaffold which is in direct spatial and functional contact with the immediately overlaid creeping fat. The scaffold contained multiple proteins, but only fibronectin production was singularly upregulated by TGF-b1. The muscle cell-derived matrix triggered migration of pre-adipocytes out of mesenteric fat, fibronectin being the dominant factor responsible for their migration. Blockade of α5β1 on the pre-adipocyte surface inhibited their migration out of mesenteric fat and on 3D decellularized intestinal tissue extracellular matrix. Conclusion Crohn’s disease creeping fat appears to result from the migration of pre-adipocytes out of mesenteric fat and differentiation into adipocytes in response to an increased production of fibronectin by activated muscularis propria cells. These new mechanistic insights may lead to novel approaches for prevention of creeping fat-associated stricture formation.

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Topical oro-dispersible budesonide tablets for stricture prevention after near circumferential ESD for esophageal squamous cell cancer – a case report

Zeitschrift für Gastroenterologie ◽

10.1055/a-1409-1076 ◽

2021 ◽

Author(s):

Daniel Mathies ◽

Tsuneo Oyama ◽

Ingo Steinbrück ◽

Franz Ludwig Dumoulin

Keyword(s):

Case Report ◽

High Risk ◽

Endoscopic Resection ◽

Squamous Cell ◽

Squamous Cell Cancer ◽

Cell Cancer ◽

Complete Healing ◽

Esophageal Squamous Cell Cancer ◽

Stricture Formation ◽

Local Injections

Abstract Background Endoscopic resection is the treatment of choice for early esophageal cancers. However, resections comprising more than 70–80 % of the circumference are associated with a high risk of stricture formation. Currently, repetitive local injections and/or systemic steroids are given for prevention. Case report We present here the case of a 78-year-old male patient who had a near circumferential endoscopic submucosal dissection for a pT1a mm, L0, V0, R0, G2 esophageal squamous cell cancer. At the end of endoscopic resection, 80 mg of triamcinolone was injected locally. The patient was then treated with oro-dispersible budesonide tablets (2 × 1 mg/day) and nystatin (4 × 100 000 I.E.) for 8 weeks. This treatment resulted in complete healing without any stricture formation and did not result in any complications. Discussion Treatment with orodispersible budesonide tablets could help prevent strictures after large endoscopic resections in the esophagus.

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EFFICACY OF SELECTIVE NUCLEAR FACTOR KAPPA B (NFκB) INHIBITOR, PYROLIDIUM DITHIOCARBAMATE, TO PREVENT ON URETHRAL STRICTURE FORMATION IN RATS

European Urology Supplements ◽

10.1016/s1569-9056(06)60153-x ◽

2006 ◽

Vol 5 (2) ◽

pp. 59

Author(s):

S. Kirecci ◽

E. Ozbek ◽

A. Otunctemur ◽

L. Ozcan ◽

A. Somay ◽

...

Keyword(s):

Urethral Stricture ◽

Nuclear Factor Kappa B ◽

Stricture Formation ◽

Nuclear Factor ◽

Nuclear Factor Kappa

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Prevention of stricture formation after endoscopic sclerotherapy of esophageal varices

Gastrointestinal Endoscopy ◽

10.1016/s0016-5107(89)72838-8 ◽

1989 ◽

Vol 35 (5) ◽

pp. 377-380 ◽

Cited By ~ 16

Author(s):

Harry Snady ◽

Alan S. Rosman ◽

Mark A. Korsten

Keyword(s):

Esophageal Varices ◽

Endoscopic Sclerotherapy ◽

Stricture Formation

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A comparative study evaluating the esophageal transit time of eight healthy cats when pilled with the FlavoRx pill glide versus pill delivery treats

Journal of Feline Medicine and Surgery ◽

10.1016/j.jfms.2009.09.017 ◽

2010 ◽

Vol 12 (4) ◽

pp. 286-290 ◽

Cited By ~ 5

Author(s):

Alexander D. Bennett ◽

Catriona M. MacPhail ◽

Debra S. Gibbons ◽

Michael R. Lappin

Keyword(s):

Comparative Study ◽

Transit Time ◽

Esophageal Stricture ◽

Stricture Formation ◽

Delivery Method ◽

Esophageal Transit ◽

One Step

Retention of tablets or capsules in the feline esophagus can be associated with esophagitis and esophageal stricture formation. The objective of this study was to evaluate the esophageal passage of tablets and capsules when administered with either a one-step pill gun with flavored liquid (FlavoRx pill glide) or a pill delivery treat (Pill Pockets). Four different medication administrations were evaluated on different days in eight normal cats: tablets with FlavoRx pill glide (T-FG), tablets with pill delivery treats (T-PP), capsules with FlavoRx pill glide (C-FG) and capsules with pill delivery treats (C-PP). The estimated average transit time was 36 s for T-FG, 60 s for T-PP, 16 s for C-FG, and 24 s for C-PP. The results of this study suggest that either pill delivery method is acceptable for successful passage of tablets or capsules into the stomach of cats using a single replicate.

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EXPERIENCE OF EVALUATION OF PATIENTS OF OBSTRUCTIVE JAUNDICE BY SONOGRAPHY AND MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY AT A TERTIARY CARE CENTRE IN EASTERN INDIA

10.36106/ijar/7914686 ◽

2021 ◽

pp. 61-64

Author(s):

Santosh Kumar Prasad ◽

Nupur Nupur ◽

Akshit Pathak ◽

Indra Shekhar Thakur ◽

Vijay Shankar Prasad

Keyword(s):

Magnetic Resonance ◽

Obstructive Jaundice ◽

Hepatic Duct ◽

Tertiary Care ◽

Pancreatic Head ◽

Magnetic Resonance Cholangiopancreatography ◽

Stricture Formation ◽

Tertiary Care Centre ◽

Left Hepatic Duct ◽

Cross Sectional

INTRODUCTION: Jaundice means yellow due to the yellowish discolouration of skin, sclera, and mucous membrane seen in jaundice caused by bilirubin pigment. It is divided in to two forms obstructive(surgical) and non- obstructive (non-surgical). AIM AND OBJECTIVE: To evaluate patients of obstructive jaundice by sonography and magnetic resonance cholangiopancreatography and compare the reporting and ndings by both the modalities. MATERIALS AND METHODS: Cross sectional observational study done from November 2018 to October 2020 and consists of 32 patients who had clinical jaundice and consented to being subjected to both ultrasound and MRCP. OBSERVATIONS:Both USG and MRCP were able to detect extrahepatic CBD dilatation equally in 25 patients. In 5(15.6%) patients USG and MRI both demonstrated intrahepatic mass causing obstruction at the level of conuence of right and left hepatic duct or CHD. Ultrasonography was able to detect the intrinsic mass of the extrahepatic common bile duct in 2(6.2%) patients out of 32 patients in our study population. MRCP could detect the same in 6(18.7%) patients. In our study narrowing of CBD with stricture formation and upstream dilatation of biliary tree was identied in 10(31.2%) patients on MRCP. Ultrasound could diagnose the same in one patient. Both USG and MRCP were able to detect pancreatic head mass as well as pseudocyst. CONCLUSION: The accuracy of MRCP was found to be comparable to that of ERCP for diagnosis of etiology for obstructive jaundice. MRCP allows better lesion characterization and assessment. However, the patchy availability of MR machines become the main achilles heel for the surgeons as well as the radiologists. Hence the valuable role of the omnipresent ultrasonography become immense.

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Caustic and Toxic Ingestions

10.2310/7ccsp.8137 ◽

2017 ◽

Author(s):

CDR Thomas Q Gallagher ◽

CDR Robert L Ricca

Keyword(s):

Surgical Management ◽

Management Strategies ◽

Treatment Strategies ◽

Tracheobronchial Tree ◽

High Rate ◽

Health Concern ◽

Endoscopic Management ◽

Caustic Ingestion ◽

Stricture Formation ◽

Accidental Ingestion

Ingestion of caustic substances remains a potentially fatal public health concern with extensive morbidity and the possibility of long-term sequelae. The management strategies of these complex injuries continue to be extensively studied in the literature. Areas of interest include the most efficacious treatment of caustic esophageal stricture to preserve the native esophagus, use of steroids, and use of esophageal stents. Prevention of accidental ingestion through strategies to limit the availability of caustic substances is a key factor in reducing the incidence of injury, but there continues to be a high rate of accidental ingestion in developing countries with less rigorous manufacturing standards. Initial evaluation includes endoscopic evaluation of the esophagus and tracheobronchial tree. Optimal treatment strategies, including the use of proton pump inhibitors to reduce gastroesophageal reflux, steroid use to prevent stricture formation, and use of stents for management of strictures, continue to be debated. Initial surgical management includes esophagectomy for full-thickness injury with abdominal exploration. Multiple surgical options exist for both restoration of gastrointestinal continuity after esophagectomy and the management of strictures refractory to medical management, including reverse gastric tube, colonic interposition, and gastric advancement. Numerous small studies have evaluated the efficacy of these interventions, but there continues to be a need for larger prospective studies to develop a worldwide consensus opinion on best practices. We provide a review of the recent literature and practice recommendations for the management of injuries due to caustic ingestion. Key words: caustic ingestion, endoscopic management, stricture, surgical management

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RA08.05: ENDOSCOPIC THERAPY AND SURVEILLANCE VERSUS ESOPHAGECTOMY FOR EARLY ESOPHAGEAL ADENOCARCINOMA: A REVIEW OF EARLY OUTCOMES AND COST ANALYSIS

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra08.05 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 38-38

Author(s):

Piers Boshier ◽

Andrea Wirsching ◽

Rajesh Krishnamoorthi ◽

Michael Larsen ◽

Shayan Irani ◽

...

Keyword(s):

Cost Analysis ◽

Esophageal Adenocarcinoma ◽

Surgical Therapy ◽

Conflicts Of Interest ◽

Endoscopic Therapy ◽

Clinical Stage ◽

Oncologic Outcomes ◽

Stricture Formation ◽

Endoscopic Procedures ◽

Same Day Discharge

Abstract Background Endoscopic therapy is considered to be comparable to esophagectomy with respect to oncologic outcomes in early (clinical stage T1) esophageal adenocarcinoma (EC). The current study aims to compare early outcomes and financial costs, associated with endoscopic versus surgical therapy for early EC. Methods Retrospective review of patients undergoing either endoscopic or surgical therapy for cT1 EC between 2010 and 2015 at a single high-volume center. To ensure comparability between treatment groups only those patients who were deemed medically fit to undergo esophagectomy, regardless of ultimate management, were included. Cost analysis was performed for each patient group and was compared to procedural outcomes. Results Forty-three patients met the inclusion criteria for this study (endoscopic therapy n = 20; esophagectomy n = 23). All patients who underwent endoscopic therapy had clinical stage T1A, whilst 15 patients in the esophagectomy group had T1B disease (P < 0.001). Patient groups were well matched for all other baseline characteristics (P > 0.05). For patients undergoing endoscopic therapy a median of six interventions were performed per patient (range 2–18). Same day discharge was achieved after 98% of all endoscopic procedures with 72% of cases performed under general anesthesia. Endoscopic dilations due to stricture formation were required in five (25%) patients after endoscopic therapy. Esophagectomy was associated with a median hospital stay of 9 (8–13) days and greater procedure specific morbidity compared to endoscopic therapy. Median treatment costs for patients undergoing esophagectomy were significantly greater than that incurred for patients receiving endoscopic therapy only ($53,849, 95%-confidence interval: 50,541–88,784 vs. $22,640, 95%CI: 18,754–46,705, P < 0.001). The minimum cost associated with esophagectomy in the current study was approximately four times greater than for endoscopic therapy ($40,410 vs. $9236). In comparison the maximum cost incurred for surgical and endoscopic therapy were $247,808 and $127,508 respectively. Overall costs were significantly correlated to either number and severity or postoperative complications or number of endoscopic procedures performed (P < 0.002). Conclusion In patients with early EC endoscopic therapy was associated with lower rates of procedure specific morbidity compared to esophagectomy. Despite an increased number of interventions and longer duration of therapy, overall costs were significantly lower in patients undergoing endoscopic therapy when compared to esophagectomy. Disclosure All authors have declared no conflicts of interest.

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