The use of a self-assembling peptide gel for stricture prevention in the esophagus after endoscopic submucosal dissection: a US 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 de fi ned as mucosal defects > 75% of the circumference. Stricture was de fi ned 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 fi nd- ings. (Gastrointest Endosc 2024;100:213-20.)