Kangfuxin solution alleviates esophageal stenosis after endoscopic submucosal dissection:A natural ingredient strategy

BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD.AIM To examine the effectiveness and underlying mechanism of Kangfuxin solution(KFX)in mitigating excessive fibrotic repair of the esophagus post-ESD.METHODS Pigs received KFX at 0.74 mL/kg/d for 21 days after esophageal full circumferential ESD.Endoscopic examinations occurred on days 7 and 21 post-ESD.In vitro,recombinant transforming growth factor(TGF)-β1(5 ng/mL)induced a fibrotic microenvironment in primary esophageal fibroblasts(pEsF).After 24 hours of KFX treatment(at 1.5%,1%,and 0.5%),expression ofα-smooth muscle actin-2(ACTA2),fibronectin(FN),and type collagen I was assessed.Profibrotic signaling was analyzed,including TGF-β1,Smad2/3,and phosphor-smad2/3(p-Smad2/3).RESULTS Compared to the Control group,the groups treated with KFX and prednisolone exhibited reduced esophageal stenosis,lower weight loss rates,and improved food tolerance 21 d after ESD.After treatment,Masson staining revealed thinner and less dense collagen fibers in the submucosal layer.Additionally,the expression of fibrotic effector molecules was notably inhibited.Mechanistically,KFX downregulated the transduction levels of fibrotic functional molecules such as TGF-β1,Smad2/3,and p-Smad2/3.In vitro,pEsF exposed to TGF-β1-induced fibrotic microenvironment displayed increased fibrotic activity,which was reversed by KFX treatment,leading to reduced activation of ACTA2,FN,and collagen I.The 1.5%KFX treatment group showed decreased expression of p-Smad 2/3 in TGF-β1-activated pEsF.CONCLUSION KFX showed promise as a therapeutic option for post-full circumferential esophageal ESD strictures,potentially by suppressing fibroblast fibrotic activity through modulation of the TGF-β1/Smads signaling pathway.

Repair of stricture of cervical esophagus with platysma myocutaneous flaps

Objective To observe the effect of repairing stricture of the cervical esophagus with platysma myocutaneous flaps.Methods Fifteen patients with stricture of the cervical esophagus were treated by repair with platysma myocutaneous flaps. The causes of stricture included anastomotic stenosis of the cervical esophagus after colon graft transplantation due to esophageal caustic injury (12 patients), anastomotic stenosis after stomach transposition due to resection of the upper esophageal cancer (2), and stricture caused by limited erosive injury of the cervical esophagus (1). The lengths of stricture were about 3.5 -4.5 cm. The stricture was incised longitudinally. The platysma myocutaneous flaps about 4 cm-5 cm×6 cm-7 cm were resected and were transposed to repair the stricture. Results All flaps survived and no death or serious complications occurred after operation. All patients gained normal functions in swallowing food.Conclusion Repairing stricture of the cervical esophagus with platysma myocutaneous flaps is simple, safe and effective.