4.7 Article

A novel tetra-PEG based hydrogel for prevention of esophageal stricture after ESD in a porcine model

Journal

COLLOIDS AND SURFACES B-BIOINTERFACES
Volume 226, Issue -, Pages -

Publisher

ELSEVIER
DOI: 10.1016/j.colsurfb.2023.113321

Keywords

Tetra -PEG; Hydrogel; Esophageal stricture; Endoscopic submucosal dissection

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Endoscopic submucosal dissection (ESD) is an effective treatment for early esophageal cancer and precancerous lesions, but it often leads to postoperative esophageal stricture. This study developed a tetra-armed poly(ethylene glycol) (Tetra-PEG) hydrogel and demonstrated its efficacy in preventing ESD-induced stricture in a porcine model. The Tetra-PEG hydrogel exhibited great biocompatibility, moisture retention, tissue adhesion, and mechanical strength. Compared to the control group, the Tetra-PEG hydrogel promoted early esophageal ulcer healing by enhancing epithelium regeneration, reducing inflammation, and fibrosis through the TGF-β/Smad2 signaling pathway.
Endoscopic submucosal dissection (ESD) is an accepted treatment for early esophageal cancer and precancerous lesions, but resection of a large mucosal area often leads to postoperative esophageal stricture. Biomaterials provide a new option for the treatment of post-ESD ulcers. In this study, we developed a well-defined ammonolysis-based tetra-armed poly (ethylene glycol) (Tetra-PEG) hydrogel and investigated its efficacy and related mechanisms for preventing esophageal ESD-induced stricture in a porcine model. In terms of material properties, Tetra-PEG hydrogel present great biocompatibility,great capability to retain moisture, strong tissue adhesion and high mechanical strength. Then, six domestic female pigs were randomly divided into PEG (n = 3) and control groups (n = 3). A 3/4 of the esophageal circumference ESD was performed in all pigs. In PEG group, Tetra-PEG hydrogel was easily delivered via endoscopy and adhered to the ulcer bed tightly. Compared to control group, Tetra-PEG hydrogel accelerated esophageal ulcer healing at an early stage with enhanced epithelium regeneration, milder inflammation and lesser fibrosis by regulating TGF-& beta;/Smad2 signaling. Taken together, our findings reveal Tetra-PEG hydrogel is a promising and attractive candidate for preventing the formation of fibrotic stricture in the process of esophageal ESD-induced ulcer repair.

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