Use of rebamipide solution as a submucosal injection material to prevent esophageal stricture after endoscopic submucosal dissection: Animal study.

Abstract

Background and study aims: It is desirable to develop a safe, cost-effective, and easy approach to prevent strictures after esophageal endoscopic submucosal dissection (ESD). We explored use of a novel rebamipide solution, an anti-ulcer drug, as a submucosal injection material for preventing esophageal stricture after ESD.

Methods: In 15 swine, two half-circumferential ESDs were performed at the proximal and distal ends of the middle thoracic esophagus using 2% rebamipide solution or saline (control) as submucosal injection material. Five swine were sacrificed on postoperative days (PODs) 7, 14, and 21, respectively. Follow-up endoscopy was performed weekly until sacrifice. ESD-related outcomes, degree of stricture, and histological characteristics were evaluated.

Results: ESD-related outcomes were similar in both groups, with all post-ESD ulcers epithelialized by POD 14. Mean mucosal constriction rate in the rebamipide and control groups on PODs 14 and 21 were 19.1 ± 7.2% vs. 21.0 ± 6.4% ( P = 0.40) and 13.3 ± 6.8% vs. 20.8 ± 6.1% ( P  = 0.08), respectively. The rebamipide group peaked and showed milder constriction by POD 21, whereas the control group seemed to plateau. Histologically, mean fibrosis thickness in the rebamipide and control groups on days 14 and 21 were 807.0 ± 238.9 µm vs. 972.8 ± 395.1 µm ( P  = 0.40) and 782.8 ± 281.5 µm vs. 1087.0 ± 476.1 µm ( P  = 0.13), respectively.

Conclusions: The rebamipide solution showed no statistically significant benefit in preventing post-ESD stricture. However, given the small sample size of this study, further studies are needed to clarify its potential role.