Effects of Lugol staining on stenosis formation induced by radiofrequency ablation of esophageal squamous epithelium: a study in a porcine model

D W Schölvinck, L Alvarez Herrero, M Visser, J J G H M Bergman, B L A M Weusten

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Preliminary data show higher stricture rates after radiofrequency ablation (RFA) for early esophageal squamous neoplasia compared with Barrett's esophagus. We studied the effects of Lugol stain (LS) directly prior to RFA on stricture formation in squamous epithelium. Of 16 pigs, the distal half of the esophagus was LS, followed by circumferential RFA (single application 12 J/cm(2) ) in the unstained and stained esophagus. Pigs were euthanized at day 0 (n = 4), 3 (n = 4), or 28 (n = 8). Histology was evaluated in four areas: blank-control (no RFA, no LS), blank-RFA (no LS), LS+RFA, and LS-control (no RFA). Stenosis severity in LS+RFA and blank-RFA at 28 days was assessed by the ratio of the mucosal diameter at the RFA area to the diameter 2 cm proximal of this zone. Histology showed submucosal edema in 50% of LS+RFA versus 0% in blank-RFA. Severity and depth of inflammation (day 3) was equal in LS+RFA and blank-RFA. Severity and depth of fibrosis (day 28) appeared more severe in LS+RFA. Consequently, stenosis was present in 100% (LS+RFA) versus 12.5% (blank-RFA). The stenosis-severity ratio was 0.40 (interquartile range 0.29-0.45) in LS+RFA versus 0.73 (interquartile range 0.64-0.78) in blank-RFA (P = 0.012). Limitations of this study were the difference in uptake of LS between pigs and humans, the difference in esophageal anatomy between pigs and humans, and between the proximal and distal esophagus within pigs. In conclusion, in the porcine squamous esophagus, stenosis rate and severity after RFA increased when preceded by LS. LS may be contributing in the altered response of squamous epithelium to RFA as compared with Barrett's esophagus.

Original languageEnglish
Pages (from-to)603-11
Number of pages9
JournalDiseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
Volume28
Issue number7
DOIs
Publication statusPublished - Oct 2015

Keywords

  • Animals
  • Carcinoma, Squamous Cell/pathology
  • Catheter Ablation/adverse effects
  • Coloring Agents/adverse effects
  • Epithelium/pathology
  • Esophageal Neoplasms/pathology
  • Esophageal Squamous Cell Carcinoma
  • Esophageal Stenosis/etiology
  • Esophagus/drug effects
  • Iodides/adverse effects
  • Models, Animal
  • Severity of Illness Index
  • Swine
  • Treatment Outcome

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