The first experience of using autolipoaspirate in combined endoscopic treatment of severe cicatricial stricture of the esophagus

Abstract

A 71-year-old patient with cicatricial stricture of the esophagus at the place of residence underwent bougienage, balloon dilatation and electric incision of the scar with a short-term effect.In March 2020, the patient applied to the Petrovsky National Research Center of Surgery with dysphagia grade 3 according to Bown. In the endoscopic department, multiple critical cicatricial strictures of presumably burn etiology were diagnosed, and therefore a long course of endoscopic bougienage was carried out, starting with Soehendra bougie with a diameter of 6 Fr to Savary bougie 45 Fr with an interval from 1–2 days to 2 weeks. Due to the tendency to rapid restenosis during this time, treatment was supplemented with 4 courses of intramural injections of dexamethasone solution. Despite the lack of a stable effect, the patient refused surgical treatment. Due to persistent restenosis, an innovative treatment was carried out—intramural injection of autologous lipoaspirate (nanofat) into the narrowed zone in order to reduce the density and rigidity of the scar tissue. At the final stage, in order to stabilize the lumen and prevent further restenosis, a course of intramural injections of triamcinolone was performed. This made it possible to successfully complete a two-year course of planned combined endoscopic treatment.