A feasibility study of chemically assisted endoscopic submucosal mechanical dissection using mesna for superficial esophageal squamous cell carcinomas

Vocal Fold Submucosal Mesna Injection and Microflap Elevation in a Rabbit Model

OBJECTIVE

Mesna triggers chemical dissection in tissues by breaking down disulfide bonds and is used during surgical dissections in several areas. In this study, we aimed to investigate the effect of submucosal mesna infiltration on microflap elevation and the histopathological findings of its effects on the vocal fold lamina propria in a rabbit model.

METHODS

Eight adult male New Zealand white rabbits were used in the study. Each vocal fold was randomized, and 0.1 mL of mesna was injected into one-fold and 0.1 mL of saline to the contralateral fold. An incision was made on the epithelium and elevation was performed. The animals were sacrificed after two weeks, and the vocal folds were excised. Inflammatory response, fibrosis, and epithelial thickness were evaluated with hematoxylin eosin and Masson's Trichrome staining. Elevation time and histopathological features were compared between the two groups.

RESULTS

The elevation time (20.9 ± 1.6 second) in the saline group was significantly higher (P < 0.05) than in the mesna group (15.0 ± 3.4 second). The inflammation (1.3 ± 0.5 vs. 1.1 ± 1.0, respectively) and fibrosis scores (1.0 ± 0.8 vs. 0.8 ± 0.7, respectively) did not differ significantly (P > 0.05 in both). Epithelial thickness (12.5 ± 4.7 vs. 10.3 ± 5.3, respectively) did not differ significantly (P ˃ 0.05) in the mesna and saline groups either.

CONCLUSION

We determined that mesna facilitates the microflap elevation of the vocal folds in rabbits and does not damage the histological structure of vocal folds. This study encourages future studies to evaluate the use of mesna, now actively used across disciplines, in phonosurgery as well.

Use of Mesna in the treatment of ossicular chain fixation related to tympanosclerosis; prospective, clinical study

OBJECTIVE

Mesna is a thiol compound effective in the connective tissue, which is used for its chemical dissector, mucolytic, mucosal damage preventive and antioxidant effects. The aim of this study was to investigate Mesna's effects in easy dissection in type 4 tympanosclerosis cases and in the prevention of formation of new sclerotic plaques.

METHODS

11 patients were included in the study. All patients were in the Wielinga Kerr type 4 class of tympanosclerosis. All patients were administered a 100% concentration of Mesna in the middle ear during tympanosclerosis surgery. All patients underwent audiological evaluation before and 20 months after the operation. Air-conduction thresholds, bone-conduction thresholds and air-bone difference were statistically compared.

RESULTS

The patients were followed-up for a mean 20.48 ± 2.37 months. The mean preoperative air-conduction threshold of the patients was 58.09 ± 9.73 dB and the mean postoperative air-conduction threshold was 34.63 ± 15.46 dB and there was a significant difference. The mean preoperative bone-conduction threshold of the patients was 16.27 ± 5.47 dB and the mean postoperative bone-conduction threshold was 14.72 ± 6.11 dB and there was a significant difference. The mean preoperative air-bone gap of the patients was 41.81 ± 10.51, and the mean postoperative air-bone gap was 19.90 ± 12.48, and the difference was statistically significant.

CONCLUSION

Mesna prevented hearing loss related to type 4 tympanosclerosis and prevented the formation of new sclerotic structures in our follow-up period. We believe that this effect is due to the chemical dissector and antioxidant effects of Mesna.

Application of MESNA in endoscopic submucosal dissection for esophageal diseases

With the development of digestive endoscopy, early esophageal carcinoma, esophageal leiomyoma, achalasia, and mediastinal lesions, which were previously treated by thoracoscopy or thoracotomy, may be treated by digestive endoscopy. Endoscopic submucosal dissection (ESD) can achieve en bloc resection of large gastrointestinal mucosal and submucosal lesions and has become the first-line treatment for early esophageal cancer and precancerous lesions without lymph node metastasis. Submucosal tunnel endoscopy has expanded endoscopic indications by establishing a submucosal tunnel, and it has been applied in esophageal lesions originating from the muscularis propia and even mediastinal tumors. An ideal submucosal fluid infusion may shorten dissection time during ESD or submucosal tunnel endoscopy. Selecting appropriate submucosal injection is one of the important factors for ESD success. Submucosal injections of sodium-2-mercaptoethanesulfonate can soften tissues and facilitate endoscopic submucosal dissection and is worthy of clinical promotion.

Endoscopic Myotomy for Foregut Motility Disorders

Peroral endoscopic myotomy (POEM) is an advanced endoscopic procedure classically performed for the treatment of achalasia. The procedure is based on principles of submucosal endoscopy and is composed of a mucosal incision, submucosal tunneling, myotomy, and mucosal closure. Multiple published studies that collectively include more than 6000 patients reported clinical success in more than 80% to 90% of patients. Recent literature also suggested durability of response over a medium-term follow-up. POEM is associated with a low rate of adverse events when performed by experienced operators. Gastroesophageal reflux is not infrequent after POEM but does not seem significantly different from reflux that occurs after Heller myotomy. POEM also seems to be effective in the treatment of spastic esophageal disorders (eg, jackhammer and diffuse esophageal spasm). Last, the role of gastric POEM (G-POEM) in the treatment of gastroparesis has been investigated in recent studies with promising results.

Effect of Submucosal Mesna Application on Mucoperichondrial Elevation in Septoplasty

OBJECTIVE

It was revealed that the thiol compound named mesna chemically softens the connective tissue with submucosal injection, and facilitates the endoscopic submucosal dissection. The authors aimed to investigate the effect of mesna injection on mucoperichondrial elevation during septoplasty operation.

METHODS

This study was planned as a patient-control study and performed. Fifty-six patients who had septoplasty operation were divided into 2 groups that are submucosal mesna (group 1) and submucosal saline (group 2) applied ones. In both groups, the measurement was initiated by a timer during the start of septal incision and elevation processes. After bilateral subperichondrial and subperiostal elevation were finished, timer was stopped and time was recorded. After that, mucosal integrity was reviewed and mucosal damage status was recorded. The difficulty of mucoperichondrial elevation for the surgeon was recorded for each patient.

RESULTS

Twenty-five (44.7%) of the patients who participated in our study were females while 31 (55.3%) were males. The average elevation periods were 201.4 ± 74.3 seconds in group 1 and 260.2 ± 84.1 seconds in group 2. In mesna applied patients, elevation period was statistically and significantly shorter (P = 0.009). Impairment in mucosal integrity was observed as 33.3% in group 1 and 58.8% in group 2. In mesna applied patients, significantly less impairment in mucosal integrity was observed (P = 0.031). The average mucoperichondrial elevation difficulty for the surgeon is observed as 4.83 ± 2.47 in group 1 and 6.5 ± 1.9 in group 2. Mesna applied patients were defined as significantly easier patients for the surgeon (P = 0.006).

CONCLUSION

Submucosal mesna application is an approach that provides a convenient, fast, and effective mucoperichondrial elevation in septoplasty and protects the mucosal integrity.