Artificial dermis for protecting gastrointestinal mucosal defects: A feasibility study in ex vivo and in vivo porcine models

Although post-endoscopic submucosal dissection (ESD) mucosal defects can lead to delayed bleeding and perforation, an optimal protective method has not yet been established. This study aimed to evaluate the feasibility of using artificial dermis to protect against gastrointestinal mucosal defects. Ex vivo and in vivo porcine models were used. Artificial dermis sheets (collagen monolayer or collagen–silicone bilayer) were applied to 2-cm post-ESD ulcers in the stomach, rectum, and esophagus and fixed using standard endoscopic clips. Fixation success, coverage durability, adverse events, and histopathological findings were evaluated. In the ex vivo experiments, artificial dermis was successfully fixed with clips, both manually and endoscopically, without material damage (4/4 sites per experiment). In the in vivo experiments, fixation was successful at all planned gastric and esophageal sites (5/5, 100%). The bilayer sheets appeared to remain in place more consistently at day 3 in the stomach. No serious adverse events were observed. Endoscopic application of artificial dermis was technically feasible for temporary coverage of gastrointestinal mucosal defects in porcine models, with collagen–silicone bilayer sheets showing more consistent retention during the initial observation period. However, further clinical studies are warranted.