A narrative review of esophageal tissue engineering and replacement: where are we?

Abstract

Long-gap esophageal defects, whether congenital or acquired, are very difficult to manage. Any significant surgical peri-esophageal dissection that is performed to allow for potential stretching of two ends of a defect interrupts the esophageal blood supply and leads to complications such as leak and stricture, even in the youngest, healthiest patients. The term "congenital" applied to these defects refers mainly to long-gap esophageal atresia (LGA). Causes of acquired long-segment esophageal disruption include recurrent leaks and fistulae after primary repair, refractory GERD, caustic ingestions, cancer, and strictures. 5,000-10,000 patients per year in the US require esophageal replacement. Gastric, colonic, and jejunal pull-up surgeries are fraught with high rates of both short and long term complications thus creating a space for a better option. Since the 1970's many groups around the world have been unsuccessfully attempting esophageal replacement with tissue-engineered grafts in various animal models. But, recent advances in these models are now combining novel technologic advances in materials bioscience, stem-cell therapies, and transplantation and are showing increasing promise to human translational application. Transplantation has been heretofore unsuccessful, but given modern improvements in transplant microsurgery and immunosuppressive medications, pioneering trials in animal models are being undertaken now. These rapidly evolving medical innovations will be reviewed here.

Recent Advances in the Genetic Pathogenesis, Diagnosis, and Management of Esophageal Atresia and Tracheoesophageal Fistula: A Review

“…In a recent pediatric animal model evaluating tissue‐engineered esophageal implants, histologic features, including complete epithelialization and smooth muscle proliferation, were observed with graft survival and resumption of normal eating and animal growth at 1 year (21). Esophageal transplantation remains in the early phases of exploration but has also shown promise (22).…”

Tissue Engineering for Gastrointestinal and Genitourinary Tracts

“…Indeed, such a reconstruction would imply a particular architecture and the creation of a transition zone between the epithelia. In addition to Tables 1-3, readers may profit from reading several review articles [83,[172][173][174][175][176][177][178].…”

Tissue Engineering for Gastrointestinal and Genitourinary Tracts

“…In addition to Table 1 (a, b and c), readers may profit from reading several review articles [75,[164][165][166][167][168][169][170].…”