Readily available components help patient regenerate esophagus

Last Updated: 2016-04-19

By David Douglas

NEW YORK (Reuters Health) - An off-the-shelf non-biological scaffold along with a commercially available extracellular matrix has led to successful regeneration of the esophagus in a 24-year-old man, according to a new case report.

"Regenerating the esophagus within the human body may have great implications for those requiring surgery for esophageal cancer, trauma, and for those born with defects in the esophagus," said Dr. Kulwinder S. Dua of the Medical College of Wisconsin, Milwaukee.

"After surgery, the majority of these patients currently have their stomach pulled up into the chest to re-establish continuity resulting in life-long disabling side-effects," he told Reuters Health by email.

Until now, regenerative medicine techniques to replace the esophagus had only been tested in animals, Dr. Dua and colleagues note in a paper online April 8 in The Lancet.

Their patient was urgently transferred to the cardiothoracic unit with dysphagia, odynophagia, neck pain, fever, and chills and evidence of a large paraspinal abscess. He had been in a car accident five years earlier that resulted in quadriplegia requiring use of metal plates in the cervical spine.

Removal of the plates revealed a defect in the pharyngeal-pharyngo-esophageal region. It was too long for end-to-end repair and the patient was too ill for formal pull-up or esophageal replacement procedures.

The defect could not be closed with repeat surgery and eventually, with the patient's full consent, the team endoscopically placed a fully covered, self-expanding, metal stent. This bridged a 5 cm full-thickness esophageal segment destroyed by the mediastinal abscess and allowed direct communication between the hypopharynx and the mediastinum.

A commercially available extracellular matrix was used to cover the stent and was sprayed with autologous platelet-rich plasma adhesive gel. The sternocleidomastoid muscle was placed over the matrix.

Because of migration, the stent was replaced after four weeks with three stents telescopically aligned to improve anchoring. These were removed after 3.5 years. The researchers saw full-thickness regeneration of the esophagus with stratified squamous epithelium, a normal five-layer wall, and peristaltic motility with bolus transit. Four years after stent removal, the patient was eating a normal diet and maintaining a steady weight.

"Based on the experience gained from this one case," concluded Dr. Dua, "we need to go from bedside-to-bench by doing animal studies followed by phase 1 and phase 2 clinical trials before we can consider using this approach in clinical practice."

Commenting by email, Dr. Martin Birchall, co-author of an accompanying editorial, told Reuters Health, "Oesophageal reconstruction is one of the great outstanding surgical challenges."

"This report provides a window into a future where we may regenerate functional, layered tubular organs and restore swallowing to thousands," Dr. Birchall, of University College London, added.

SOURCE: http://bit.ly/1Vg9TIc and http://bit.ly/1qCK6gj

Lancet 2016.