US doctors reconstruct severely damaged oesophagus in patient

Doctors in the US, including one of Indian-origin, have reported the first case of a 24-year-old man whose severely damaged oesophagus was successfully reconstructed using commercially available metal stents and skin tissue.
Professor Kulwinder Dua from the Medical College of Wisconsin in US and colleagues reported using metal stents as a non-biological scaffold and a regenerative tissue matrix from donated human skin to rebuild a full-thickness 5cm defect in the oesophagus of the patient.
The patient was urgently admitted to hospital with a disrupted oesophagus resulting in life-threatening infection and inability to swallow following complications from an earlier car accident which had left him partially paralysed.

Despite several surgeries, the defect in the oesophagus was too large to repair.
Removal of the oesophagus (oesophagectomy) to treat cancer or injury requires reconnecting the remaining part of the oesophagus to the stomach to allow swallowing and the passage of food.
Part of the stomach or colon is used to make this connection. However, the procedure was not possible in this case because the defect in the oesophagus was too large, and the patient too ill to undergo the procedure.

The team hypothesised that if the 3D shape of the oesophagus could be maintained in its natural environment for an extended period of time while stimulating regeneration using techniques previously validated in animals, esophageal reconstruction may be possible.

To maintain the shape of the oesophagus and bridge the large defect, they used an endoscope to place self-expanding metal stents.
The defect was then covered with regenerative tissue matrix and sprayed with a platelet-rich plasma gel produced from the patient's own blood, to deliver high concentrations of growth factors that not only stimulate growth but also attract stem cells to stimulate healing and regeneration.
The sternocleidomastoid, a muscle running along the side of the neck, was placed over the matrix and the adhesive platelet-rich plasma gel.
The team planned on removing the stent 12 weeks after reconstruction, but the patient delayed the procedure for three and a half years.

One year after the stents were removed, endoscopic ultrasound images showed areas of fibrosis (scarring) and regeneration of all five layers of the oesophageal wall.
Full recovery of functioning was also established by swallowing tests showing that esophageal muscles were able to propel water and liquid along the oesophagus into the stomach in both upright and sitting positions.
But, how long the regeneration process took is unclear because the patient delayed stent removal for several years.
"This is a first in human operation and one that we undertook as a life-saving measure once we had exhausted all other options available to us and the patient," said Dua.

The case was reported in The Lancet journal.