Experimental studies of a hybrid artificial esophagus combined with autologous mucosal cells

Preliminary results, obtained using an artificial esophagus combined with autologous mucosal cells in dogs, are reported. The authors' prosthesis is a silicone tube coated with freeze dried collagen sponge. Cells infiltrate this collagen layer and synthesize new tissue, which will become the neoesophagus. The silicone tube imparts rigidity to the prosthesis and prevents infection, leakage, and dislocation of the prosthesis at the anastomotic site. After formation of the epithelized neoesophageal lumen, the silicone tube drops into the stomach as the result of peristalsis in response to food. Eventually, no artificial prosthesis remains in place, and the defect is replaced by ingrowing tissue. This process was shortened by mucosal cell seeding. Before replacement, the authors harvested oral mucosal (OM) cells, cultured them for 10 days, and seeded them in the collagen layer of the prosthesis just after anastomosis. The neo-esophageal lumen was formed 1 week after the operation without any local complications, infection, leakage, or stenosis, and 2 weeks later the firm, epithelized neoesophagus was completed. OM cell seeding accelerated not only epithelization, but also regeneration of mesenchymal tissue. Parallel with this, transmission electron microscopy showed that most of the cells in the neoesophagus exhibited large nuclei and prominent rough endoplasmic reticulum, indicative of active collagen production.