Esophageal tissue engineering: a new approach for esophageal replacement

Area of Science:

• Regenerative Medicine
• Biomaterials Science
• Gastroenterology

Background:

• Congenital and acquired esophageal disorders necessitate tissue replacement.
• Current surgical methods like gastric and colonic interposition have limitations, including stenosis.
• Regenerative medicine offers biological constructs for tissue repair and regeneration.

Purpose of the Study:

• To review the literature on esophageal tissue engineering.
• To discuss implications, compare methodologies, and suggest future directions.
• To evaluate the potential of tissue engineering as an alternative to conventional esophageal replacement.

Main Methods:

• Comprehensive literature search of Medline, Embase, Cochrane Library, and other databases.
• Inclusion of English full-text articles and examination of reference lists.
• Contacting experts in the field for additional information.

Main Results:

• Acellular scaffolds showed promise for short defects but poor results for long tubular defects, leading to stenosis and mortality.
• Stenting reduced stenosis and promoted cell migration; omental wrapping for vascularization had uncertain benefits.
• Seeded scaffolds with muscle and epithelial cells in animal models indicated a prerequisite for complete esophageal replacement.

Conclusions:

• Decellularized matrices and smart polymers show potential as scaffolds.
• Future approaches must address peristalsis and vascularization in engineered esophagus.
• Esophageal tissue engineering presents a viable alternative, but significant challenges remain.