Esophagus Bioengineering

Tissue engineering represents a promising and innovative strategy for the treatment of complex congenital and acquired esophageal disorders, particularly in patients for whom conventional therapies have failed or current options for organ replacement remain inadequate. Current approaches have explored the use of synthetic and biological scaffolds, cell-based therapies, or combinations of both to promote tissue regeneration and restoration of function. Increasing evidence suggests that, in order to achieve a functional esophagus, hybrid strategies incorporating exogenous cell delivery may further enhance regenerative outcomes while simultaneously modulating inflammatory responses.

Importantly, the feasibility and effectiveness of esophageal tissue engineering are strongly influenced by the extent and depth of the defect. Encouraging results achieved in partial-thickness defects and patch repair models have supported early clinical translation. Reconstruction of full-thickness circumferential esophageal defects, as required in long-gap esophageal atresia, remains a challenge, primarily due to luminal stenosis, anastomotic leakage, and incomplete regeneration of organized muscular and neuromuscular structures. Recently, the first preclinical demonstration of secondary peristalsis and stent independence in a circumferential, cell-seeded esophageal graft in a growing large-animal model has provided important proof of concept, though translation to longer grafts and clinical application remains to be established. Further preclinical and translational research is required to develop safe, reproducible, and standardized strategies for circumferential esophageal replacement, supported by transparent and comprehensive reporting of experimental outcomes.

Consequently, further preclinical and translational research is required to develop safe, reproducible, and standardized strategies for circumferential esophageal replacement. Such efforts must be supported by transparent and comprehensive reporting of experimental outcomes to facilitate meaningful comparison and clinical translation. In this review, we summarize current esophageal tissue engineering strategies relevant to esophageal atresia, critically evaluate the available evidence, and discuss future directions in the field.