Academic literature on the topic 'Esophageal substitue'

Background: Since the esophagus has no redundancy, congenital and acquired esophageal diseases often require esophageal substitution, with complicated surgery and intestinal or gastric transposition. Peri-and-post-operative complications are frequent, with major problems related to the food transit and reflux. During the last years tissue engineering products became an interesting therapeutic alternative for esophageal replacement, since they could mimic the organ structure and potentially help to restore the native functions and physiology. The use of acellular matrices pre-seeded with cells showed promising results for esophageal replacement approaches, but cell homing and adhesion to the scaffold remain an important issue and were investigated. Methods: A porcine esophageal substitute constituted of a decellularized scaffold seeded with autologous bone marrow-derived mesenchymal stromal cells (BM-MSCs) was developed. In order to improve cell seeding and distribution throughout the scaffolds, they were micro-perforated by Quantum Molecular Resonance (QMR) technology (Telea Electronic Engineering). Results: The treatment created a microporous network and cells were able to colonize both outer and inner layers of the scaffolds. Non seeded (NSS) and BM-MSCs seeded scaffolds (SS) were implanted on the thoracic esophagus of 4 and 8 pigs respectively, substituting only the muscle layer in a mucosal sparing technique. After 3 months from surgery, we observed an esophageal substenosis in 2/4 NSS pigs and in 6/8 SS pigs and a non-practicable stricture in 1/4 NSS pigs and 2/8 SS pigs. All the animals exhibited a normal weight increase, except one case in the SS group. Actin and desmin staining of the post-implant scaffolds evidenced the regeneration of a muscular layer from one anastomosis to another in the SS group but not in the NSS one. Conclusions: A muscle esophageal substitute starting from a porcine scaffold was developed and it was fully repopulated by BM-MSCs after seeding. The substitute was able to recapitulate in shape and function the original esophageal muscle layer.

Tissue engineering appears promising as an alternative technique for esophageal replacement. Mesenchymal stem cells (MSCs) could be of interest for esophageal regeneration. Evaluation of the ability of an acellular matrix seeded with autologous MSCs to promote tissue remodeling toward an esophageal phenotype after circumferential replacement of the esophagus in a mini pig model. A 3 cm long circumferential replacement of the abdominal esophagus was performed with an MSC-seeded matrix (MSC group, n = 10) versus a matrix alone (control group, n = 10), which has previously been matured into the great omentum. The graft area was covered with an esophageal removable stent. A comparative histological analysis of the graft area after animals were euthanized sequentially is the primary outcome of the study. Histological findings after maturation, overall animal survival, and postoperative morbidity were also compared between groups. At postoperative day 45 (POD 45), a mature squamous epithelium covering the entire surface of the graft area was observed in all the MSC group specimens but in none of the control group before POD 95. Starting at POD 45, desmin positive cells were seen in the graft area in the MSC group but never in the control group. There were no differences between groups in the incidence of surgical complications and postoperative death. In this model, MSCs accelerate the mature re-epitheliazation and early initiation of muscle cell colonization. Further studies will focus on the use of cell tracking tools in order to analyze the becoming of these cells and the mechanisms involved in this tissue regeneration.

Introduction and aim of the study. Long-gap esophageal atresia (LGEA) is a congenital anomaly in which the gap between both ends of the esophagus exceeds three intervertebral spaces and is an esophageal atresia without air in the abdomen. The defect is both therapeutic and surgical challenge. This review aims at providing an overview of the most recent literature on the effective methods for treatment of LGEA, and the most frequent complications and experts’ recommendations on this subject. Material and methods. The systematic review was based on available data collected using PubMed database and the Google Scholar web search engine. Analysis of the literature. There is no consensus on the ideal technique for surgical treatment of LGEA. There are two possible approaches for opening the thorax – thoracotomy and thoracoscopy. The techniques stimulating esophageal elongation include external and internal traction techniques, magnetic compression anastomosis and intramural botulinum type A toxin injection. Replacement methods are a viable option when it is impossible to preserve the native esophagus. Decellularized matrices seem to be promising in developing an esophageal substitute. Regardless of the surgical approach a common complication of surgical treatment is anastomotic stenosis which requires further surgical interventions. Conclusion. Elongation techniques are effective in approximation of the proximal and distal esophagus. The future lies with tissue engineering and inventing an off-the-shelf esophageal substitute. The centralization of treatment is recommended. After discharge from hospital interdisciplinary outpatient assessment and care is required. Further prospective studies are needed to determine the optimal mode of treatment and prevent complications associated with LGEA.

Gastric carcinoma is one of the most common secondary malignancies in esophageal cancer patients. We herein report our surgical procedure for esophageal reconstruction in esophageal cancer patients associated with synchronous or metachronous early gastric adenocarcinoma. Gastric adenocarcinoma was removed by pyloroantrectomy with preservation of the right gastroepiploic artery and vein, and a pedunculated short gastric tube was used as an esophageal substitute in a Roux-en-Y fashion. Surgical data of 6 esophageal cancer patients who underwent this type of surgery between 1993 and 2012 were analyzed. Three patients had synchronous early gastric carcinoma and the remaining 3 patients had metachronous early gastric adenocarcinoma. The gastric tube was easily pulled up to the neck and no problems occurred during this procedure. Postoperative complications, including leakage of esophagogastrostomy, acute respiratory failure, and diffuse peritonitis, were observed in 3 patients. No patients suffered from necrosis of the gastric tube. Although 3 patients died of other diseases, gastric cancer recurrence has not been observed to date. Despite the need for precaution to ensure technical safety, pyloroantrectomy and esophageal reconstruction using a pedunculated short gastric-tube are oncologically feasible as a potential curative surgery for esophageal cancer patients with early gastric adenocarcinoma.

Introduction and aim. Corrosive strictures of the upper cervical esophagus and hypopharynx are hard to treat in the operating room because there is a high chance of aspiration during swallowing after a high-up or proximal esophageal anastomosis. In this cases, we aimed to evaluate the role of intraoperative dilatation of the proximal hypopharyngeal and cervical esophageal stumps during surgery. Material and methods. Patients who underwent surgery and had upper cervical esophageal and hypopharyngeal strictures from corrosive substance ingestion were included. Results. Out of total 27 patients, 10 had a cricopharyngeal or proximal cervical esophageal stricture with a long segment tho racic esophageal stricture that was treated with intra-operative dilatation (IOD) of the proximal hypopharyngeal stump. IOD was done in two cases with Hegar’s dilator and in three cases with wire-guided Savary Gillard dilators. In 74% (20/27) of the cases, the colon was frequently used as an esophageal substitute, while the stomach was only used in 10 cases. On follow-up, none of them developed repeated aspirations or required a tracheotomy. Conclusion. IOD of the proximal hypopharyngeal and cervical esophageal stumps during surgery for corrosive upper cervi cal esophageal or cricopharyngeal strictures helps to save the proximal stump and avoid frequent hospital stays and multiple surgeries.

La restauration de la continuité digestive suite à l'ablation d'une portion de l'œsophage consiste à la réalisation chirurgicale d’une anastomose œsogastrique intra-thoracique. Néanmoins des complications post-opératoires sont décrites telles que des atteintes pulmonaires, des fistules, des sténoses, des nécroses de plastie, et un reflux gastro-œsophagien. Le développement d'un substitut issu de l'ingénierie tissulaire dérivé de la matrice œsophagienne biologique décellularisée (MBD) est prometteur dans la perspective d’améliorer la prise en charge du traitement chirurgical pour le remplacement de l’œsophage. L'objectif principal de cette étude était d'optimiser la conception d’une MBD de porcs et de caractériser ses propriétés biologiques et mécaniques. Le second objectif était de cellulariser la MBD au moyen de cellules immuno-privilégiées, facilement disponibles : les cellules stromales mésenchymateuses humaines issues de la gelée de Wharton (CSM-GW).La décellularisation de l'œsophage était réalisée selon un protocole basé sur la perfusion dynamique de solutions chimiques et enzymatiques de la lumière de l’organe. L’analyse histologique et la quantification de l’ADN résiduel de la MBD permettaient de déterminer l’efficacité du protocole de décellularisation. L'ultrastructure de la MBD était analysée par des marquages immunohistochimiques (IHC), et la composition du contenu protéique de la matrice extracellulaire (MEC) était décrite par spectrométrie de masse. Les tests de cytotoxicité in-vitro de la MBD étaient réalisés conformément à la norme ISO 10993-5. L’évaluation de la force de rétention à la suture, la résistance à la traction et la pression à l’éclatement de la MBD consistait à décrire le comportement mécanique du substitut en regard de son utilisation clinique.Les CSM-GW utilisées pour la cellularisation de la MBD étaient extraites à partir de cordons ombilicaux humains et leur profilage par cytométrie en flux permettait de confirmer la pureté de la population cellulaire. La réponse immunitaire des CSM-GW était quantifiée après une co-culture avec des cellules mononucléées du sang périphérique (PBMC). Le phénotypage des PBMC permettait d’évaluer l’expression des marqueurs immunitaires au contact des MSC-GW, et l’étude du sécrétome, par une méthode immuno-enzymatique (ELISA), quantifiait le relargage des cytokines. La stratégie de cellularisation de la MBD proposée reposait sur le développement de feuillets cellulaires de MSC-GW. La validation du protocole de fabrication des feuillets consistait en la caractérisation du phénotype cellulaire par IHC et l’étude mécanique des feuillets permettait de mesurer leur résistance à la perforation.L’absence de contenu cellulaire et la quantification de l’ADN résiduel de la MBD confirmaient l’efficacité de la décellularisation selon les critères de validation en vigueur. L’ultrastructure et les composants biologiques de la MEC étaient préservés et l'analyse protéomique de la MEC mettait en évidence une complexité protéique. Le traitement de décellularisation n’induisait pas de toxicité de la MBD et le comportement mécanique de la MBD était adapté à son utilisation en tant que substitut œsophagien.La culture des CSM-GW sous forme de feuillets favorisait la cellularisation de la MBD. Une fois ensemencés, les feuillets avaient conservé leur phénotype cellulaire et leur caractéristiques immuno-privilégiées. Un remodelage tissulaire in-vitro était visible ainsi que la formation d’une nouvelle MEC produite par les CSM-GW.Les caractérisations de la MBD obtenue offraient une complexité biologique et un comportement mécanique favorable à son utilisation en tant que substitut œsophagien. La MBD était cellularisable avec des feuillets cellulaires de CSM-GW, pouvant favoriser ainsi l'intégration et le remodelage des tissus
Upon removal of a portion of the esophagus, the restoration of the digestive continuity involves the surgical creation of an intrathoracic esophagogastric anastomosis. However, postoperative complications such as lung impairments, fistulas, strictures, graft necrosis, and gastroesophageal reflux are reported. The enhancement of surgical procedures for esophageal replacement has made promising progress by the development of a substitute through tissue engineering that utilizes a decellularized biological esophageal matrix (DEM). The primary objective of this study was to optimize the design of porcine DEM and characterize its biological and mechanical properties. The secondary objective was to cellularize DEM using readily available immune-privileged human mesenchymal stromal cells derived from Wharton's jelly (hMSCs-WJ).Esophageal decellularization was performed according to a protocol based on the dynamic perfusion of chemical and enzymatic solutions through the organ lumen. Histological analysis and residual DNA quantification of the DEM were conducted to determine the efficiency of the decellularization protocol. The ultrastructure of the DEM was analyzed using immunohistochemical (IHC) labeling, and the composition of the extracellular matrix (ECM) protein content was described by mass spectrometry. In-vitro cytotoxicity tests of DEM were conducted following ISO 10993-5 standards. The evaluation of suture retention strength, tensile strength, and bursting pressure of DEM aimed to describe the mechanical behavior of the substitute for clinical use.hMSCs-WJ used for DEM cellularization were extracted from human umbilical cords, and their flow cytometry profiling confirmed the purity of the cell population. The immune response of hMSCs-WJ was quantified after co-culture with peripheral blood mononuclear cells (PBMCs). PBMCs phenotyping assessed the expression of immune markers in contact with hMSCs-WJ, while enzyme-linked immunosorbent assay (ELISA) quantified cytokine release. The proposed DEM cellularization strategy involved the development of cell sheets from hMSCs-WJ. The validation of the cell sheet production protocol involved the characterization of the cellular phenotype by IHC analysis, and the mechanical study of the sheets measured their resistance to perforation.The absence of cellular content and residual DNA quantification in DEM confirmed the efficacy of decellularization according to current validation criteria. The ultrastructure and biological components of the ECM were preserved, and proteomic analysis highlighted protein complexity. Decellularization treatment did not induce DEM toxicity, and the mechanical behavior of DEM was suitable for its use as an esophageal substitute.Culturing hMSCs-WJ as cell sheets promoted the cellularization of the DEM. Once seeded, the sheets retained their cellular phenotype and immune-privileged characteristics. In-vitro tissue remodeling was visible, along with the formation of a new ECM produced by hMSCs-WJ.Characterization of the obtained DEM offered biological complexity and favorable mechanical behavior for its use as an esophageal substitute. DEM was cellularizable with hMSCs-WJ cell sheets, potentially promoting tissue integration and remodeling

Introduction. The quality of substitute speech with laryngectomees patients with or without the implanted voice prosthesis type Provox II on the bases of two clinical cases was compared. Material and methods. The evaluation of voice was compared on the bases of two patients treated in Otolaryngological and Laryngological Oncology Clinic. The patients K.P. aged 46 (medical history number 2778/2008) who, on March 12, 2008 underwent total laryngectomy with the Rethie method including the removal of left thyroid lobe due to thyroid and larynx cancer. The patients D.K. ages 44 (medical history number 13705/2010) who on November 4, 2010 underwent total laryngectomy with the Rethie method including selective lymphe node operation of Region II on the right side with the implanting of the voice prosthesis type Provox II due to larynx cancer. Each patients was instructed on tracheostomy care and systematic performing of the fallowing exercises: diaphragmatic‑ribbed tract breathing loosening masseter muscle system and esophageal sphincter, the use of lauder reflection in the process of voice production, the method of obtaining loud reflection lengthening of the time of phonation and eliminating breath sounds. The evaluation of the quality of substitutive speech was performed after three months. Results. On the basis of the conversation with the patients, it turned out that the patient with the implanted voice prosthesis had better quality of substitutive speech and better communication possibility. Conclusions. The learned substitutive speech with the interoperatively implanted the voice prosthesis type P. II turned out to be the best way of communication.