NEW YORK — Doctors, including an Indian American doctor, reported the first case of a human patient whose severely damaged esophagus was reconstructed using commercially available stents and skin tissues.
After the 24-year-old man was paralyzed in a car crash seven years ago, doctors struggled to repair his disrupted esophagus.
Despite several surgeries, the defect in the esophagus was too large to repair, and it was resulting in a life-threatening infection, the physicians noted in the paper published in the journal The Lancet.
The team of doctors decided to try a technique previously tested only in animals to reconstruct the upper esophagus with stents and skin tissue approved by the Food and Drug Administration.
“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,” Kulwinder Dua, a professor at the Medical College of Wisconsin.
The doctors used metal stents as a non-biological scaffold and a regenerative tissue matrix from donated human skin to rebuild a full-thickness 5 cm defect in the esophagus of the patient.
They inserted an endoscope containing a wire through the man’s stomach and up through what remained of his esophagus, leading to his mouth.
Guided by the wire, they then inserted three stents to recreate the structure of the esophagus and covered it with skin tissue.
The tissue was then sprayed with a gel made from the patient’s own blood, which contained natural substances to attract stem cells.
Although the doctors wanted to remove the stents about three months after the surgery, the patient refused, fearing he would not be able to eat and drink; he was also worried about possible scarring.
Nearly four years later, doctors removed the stents after the man had trouble swallowing when a problem arose with the lower stent.
One year after that, doctors examined the man’s esophagus and found that all five layers of the esophagus had regrown, closely resembling a normal one.
The patient now does not need a feeding tube and also has not reported any other complications.
Swallowing tests showed full recovery and functioning was also established with esophageal muscles able to propel water and liquid along the esophagus into the stomach in both upright and 45-degree sitting positions.
“The approach we used is novel, because we used commercially available products that are already approved for use in the human body and hence didn’t require complex tissue engineering,” Dua explained.
The research, including animal studies and clinical trials, are now needed to investigate whether the technique can be reproduced and used in other similar cases.
“The use of this procedure in routine clinical care is still a long way off, as it requires rigorous assessment in large animal studies and phase one and two clinical trials,” Dua stated.
The esophagus is a hollow muscular tube that connects the mouth to the stomach carrying food and liquids.