title: Esophageal preservation in five male patients after endoscopic inner-layer circumferential resection in the setting of superficial cancer: a regenerative medicine approach with a biologic scaffold.
abstract: As a result of injury caused by chronic gastroesophageal reflux, Barrett's esophagus with high-grade dysplasia and esophageal adenocarcinoma are rapidly increasing problems in the United States. The current standard of care involves esophagectomy, a procedure associated with a high morbidity, a negative impact on long term quality of life, and a mortality rate of 1-6 percent. An entirely endoscopic technique for circumferential, long segment en bloc removal of the mucosa and submucosa with subsequent placement of a biologic scaffold material that promotes a constructive remodeling response and minimizes stricture is described herein. The results of this approach are reported for five patients with 4-24-month follow-up. Restoration of normal mature, K4+/K14+, squamous epithelium, and return to a normal diet without significant dysphagia is reported for all patients. Two of five patients show a small focus of recurrent Barrett's esophagus at the gastroesophageal junction, but the entire length and circumference of the reconstituted esophageal mucosa remains free of disease. This experience provides evidence that a regenerative medicine approach may, for the first time, enable aggressive endoscopic resection of early stage neoplasia without the need for esophagectomy and its associated complications.
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. badylaks@upmc.edu
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Badylak
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Hoppo
authors.forename: Alejandro
authors.initials: A
authors.lastname: Nieponice
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Gilbert
authors.forename: Jon M
authors.initials: JM
authors.lastname: Davison
authors.forename: Blair A
authors.initials: BA
authors.lastname: Jobe
mesh_terms: D000368:Aged; D001706:Biopsy; D004724:Endoscopy; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D044968:Regenerative Medicine / Q000379:methods*; D054457:Tissue Scaffolds / Q000737:chemistry*