title: In-vivo oesophageal regeneration in a human being by use of a non-biological scaffold and extracellular matrix.
abstract: BACKGROUND
  Tissue-engineered extracellular matrix populated with autologous pluripotent cells can result in de-novo organogenesis, but the technique is complex, not widely available, and has not yet been used to repair large oesophageal defects in human beings. We aimed to use readily available stents and extracellular matrix to regenerate the oesophagus in vivo in a human being to re-establish swallowing function.
  
  
  METHODS
  In a patient aged 24 years, we endoscopically placed a readily available, fully covered, self-expanding, metal stent (diameter 18 mm, length 120 mm) to bridge a 5 cm full-thickness oesophageal segment destroyed by a mediastinal abscess and leading to direct communication between the hypopharynx and the mediastinum. A commercially available extracellular matrix was used to cover the stent and was sprayed with autologous platelet-rich plasma adhesive gel. The sternocleidomastoid muscle was placed over the matrix. After 4 weeks, stent removal was needed due to stent migration, and was replaced with three stents telescopically aligned to improve anchoring. The stents were removed after 3·5 years and the oesophagus was assessed by endoscopy, biopsy, endoscopic ultrasonography, and high-resolution impedance manometry.
  
  
  RESULTS
  After stent removal we saw full-thickness regeneration of the oesophagus with stratified squamous epithelium, a normal five-layer wall, and peristaltic motility with bolus transit. 4 years after stent removal, the patient was eating a normal diet and maintaining a steady weight.
  
  
  CONCLUSIONS
  Maintenance of the structural morphology of the oesophagus with off-the-shelf non-biological scaffold and stimulation of regeneration with commercially available extracellular matrix led to de-novo structural and functional regeneration of the oesophagus.
  
  
  BACKGROUND
  None.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: kdua@mcw.edu.
authors.forename: Kulwinder S
authors.initials: KS
authors.lastname: Dua
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Hogan
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University, Evanston, IL, USA.
authors.forename: Abdul A
authors.initials: AA
authors.lastname: Aadam
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Gasparri
mesh_terms: D000038:Abscess / Q000601:surgery*; D001860:Bone Plates; D002574:Cervical Vertebrae / Q000601:surgery*; D020878:Device Removal; D004724:Endoscopy; D004935:Esophageal Diseases / Q000601:surgery*; D004947:Esophagus; D005109:Extracellular Matrix; D048091:Guided Tissue Regeneration / Q000379:methods*; D006801:Humans; D008297:Male; D008365:Manometry; D008477:Mediastinal Diseases / Q000601:surgery*; D010608:Pharyngeal Diseases / Q000601:surgery*; D013122:Spinal Diseases / Q000601:surgery; D016103:Spinal Fractures / Q000601:surgery*; D015607:Stents; D054457:Tissue Scaffolds; D055815:Young Adult