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Giordano A, Mastronardi M, Podda M, Bonavina L, Cuccurullo D, Anania G, Bergamini C, Galloro G, Hassan C, Parodi MC, Agresta F, Montori G, Sartelli M, Catena F, Fugazzola P, Ansaloni L, Marciano E, Geraci G, Maurano A, Avellino M, Massella A, Orlandini B. Diagnosis and management of caustic ingestion: an interdisciplinary nationwide cross-sectional survey from the Italian society of endoscopic surgery and new technologies (SICE), the Italian society of digestive endoscopy (SIED), the world society of emergency surgery-Italy chapter (WSESit), and the Italian society of surgical endoscopy and digestive diseases (ISSE). Updates Surg 2025:10.1007/s13304-025-02166-5. [PMID: 40080354 DOI: 10.1007/s13304-025-02166-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Accepted: 03/03/2025] [Indexed: 03/15/2025]
Abstract
Caustic ingestion (CI) in adults represents a potentially life-threatening condition. Diagnosis and management of CI in real life remain challenging. The aim of the survey is to evaluate on a national scale the multidisciplinary management of these patients. 24-item online Survey was sent to the mailing lists and social media of Italian Society of Endoscopic Surgery and New Technologies, Italian Society of Digestive Endoscopy, World Society of Emergency Surgery-Italy Chapter, and Italian Society of Surgical Endoscopy and Digestive Diseases. Overall, 240 subjects answered to the survey, corresponding to 22.1% of the total members of the scientific societies involved. 131 (54.5%) respondents evaluated fewer than ten CI patients per year. The recommendations provided by the WSES and SIED guidelines were followed by 133 (55.2%) and 83 (34.4%) participants, respectively. Emergency surgery was advocated by 180 (77.6%) of the respondents for patients with transmural necrosis or signs of perforation, using minimally invasive surgery in 47% of the cases and considering initial esophagojejunal anastomosis as safe in 33 (14.2%) of the responses. Our study is the first to provide real-life data on how the management of CI varies across Italian physicians, according to regional, institutional, and specialty-related factors. This survey highlights the need for standardized and uniform guidelines.
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Affiliation(s)
- Alessio Giordano
- Emergency Surgery Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Manuela Mastronardi
- Department of Medicine, Surgery and Health Sciences, General Surgery Unit, University Hospital of Trieste, Trieste, Italy
| | - Mauro Podda
- Department of Surgical Science, Cagliari State University, Cagliari, Italy
| | - Luigi Bonavina
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Diego Cuccurullo
- Department of Surgery, Ospedale Monaldi-Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Gabriele Anania
- Department of Surgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Carlo Bergamini
- Emergency Surgery Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Giuseppe Galloro
- Department of Clinical Medicine, Surgery Digestive Surgical Endoscopy Unit, University of Naples Federico II, Naples, Italy
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Maria Caterina Parodi
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Teaching Hospital San Martino, Genoa, Italy
| | - Ferdinando Agresta
- Department of General Surgery, Ulss2 Marca Trevigiana, Vittorio Veneto, Treviso, Italy
| | - Giulia Montori
- Department of General Surgery, Ulss2 Marca Trevigiana, Vittorio Veneto, Treviso, Italy
| | | | - Fausto Catena
- Emergency and Trauma Surgery Unit, Bufalini Hospital, Cesena, Italy
| | - Paola Fugazzola
- Department of General and Emergency Surgery, Policlinico San Matteo, Pavia, Italy
| | - Luca Ansaloni
- Department of General and Emergency Surgery, Policlinico San Matteo, Pavia, Italy
| | | | - Girolamo Geraci
- Emergency and General Surgery Unit, Palermo University Hospital "P. Giaccone", Palermo, Italy
| | - Attilio Maurano
- Digestive Endoscopy Unit, Mercato San Severino Hospital, Mercato San Severino, Salerno, Italy
| | - Manuela Avellino
- Digestive Endoscopy Unit, Santa Maria Delle Grazie Hospital, Pozzuoli, Italy
| | - Arianna Massella
- Emergency Endoscopy Unit, Verona University Hospital, Verona, Italy
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Singh AK, Gunjan D, Dash NR, Poddar U, Gupta P, Jain AK, Lahoti D, Nayer J, Goenka M, Philip M, Chadda R, Singh RK, Appasani S, Zargar SA, Broor SL, Nijhawan S, Shukla S, Gupta V, Kate V, Makharia G, Kochhar R. Short-term and long-term management of caustic-induced gastrointestinal injury: An evidence-based practice guidelines. Indian J Gastroenterol 2025:10.1007/s12664-024-01692-1. [PMID: 39982600 DOI: 10.1007/s12664-024-01692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 09/15/2024] [Indexed: 02/22/2025]
Abstract
The Indian Society of Gastroenterology has developed an evidence-based practice guideline for the management of caustic ingestion-related gastrointestinal (GI) injuries. A modified Delphi process was used to arrive at this consensus containing 41 statements. These statements were generated after two rounds of electronic voting, one round of physical meeting, and extensive review of the available literature. The exact prevalence of caustic injury and ingestion in developing countries is not known, though it appears to be of significant magnitude to pose a public health problem. The extent and severity of this preventable injury to the GI tract determine the short and long-term outcomes. Esophagogastroduodenoscopy is the preferred initial approach for the evaluation of injury and contrast-enhanced computed tomography is reserved only for specific situations. Low-grade injuries (Zargar grade ≤ 2a) have shown better outcomes with early oral feeding and discharge from hospital. However, patients with high-grade injury (Zargar grade ≥ 2b) require hospitalization as they are at a higher risk for both short and long-term complications, including luminal narrowing. These strictures can be managed endoscopically or surgically depending on the anatomy and extent of stricture, expertise available and patients' preferences. Nutritional support all along is crucial for all these patients until nutritional autonomy is established.
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Affiliation(s)
- Anupam Kumar Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Deepak Gunjan
- Department of Gastroenterology and HNU, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Nihar Ranjan Dash
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Ajay Kumar Jain
- Department of Gastroenterology, Choithram Hospital and Research Center, Indore, 452 014, India
| | - Deepak Lahoti
- Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, New Delhi, 110 017, India
| | - Jamshed Nayer
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Mahesh Goenka
- Institute of Gastrosciences and Liver Transplant, Apollo Multispeciality Hospitals, Kolkata, 700 054, India
| | | | - Rakesh Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Rajneesh Kumar Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Sreekanth Appasani
- Department of Gastroenterology and Hepatology, Krishna Institute of Medical Sciences, Secunderabad, 500 003, India
| | - Showkat Ali Zargar
- Department of Gastroenterology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | - Sohan Lal Broor
- Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospitals, New Delhi, 110 076, India
| | - Sandeep Nijhawan
- Department of Gastroenterology and Hepatology, Sawai Man Singh Medical College, Jaipur, 302 004, India
| | - Siddharth Shukla
- Department of Medicine and Gastroenterology, Base Hospital, Guwahati, 781 028, India
| | - Vikas Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Vikram Kate
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605 006, India
| | - Govind Makharia
- Department of Gastroenterology and HNU, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Rakesh Kochhar
- Department of Gastroenterology and Hepatology, Paras Hospital, Panchkula, 134 109, India.
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Hoeppner J. [Technique of Colon Interposition for Oesophageal Replacement for Oesophageal Cancer]. Laryngorhinootologie 2025; 104:14-22. [PMID: 38996432 DOI: 10.1055/a-2341-0438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
Nowadays, it is only relatively rare and in selected situations that colonic interposition is chosen rather than the stomach as a reconstructive organ for replacing the oesophagus. The colon is a reliable organ for tubular replacement of the oesophagus when the stomach is not available for reconstruction. Colon interposition is a complex and complicated operation. It requires a specific indication and thorough preoperative preparation. From a technical point of view, colon interposition places high demands on the selection and surgical dissection of the vascular supply to the reconstructed organ. The reconstruction route and elevation of the interposition graft to the proximal oesophagus and the need to create 3 or 4 gastrointestinal anastomoses also place significantly higher demands than reconstruction using a gastric tube. Overall, despite the significant surgery-related morbidity, good functional results and a good quality of life can usually be achieved. The surgical technique applied in our own practice is described in detail. An overview from literature on the results of colonic interposition is given, particularly with regard to surgical complications and quality of life after colon interposition.
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Affiliation(s)
- Jens Hoeppner
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum OWL - Campus Lippe, Universität Bielefeld, Detmold, Deutschland
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Naseri R, Shafiekhani M, Rajabian M, Ashrafzadeh K, Esmaeili M, Nikoupour H. Using right colon interposition in patients with caustic ingestion, an introduction of a new surgical technique for post-gastrectomy reconstruction: a case series. J Med Case Rep 2024; 18:620. [PMID: 39710675 DOI: 10.1186/s13256-024-04978-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Accepted: 11/12/2024] [Indexed: 12/24/2024] Open
Abstract
BACKGROUND Corrosive substance ingestion is rare but can cause severe injury, especially to the upper gastrointestinal tract, and can be a potentially fatal event. Various surgical procedures have been advocated for gastroesophageal reconstruction, but especially those using the right colon, when the ileocecal valve is preserved for gastric reconstruction, are briefly exposed in literature and have not been studied in humans by controlled studies. Using the right colon is believed to be beneficial because of the anti-reflux mechanism of the ileocecal valve. This study aims to report our experience in the use of right colon interposition for gastric reconstruction in the management of caustic injury, and to assess its influence on patient outcomes. CASE PRESENTATION We describe five cases, all of which included corrosive substances ingested by patients referred to a local tertiary center institution undergoing right colon interposition for esophageal and gastric reconstruction. We evaluated five Iranian patients undergoing ileocolic segment interposition for gastric reconstruction. Of these, two were male patients (patient 1 was 51 years old, patient 2 was 32 years old), and three were female patients (patient 3 was 49 years old, patient 4 was 32 year old, patient 5 was 59 year old), with an age from 32 to 59 years (mean: 57 ± 10.95). The operating surgeon's first to fifth procedures proceeded uneventfully, with only one case of cervical leakage as a complication with spontaneous closure; relative mean operative time of 5.95 ± 1.17 hours, hospital stays of 25 ± 15.29 days for all five patients. No excess morbidity rate was observed. CONCLUSION In this case series, a novel technique for post-gastrectomy reconstruction using right colon interposition along with an ileocecal reservoir with identical advantages in improving eating capacity, and avoiding biliary reflux thanks to the presence of the ileocecal valve, is introduced.
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Affiliation(s)
- Reyhaneh Naseri
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Shafiekhani
- Shiraz Organ Transplant Center,, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Kiarash Ashrafzadeh
- Shiraz Organ Transplant Center,, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Esmaeili
- Shiraz Organ Transplant Center,, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Nikoupour
- Shiraz Organ Transplant Center,, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Li X, Zou L, Shi L, Zheng X, Xu C, Guo J. Twenty years of anastomotic stenosis combined with tracheocolonic fistula after colon replacement esophagectomy: a case report. Front Oncol 2024; 14:1471603. [PMID: 39735604 PMCID: PMC11672786 DOI: 10.3389/fonc.2024.1471603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Accepted: 11/21/2024] [Indexed: 12/31/2024] Open
Abstract
Esophageal stricture is the most common and disabling complication of esophageal injury caused by ingestion of corrosive substances. In our case, the patient developed esophageal stenosis due to ingestion of strong alkaline substances and underwent colon replacement surgery after repeated failed dilation treatments. After surgery, anastomotic stenosis and tracheocolonic fistula occurred successively, and the entire diagnosis and treatment cycle of this disease lasted for more than 20 years. Based on experience and the actual situation of the patient, we conclude that esophageal stents should be the primary treatment option, while tracheal stents should be carefully selected, and secondary surgery is not recommended.
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Affiliation(s)
- Xiaofang Li
- Department of Respiratory Medicine, The First Affiliated Hospital/College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Liutao Zou
- Department of Thoracic Surgery, Guangxi Chest Hospital, Liuzhou, China
| | - Lifeng Shi
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xueting Zheng
- Department of Gastroenterology, Shulan (Ji Nan) Hospital, Jinan, China
| | - Cuifang Xu
- Department of Gastroenterology, Shulan (Ji Nan) Hospital, Jinan, China
| | - Jichao Guo
- Lanshan District People’s Hospital, Department of Thoracic Surgery, Linyi, Shandong, China
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Pioche M, Lafeuille P, Burgevin A, Schaefer M, Monneuse O, Rivory J, Lupu A. Unblocking a terminolateral anastomosis on an interposed coloplasty for caustic esophagitis: placement of a lumen-apposing metal stent to straighten the lumen. Endoscopy 2024; 56:E786-E787. [PMID: 39299283 PMCID: PMC11412766 DOI: 10.1055/a-2410-3349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Affiliation(s)
- Mathieu Pioche
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pierre Lafeuille
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Alice Burgevin
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Marion Schaefer
- Gastroenterology and Endoscopy Unit, Brabois University Hospital, Nancy, France
| | - Olivier Monneuse
- Digestive Surgery Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Rivory
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Alexandru Lupu
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
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Bozorgmehr R, Sadeghi A, Bagheri Chokami MS, Pourhooshmandi M, Zebarjadi Bagherpour J, Iravani Z. Surgical management of catastrophic caustic ingestion in acute phase: A case report and review of the literature. Int J Surg Case Rep 2024; 122:110188. [PMID: 39159593 PMCID: PMC11380163 DOI: 10.1016/j.ijscr.2024.110188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Caustic ingestion almost occurs accidentally in children and mostly intentionally in adults. The ingestion of caustic substances can cause various degrees of damage to the gastrointestinal tract. Depending on the severity of the injury, surgery may be a part of the treatment plan. PRESENTATION OF CASE A 32-year-old man was referred to our hospital after swallowing drain cleaner. Due to evidence of peritonitis and endoscopy results, he underwent emergency surgery. During the surgery, necrotic parts, including the esophagus, stomach, duodenum, head of the pancreas, and initial part of the jejunum, were resected. Then, after six months, colon interposition surgery was done to reconstruct the gastrointestinal tract. DISCUSSION Like trauma patients, managing patients with caustic injuries begins with an initial survey of the airway, breathing, and circulation status. In the first 48 h, early esophagoscopy is indicated to evaluate the amount of injury. Evidence of transmural necrosis or perforation is the most important indication for surgery, and surgical procedures are specific to each patient. Esophagogastrectomy is the most common surgery in cases of severe gastrointestinal injuries, but removing more abdominal organs may be needed in fewer cases. CONCLUSION This case report underscores the urgent need for further research and the development of evidence-based guidelines in managing caustic injury with extensive necrosis in the gastrointestinal tract. Our experience with this rare case highlights the importance of such guidelines in improving patient outcomes.
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Affiliation(s)
- Ramin Bozorgmehr
- Department of General Surgery, Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Ahmadreza Sadeghi
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran.
| | | | | | | | - Zahra Iravani
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
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Ola M, Zahra EMF, Amine C, Omar EA, Laila J, Zahra LF. Jejunocolic intussusception after colonic esophageal interposition-A case report. SAGE Open Med Case Rep 2024; 12:2050313X241266425. [PMID: 39055672 PMCID: PMC11271082 DOI: 10.1177/2050313x241266425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/18/2024] [Indexed: 07/27/2024] Open
Abstract
The management of gastrointestinal complications in patients with complex medical history poses significant challenges to healthcare clinicians. A 42-year-old male patient was admitted to the emergency department with excruciating abdominal pain and signs of bowel obstruction. The patient had a previous history of schizophrenia and esophageal stricture, treated 6 years ago with colonic esophageal interposition. From the computed tomography scan, intussusception of the jejunum in the colonic graft was revealed, which resolved spontaneously after a few hours probably due to the oral contrast. Although, colonic esophageal interposition is a life-saving procedure for long-esophageal strictures, there are rare complications that are still not clearly reported. Jejunocolic intussusception should raise awareness of the clinicians, as one of the potential complications of colonic esophageal interposition.
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Affiliation(s)
- Messaoud Ola
- Emergency Radiology Department of the University Hospital Ibn Sina, Rabat, Morocco
| | | | - Cherraqi Amine
- Emergency Radiology Department of the University Hospital Ibn Sina, Rabat, Morocco
| | - El Aoufir Omar
- Emergency Radiology Department of the University Hospital Ibn Sina, Rabat, Morocco
| | - Jroundi Laila
- Emergency Radiology Department of the University Hospital Ibn Sina, Rabat, Morocco
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Merritt RE. Conduit Selection for Reconstruction After Esophagectomy for Esophageal Cancer. Surg Oncol Clin N Am 2024; 33:549-556. [PMID: 38789197 DOI: 10.1016/j.soc.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
The reconstruction of the esophagus after esophagectomy presents many technical and management challenges to surgeons. An effective gastrointestinal conduit that replaces the resected esophagus must have adequate length to reach the upper thoracic space or the neck, have robust vascular perfusion, and provide sufficient function for an adequate swallowing mechanism. The stomach is currently the preferred conduit for esophageal reconstruction after esophagectomy. However, there are circumstances, where the stomach cannot be utilized as a conduit. In these cases, an alternative conduit must be considered. The current alternative conduits include colon, jejunum, and tubed skin flaps.
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Affiliation(s)
- Robert E Merritt
- Division of Thoracic Surgery, The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, N847 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210, USA.
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10
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Hoeppner J. [Technique of Colon Interposition for Oesophageal Replacement for Oesophageal Cancer]. Zentralbl Chir 2024; 149:178-186. [PMID: 38417814 DOI: 10.1055/a-2262-8552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Nowadays, it is only relatively rare and in selected situations that colonic interposition is chosen rather than the stomach as a reconstructive organ for replacing the oesophagus. The colon is a reliable organ for tubular replacement of the oesophagus when the stomach is not available for reconstruction. Colon interposition is a complex and complicated operation. It requires a specific indication and thorough preoperative preparation. From a technical point of view, colon interposition places high demands on the selection and surgical dissection of the vascular supply to the reconstructed organ. The reconstruction route and elevation of the interposition graft to the proximal oesophagus and the need to create 3 or 4 gastrointestinal anastomoses also place significantly higher demands than reconstruction using a gastric tube. Overall, despite the significant surgery-related morbidity, good functional results and a good quality of life can usually be achieved. The surgical technique applied in our own practice is described in detail. An overview from literature on the results of colonic interposition is given, particularly with regard to surgical complications and quality of life after colon interposition.
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Affiliation(s)
- Jens Hoeppner
- Klinik für Allgemein- und Viszeralchirurgie, Klinikum Lippe, Universitätsklinikum OWL - Campus Lippe, Detmold, Deutschland
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11
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Maher A, De Coppi P, Blackburn S, Loukogeorgakis S, Eaton S, Cross K, Giuliani S, Curry J, Mullassery D. Short and Medium Term Outcomes of Open and Laparoscopic Assisted Oesophageal Replacement Procedures. J Pediatr Surg 2024; 59:192-196. [PMID: 38016850 DOI: 10.1016/j.jpedsurg.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 10/10/2023] [Indexed: 11/30/2023]
Abstract
AIM OF THE STUDY We describe the short- and medium-term outcomes following open and laparoscopic assisted oesophageal replacement surgery in a single tertiary paediatric surgical centre. METHODS A retrospective review (institutional audit approval no. 3213) on patients who underwent open or laparoscopic-assisted oesophageal replacement (OAR vs. LAR) at our centre between 2002 and 2021 was completed. Data collected (demographics, early complications, stricture formation, need for oesophageal dilatations, and mortality) were analysed using GraphPad Prism v 9.50 and are presented as median (IQR). RESULTS 71 children (37 male) had oesophageal replacement surgery at a median age of 2.3 years (IQR 4.7 years). 51 were LAR (6 conversions). Replacement conduit was stomach (n = 67), colon (n = 3), or jejunum (n = 1). Most gastric transpositions had a pyloroplasty (46/67) or pyloromyotomy (14/67). Most common pathology was oesophageal atresia (n = 50 including 2 failed transpositions), caustic injury (n = 19 including 3 due to button battery), stricture of unknown cause (n = 1), and megaoesophagus (n = 1). There were 2 (2.8 %) early postoperative deaths at 2 days (major vessel thrombosis), 1 month (systemic sepsis), and one death at 5 years in the community. The rate of postoperative complications were comparable across LAR and OAR including anastomotic leak, pleural effusions, or early strictures. More patients with caustic pathology needed dilatations (60 % vs 30 % in OA, p = 0.05). CONCLUSIONS Outcomes of open and laparoscopic-assisted oesophageal replacement procedures are comparable in the short and medium term. Anastomotic stricture is higher in those with caustic injury. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ahmed Maher
- Great Ormond Street Hospital for Children, London, United Kingdom; Assiut University, Assiut, Egypt
| | - Paolo De Coppi
- Great Ormond Street Hospital for Children, London, United Kingdom; UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Simon Blackburn
- Great Ormond Street Hospital for Children, London, United Kingdom
| | | | - Simon Eaton
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Kate Cross
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - Stefano Giuliani
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - Joe Curry
- Great Ormond Street Hospital for Children, London, United Kingdom
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12
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Choi BH, Church J, Sonett J, Kiran RP. Colonic interposition in esophagectomy: an ACS-NSQIP study. Surg Endosc 2023; 37:9563-9571. [PMID: 37730851 DOI: 10.1007/s00464-023-10420-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION For patients with cancer or injury of the esophagus, esophagectomy with reconstruction using the stomach (gastric pull-up, GPU) or colon (colonic interposition, CI) can restore function but is associated with high morbidity. We sought to describe the differences in outcomes between the two replacement organs using a national database. METHODS From ACS-NSQIP, patients who underwent GPU or CI between 2006 and 2020 were identified. Univariate analyses were performed on length of stay, complications, reoperation, readmission, and mortality. Variables with P ≤ 0.2 were included in the multivariate regression. Primary outcomes were 30-day reoperation, readmission, and mortality. Data were assessed using Chi-squared tests and logistic regression. RESULTS There were 12,545 GPU and 502 CI patients. GPU patients were older with higher BMI, and more likely to be male (80.3% versus 70.3%, P < 0.0001) and white (77.8% versus 69.1%, P < 0.0001). More GPU patients had independent functional status and underlying bleeding disorders, but fewer other preoperative comorbidities than CI patients. On univariate analysis, CI patients had longer hospital stays (13 versus 10 days, P < 0.0001); more reoperations (23.9% versus 14.5%, P < 0.0001); a lower rate of discharge to home (70.9% versus 82.1%, P < 0.0001); and a higher mortality rate (6.2% versus 2.9%, P < 0.0001). On multivariate analysis, CI was associated with increased risk of reoperation but not with readmission or mortality. Reoperation was associated with CI, smoking, chronic wound, hypertension, higher ASA class, contaminated or dirty wound class, and longer operative time. Readmission was associated with female gender, hypertension, and longer operative time. Mortality was associated with age, metastatic cancer, preoperative sepsis, preoperative renal failure, malignant esophageal disease, higher ASA class, incomplete closure, and longer operative time. CONCLUSION Colonic interposition, although a more difficult option with traditionally worse outcomes, should still be considered for patients requiring esophagectomy if the stomach cannot be used to restore continuity, as differences in outcomes appear to be due to underlying frailty of patients rather than the procedure.
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Affiliation(s)
- Beatrix Hyemin Choi
- Colorectal Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, 161 Ft. Washington Avenue, Floor 8, New York, NY, 10032, USA.
| | - James Church
- Colorectal Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, 161 Ft. Washington Avenue, Floor 8, New York, NY, 10032, USA
| | - Joshua Sonett
- Thoracic Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, 161 Ft. Washington Avenue, Floor 3, New York, NY, 10032, USA
| | - Ravi Pokala Kiran
- Colorectal Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, 161 Ft. Washington Avenue, Floor 8, New York, NY, 10032, USA
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13
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Sanchez MV, Alicuben ET, Luketich JD, Sarkaria IS. Colon Interposition for Esophageal Cancer. Thorac Surg Clin 2022; 32:511-527. [PMID: 36266037 DOI: 10.1016/j.thorsurg.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Esophagectomy and colon interposition in the adult patient, either for primary alimentary reconstruction or as a secondary replacement after initial resection/reconstruction for malignant or benign disease, remains a valuable tool in the thoracic surgeon's armamentarium. It is important for surgeons to remain versed in the complexities of the operation, including preoperative preparation and decision making, operative procedural and technical variations, and recognition and timely treatment of postoperative complications. In this article, we present technical details of the procedure, a review of selected published studies, long-term results, and indications and outcomes for revisional surgery.
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Affiliation(s)
- Manuel Villa Sanchez
- Staten Island University Hospital, 501 Seaview Avenue, Suite 202, Staten Island, NY 10305, USA
| | - Evan T Alicuben
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, UPMC Presbyterian, 200 Lothrop Street, Suite C-800, Pittsburgh, PA 15213, USA
| | - James D Luketich
- Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, UPMC Presbyterian, 200 Lothrop Street, Suite C-800, Pittsburgh, PA 15213, USA
| | - Inderpal S Sarkaria
- Clinical Affairs, University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, Shadyside Medical Building, 5200 Centre Avenue, Suite 715, Pittsburgh, PA 15232, USA.
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14
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Sharma K, Sharma S, Gupta DK, Kabra SK, Bajpai M. Functional, nutritional, and developmental assessment of gastric transposition and colonic interposition: Long-term follow-up outcome analysis. J Pediatr Surg 2022; 57:333-341. [PMID: 35680464 DOI: 10.1016/j.jpedsurg.2022.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE The choice of Esophageal replacement (ER) depends on surgeons' preference and patients' anatomical condition. A cross-sectional study was done to compare the long-term outcomes of two methods of ER, Gastric transposition (GT) and Colonic interposition (CI). METHODS Children who had undergone ER from January 1997 to December 2017 with a minimum of two-year post-ER follow-up were evaluated by anthropometry, hepatobiliary scintigraphy, gastroesophageal reflux study, gastric emptying test, pulmonary function test and blood tests. RESULTS Twenty-six (Male:female=17:9) children were recruited. The median age at ER was 13 months (interquartile range 9-40 months) and mean follow-up post-ER was 116.7 ± 76.4 months (range 24-247 months). GT:CI was done in 15(57.7%):11(42.3%) cases. A greater number of abnormal oral contrast studies (p = 0.02) and re-operations (p = 0.05) were documented as baseline characteristics with CI group. The presence of gastroesophageal reflux 9/23(39.1%), duodenogastric reflux 6/24(25%), delayed gastric emptying 6/25(24%), abnormal pulmonary function test 14/22(63.6%) were documented during the study period. However, there was no significant(p>0.05) difference in nutritional, developmental and functional outcomes of both operative methods of ER in the study. CONCLUSION Assessment of nutritional, developmental and functional parameters in children after ER reveals good long-term results. There was no significant difference in CI and GT. LEVEL OF EVIDENCE Comparative study; II.
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Affiliation(s)
- Kanika Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Room no. 4001, 4th floor, Academic block, New Delhi 110029, India
| | - Shilpa Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Room no. 4001, 4th floor, Academic block, New Delhi 110029, India.
| | - Devendra Kumar Gupta
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Room no. 4001, 4th floor, Academic block, New Delhi 110029, India
| | - Sushil Kumar Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Minu Bajpai
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Room no. 4001, 4th floor, Academic block, New Delhi 110029, India
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15
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Predictive factors for the success of endoscopic dilation of esophageal caustic stricture: the experience of a French tertiary reference center. Surg Endosc 2022; 36:5660-5668. [PMID: 35790591 DOI: 10.1007/s00464-021-08781-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 10/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Predictors of the efficacy of endoscopic dilation for caustic esophageal stricture have been poorly studied. METHODS All patients undergoing an endoscopic dilation for an esophageal caustic stricture between 1990 and 2015 in a French national reference center were included. Success of dilation was defined by self-food autonomy without the need for reconstructive esophageal surgery. RESULTS During the study period, 894 patients were admitted after caustic ingestion. Among them, 101 patients developed esophageal stricture and 92 patients were eligible for analysis (missing data in 8 cases, 1 patient died before endoscopic dilation). In this cohort (median age 42 years, women 53%, strong alkali 74%, suicide attempt 77%, hydrostatic balloon use 93%), the overall success rate of dilation was 57% with a median number of 3 dilation sessions (274 sessions, range 1-17). Factors predicting the success of the procedure were: non-inflammatory stricture or non-inflammatory intercalated mucosa between stricture (88% vs 47%, p = 0.001), a single stricture versus 2 or more strictures (69% vs 47% vs 33%, respectively, p = 0.04), a stricture of less than 5 cm (70% vs 27%, p < 0.001) and the existence of mild/ moderately tight or very tight stricture (70% vs 21% of success, p < 0.001). Perforation rate was 6.5% (18/274) requiring emergency surgery in 2 cases. CONCLUSION Several characteristics of caustic esophageal strictures are significantly associated with the success rate of endoscopic dilation. Our data may be useful for customizing treatment strategies in patients with a caustic stricture.
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A renovated method of performing over 258 cases of pedicled colon segment interposition for esophageal reconstruction with integration of plastic surgery principles into general surgery procedure. Eur Surg 2022. [DOI: 10.1007/s10353-022-00766-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Bouriez D, Gronnier C, Najah H, Collet D. Making It Stick: Management of Gastroesophageal Junction Adenocarcinoma with Poorly-Cohesive Cells (PCC). Dig Dis Sci 2022; 67:2005-2009. [PMID: 35430699 DOI: 10.1007/s10620-022-07437-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 12/09/2022]
Affiliation(s)
- Damien Bouriez
- Esophagogastric Surgery Unit, Department of Digestive Surgery, Magellan Center, University Hospital of Bordeaux, 33604, Pessac, France
| | - Caroline Gronnier
- Esophagogastric Surgery Unit, Department of Digestive Surgery, Magellan Center, University Hospital of Bordeaux, 33604, Pessac, France
| | - Haythem Najah
- Esophagogastric Surgery Unit, Department of Digestive Surgery, Magellan Center, University Hospital of Bordeaux, 33604, Pessac, France
| | - Denis Collet
- Esophagogastric Surgery Unit, Department of Digestive Surgery, Magellan Center, University Hospital of Bordeaux, 33604, Pessac, France.
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18
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Challine A, Maggiori L, Katsahian S, Corté H, Goere D, Lazzati A, Cattan P, Chirica M. Outcomes Associated With Caustic Ingestion Among Adults in a National Prospective Database in France. JAMA Surg 2021; 157:112-119. [PMID: 34878529 DOI: 10.1001/jamasurg.2021.6368] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Caustic ingestion in adults may result in death or severe digestive sequelae. The scarcity of nationwide epidemiological data leads to difficulties regarding the applicability of their analysis to less specialized centers, which are nevertheless largely involved in the emergency management of adverse outcomes following caustic ingestion. Objective To assess outcomes associated with caustic ingestion in adults across a nationwide prospective database. Design, Settings, and Participants Adult patients aged 16 to 96 admitted to the emergency department for caustic ingestion between January 2010 and December 2019 were identified from the French Medical Information System Database, which includes all patients admitted in an emergency setting in hospitals in France during this period. Exposure Esophageal caustic ingestion. Main Outcomes and Measures The primary end point was in-hospital patient outcomes following caustic ingestion. Multivariate analysis was performed to assess independent predictors of in-hospital morbidity and mortality. Results Among 22 657 226 patients admitted on an emergency outpatient basis, 3544 (0.016%) had ingested caustic agents and were included in this study. The median (IQR) age in this population was 49 (34-63) years, and 1685 patients (48%) were women. Digestive necrosis requiring resection was present during the primary hospital stay in 388 patients with caustic ingestion (11%). Nonsurgical management was undertaken in 3156 (89%). A total of 1198 (34%) experienced complications, and 294 (8%) died. Pulmonary complications were the most frequent adverse event, occurring in 869 patients (24%). On multivariate analysis, predictors of mortality included old age, high comorbidity score, suicidal ingestion, intensive care unit admission during management, emergency surgery for digestive necrosis, and treatment in low-volume centers. On multivariate analysis, predictors of morbidity included old age, higher comorbidity score, intensive care unit admission during management, and emergency surgery for digestive necrosis. Conclusions and Relevance In this study, referral to expert centers was associated with improved early survival after caustic ingestion. If feasible, low-volume hospitals should consider transferring patients to larger centers instead of attempting on-site management.
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Affiliation(s)
- Alexandre Challine
- Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Hôpital 13 Saint Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France.,Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1138 Team 22, Centre de Recherche des Cordeliers, Paris, France
| | - Léon Maggiori
- Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Hôpital 13 Saint Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Sandrine Katsahian
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1138 Team 22, Centre de Recherche des Cordeliers, Paris, France.,Université de Paris, Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité d'Épidémiologie et de Recherche Clinique, Institut National de la Santé et de la Recherche Médicale, Centre d'Investigation Clinique 1418, Module Épidémiologie Clinique, Paris, France
| | - Hélène Corté
- Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Hôpital 13 Saint Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Diane Goere
- Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Hôpital 13 Saint Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Andrea Lazzati
- Department of General Surgery, Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun, 94000 Créteil, France.,Institut National de la Santé et de la Recherche Médicale, L'Institut Mondor de Recherche Biomédicale, U955, Université Paris-Est Créteil, France
| | - Pierre Cattan
- Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Hôpital 13 Saint Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Mircea Chirica
- Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
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19
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An Unusual Case of Dysphagia. ACG Case Rep J 2021; 8:e00661. [PMID: 34621907 PMCID: PMC8492369 DOI: 10.14309/crj.0000000000000661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/31/2021] [Indexed: 11/26/2022] Open
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20
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Levenson G, Berger A, Demma J, Perrod G, Domet T, Arakelian L, Bruneval P, Broudin C, Jarraya M, Setterblad N, Rahmi G, Larghero J, Cattan P, Faivre L, Poghosyan T. Circumferential esophageal replacement by a decellularized esophageal matrix in a porcine model. Surgery 2021; 171:384-392. [PMID: 34392978 DOI: 10.1016/j.surg.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 06/03/2021] [Accepted: 07/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tissue engineering is an attractive alternative to conventional esophageal replacement techniques using intra-abdominal organs which are associated with a substantial morbidity. The objective was to evaluate the feasibility of esophageal replacement by an allogenic decellularized esophagus in a porcine model. Secondary objectives were to evaluate the benefit of decellularized esophagus recellularization with autologous bone marrow mesenchymal stromal cells and omental maturation of the decellularized esophagus. METHODS Eighteen pigs divided into 4 experimental groups according to mesenchymal stromal cells recellularization and omental maturation underwent a 5-cm long circumferential replacement of the thoracic esophagus. Turbo green florescent protein labelling was used for in vivo mesenchymal stromal cells tracking. The graft area was covered by a stent for 3 months. Clinical and histologic outcomes were analyzed over a 6-month period. RESULTS The median follow-up was 112 days [5; 205]. Two animals died during the first postoperative month, 2 experienced an anastomotic leakage, 13 experienced a graft area stenosis following stent migration of which 3 were sacrificed as initially planned after successful endoscopic treatment. The stent could be removed in 2 animals: the graft area showed a continuous mucosa without stenosis. After 3 months, the graft area showed a tissue specific regeneration with a mature epithelium and muscular cells. Clinical and histologic results were similar across experimental groups. CONCLUSION Circumferential esophageal replacement by a decellularized esophagus was feasible and allowed tissue remodeling toward an esophageal phenotype. We could not demonstrate any benefit provided by the omental maturation of the decellularized esophagus nor its recellularization with mesenchymal stromal cells.
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Affiliation(s)
- Guillaume Levenson
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Department de Chirurgie Viscérale, Oncologique, et Endocrinienne, Paris, France; INSERM U976 et CIC-BT501, Université de Paris, Hôpital Saint-Louis, Paris, France. https://twitter.com/Levenson_G
| | - Arthur Berger
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Service de Gastroentérologie, Paris, France. https://twitter.com/bergerarthur7
| | - Jonathan Demma
- Hadassah Medical Center, Service de Chirurgie Générale, Université Hébraïque de Jerusalem, Jerusalem, Israel
| | - Guillaume Perrod
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Service de Gastroentérologie, Paris, France
| | - Thomas Domet
- INSERM U976 et CIC-BT501, Université de Paris, Hôpital Saint-Louis, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, Paris, France
| | - Lousineh Arakelian
- INSERM U976 et CIC-BT501, Université de Paris, Hôpital Saint-Louis, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, Paris, France
| | - Patrick Bruneval
- Department of Pathology, Georges-Pompidou European hospital, AP-HP and Université de Paris, Paris, France
| | - Chloe Broudin
- Department of Pathology, Georges-Pompidou European hospital, AP-HP and Université de Paris, Paris, France
| | - Mohamed Jarraya
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Banque de Tissus Humains, Paris, France
| | - Niclas Setterblad
- Plateforme technologique de l'IRSL/ Technological Core Facility, Saint-Louis Research Institute, Saint-louis Hospital, Université de Paris
| | - Gabriel Rahmi
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Service de Gastroentérologie, Paris, France
| | - Jerome Larghero
- INSERM U976 et CIC-BT501, Université de Paris, Hôpital Saint-Louis, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, Paris, France
| | - Pierre Cattan
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Department de Chirurgie Viscérale, Oncologique, et Endocrinienne, Paris, France; INSERM U976 et CIC-BT501, Université de Paris, Hôpital Saint-Louis, Paris, France.
| | - Lionel Faivre
- INSERM U976 et CIC-BT501, Université de Paris, Hôpital Saint-Louis, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, Paris, France. https://twitter.com/FaivreLionel1
| | - Tigran Poghosyan
- INSERM U976 et CIC-BT501, Université de Paris, Hôpital Saint-Louis, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Service de Chirugie Viscérale et Oncologique, Paris, France. https://twitter.com/PoghosyanTigra1
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Flemming S, Lock JF, Hankir M, Reimer S, Petritsch B, Germer CT, Seyfried F. Successful management of therapy-refractory pseudoachalasia after Ivor Lewis esophagectomy by bypassing colonic pull-up: A case report. World J Clin Cases 2021; 9:3971-3978. [PMID: 34141755 PMCID: PMC8180226 DOI: 10.12998/wjcc.v9.i16.3971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/26/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastric pull-up after esophagectomy is still a demanding surgical procedure and associated with considerable morbidity such as anastomotic leaks, fistulas or stenoses. These complications are usually managed by endoscopy, but in extreme cases multidisciplinary management including reoperations may be necessary. Here, we report managing therapy-refractory pseudoachalasia after Ivor Lewis esophagectomy by bypassing colonic pull-up.
CASE SUMMARY A 70-year-old male with dysphagia and regurgitation after esophagectomy with gastric pull-up reconstruction was transferred to our tertiary hospital. Since endoscopic approaches including balloon dilatation and stenting failed, retrosternal colonic pull-up with Roux-en-Y reconstruction was performed with no subsequent adverse events.
CONCLUSION Secondary colonic pull-up is a demanding but successful surgical procedure in patients suffering from therapy-refractory complaints after esophagectomy with gastric pull-up reconstruction.
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Affiliation(s)
- Sven Flemming
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Würzburg 97080, Germany
| | - Johan F Lock
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Würzburg 97080, Germany
| | - Mohammed Hankir
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Würzburg 97080, Germany
| | - Stanislaus Reimer
- Department of Internal Medicine II, Section of Gastroenterology, University Hospital of Wuerzburg, Würzburg 97080, Germany
| | - Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg 97080, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Würzburg 97080, Germany
| | - Florian Seyfried
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Würzburg 97080, Germany
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22
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Debourdeau A, Barthet M, Benezech A, Vitton V, Gonzalez JM. Assessment of long-term results of repeated dilations and impact of a scheduled program of dilations for refractory esophageal strictures: a retrospective case-control study. Surg Endosc 2021; 36:1098-1105. [PMID: 33650008 DOI: 10.1007/s00464-021-08376-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 02/09/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION In patients with benign and refractory esophageal strictures (BES), repeating initial dilations in short intervals could be recommended, but little data are available to validate this strategy. Our aim was to evaluate long-term results of a scheduled program of repeated and sustained esophageal dilations in patients with refractory strictures. METHODS Patients with BES requiring five or more dilations were retrospectively included and divided in two groups for analysis: a SCHEDULED group (SDG) where patients were systematically rescheduled for the 5 first dilations; ON-DEMAND group (ODG) where patients were dilated only in case of recurrence of the dysphagia. Comparison between SDG and ODG was done with a 1:1 matching analysis and etiology of stricture. Clinical success was defined as the absence of dysphagia for more than a year. RESULTS 39 patients with refractory BES were included with post-operative stenosis in 51.2% and post-caustic injury 28.2%; 10 were in SDG and 29 in ODG. In overall analysis (39 patients), the follow-up was 64.4 ± 32 months, success rate was 79.5% and duration of treatment was 27.3 ± 20 months, and mean number of dilations was 11.7 per patient. The need for dilations decreased significantly after 18 months of treatment with an average of 0.56 dilations per semester. Self-expandable metallic stent insertion was associated with an increased rate of complications (5.9% vs 59.1% p = 0.001). In matched analysis (10 ODG vs 10 SDG patients), the duration of treatment was lower in SDG (18.8 vs 41.4 months, p = 0,032) with a higher probability of remission (survival analysis, Log-rank: p = 0,019) and the success rate did not differ between ODG and SDG patients (80% vs 90%; NS). CONCLUSION Overall, long-term esophageal dilations resulted in a 79.5% success rate and the need for further dilatations decreased significantly in both groups after 18-month follow-up. A scheduled dilation program was associated with a higher probability of final success and lower treatment duration.
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Affiliation(s)
- Antoine Debourdeau
- Endoscopy Unit, CHU Saint Eloi, Université de Montpellier, 80 avenue Gaston Fliche, 34090, Montpellier, France.
| | - Marc Barthet
- Digestive Endoscopy Unit, North Universitary Hospital, Marseille, France
| | | | - Véronique Vitton
- Gastroenterology Unit, North Universitary Hospital, AP-HM, Marseille, France
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Farhat W, Chatelain F, Marret A, Faivre L, Arakelian L, Cattan P, Fuchs A. Trends in 3D bioprinting for esophageal tissue repair and reconstruction. Biomaterials 2020; 267:120465. [PMID: 33129189 DOI: 10.1016/j.biomaterials.2020.120465] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 02/08/2023]
Abstract
In esophageal pathologies, such as esophageal atresia, cancers, caustic burns, or post-operative stenosis, esophageal replacement is performed by using parts of the gastrointestinal tract to restore nutritional autonomy. However, this surgical procedure most often does not lead to complete functional recovery and is instead associated with many complications resulting in a decrease in the quality of life and survival rate. Esophageal tissue engineering (ETE) aims at repairing the defective esophagus and is considered as a promising therapeutic alternative. Noteworthy progress has recently been made in the ETE research area but strong challenges remain to replicate the structural and functional integrity of the esophagus with the approaches currently being developed. Within this context, 3D bioprinting is emerging as a new technology to facilitate the patterning of both cellular and acellular bioinks into well-organized 3D functional structures. Here, we present a comprehensive overview of the recent advances in tissue engineering for esophageal reconstruction with a specific focus on 3D bioprinting approaches in ETE. Current biofabrication techniques and bioink features are highlighted, and these are discussed in view of the complexity of the native esophagus that the designed substitute needs to replace. Finally, perspectives on recent strategies for fabricating other tubular organ substitutes via 3D bioprinting are discussed briefly for their potential in ETE applications.
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Affiliation(s)
- Wissam Farhat
- Université de Paris, Inserm, U976 HIPI, F-75006, Paris, France; AP-HP, Hôpital Saint-Louis, 1 avenue Vellefaux, F-75010, Paris, France; CEA, IRIG, F-38000, Grenoble, France
| | - François Chatelain
- Université de Paris, Inserm, U976 HIPI, F-75006, Paris, France; AP-HP, Hôpital Saint-Louis, 1 avenue Vellefaux, F-75010, Paris, France; CEA, IRIG, F-38000, Grenoble, France
| | - Auriane Marret
- Université de Paris, Inserm, U976 HIPI, F-75006, Paris, France; AP-HP, Hôpital Saint-Louis, 1 avenue Vellefaux, F-75010, Paris, France; CEA, IRIG, F-38000, Grenoble, France
| | - Lionel Faivre
- Université de Paris, Inserm, U976 HIPI, F-75006, Paris, France; Assistance Publique - Hôpitaux de Paris, Unité de Thérapie Cellulaire, Hôpital Saint-Louis, Paris, France
| | - Lousineh Arakelian
- Université de Paris, Inserm, U976 HIPI, F-75006, Paris, France; Assistance Publique - Hôpitaux de Paris, Unité de Thérapie Cellulaire, Hôpital Saint-Louis, Paris, France
| | - Pierre Cattan
- Université de Paris, Inserm, U976 HIPI, F-75006, Paris, France; Assistance Publique - Hôpitaux de Paris, Service de Chirurgie Digestive, Hôpital Saint-Louis, Paris, France
| | - Alexandra Fuchs
- Université de Paris, Inserm, U976 HIPI, F-75006, Paris, France; AP-HP, Hôpital Saint-Louis, 1 avenue Vellefaux, F-75010, Paris, France; CEA, IRIG, F-38000, Grenoble, France.
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24
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Agarwal A, Srivastava DN, Madhusudhan KS. Corrosive injury of the upper gastrointestinal tract: the evolving role of a radiologist. Br J Radiol 2020; 93:20200528. [PMID: 32706982 DOI: 10.1259/bjr.20200528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Corrosive injury is a devastating injury which carries significant morbidity. The upper gastrointestinal tract is predominantly affected with severity ranging from mild inflammation to full thickness necrosis which may result in perforation and death. Among the complications, stricture formation is most common, causing dysphagia and malnutrition. Endoscopy has a pivotal role in the diagnosis and management, with a few shortcomings. Imaging has an important role to play. Besides radiography, there is an increasing role of CT scan in the emergency setting with good accuracy in identifying patients who are likely to benefit from surgery. Further, CT scan has a role in the diagnosis of complications. Oral contrast studies help in assessing the severity and extent of stricture formation and associated fistulous complications in the subacute and chronic phase. The scope of intervention radiology for this condition is increasing. Fluoroscopy-guided balloon dilatation, drainage of collections or mucoceles, endovascular embolization of point bleeders, placement of feeding jejunostomy and image-guided biopsy are among the procedures that are being performed. Through this review we aim to stress the role the radiologist plays in the diagnosis and follow-up of these patients and in performing radiological interventions. Besides this, we have also highlighted few salient points to help understand the pathophysiology and management of such injuries which is paramount to ensure a good long-term outcome.
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Affiliation(s)
- Ayushi Agarwal
- Department of Radiodiagnosis All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India 110029
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India 110029
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25
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Sharma P, Pancholi M. Two-Point Fixation Technique in Retrosternal Midcolon Interposition for Corrosive Stricture of Esophagus-Our Experience With 25 Patients. Surg Innov 2020; 27:675-682. [PMID: 32909909 DOI: 10.1177/1553350620958568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. In 1911, Vuillet and Kelling independently described the anatomical and surgical bases of esophageal replacement with the colon. An important complication, in particular in later follow-up, is redundancy of the interposed colon, seen more after retrosternal interposition. The best treatment is prevention by a meticulous surgical technique and measurement of the length of the colon needed to replace the esophagus. Methods. This was a retrospective study of innovative surgical technique. A total of 25 patients with corrosive stricture of the esophagus undergoing two-point fixation in retrosternal colon interposition were included in the study. Preventive Operative Technique. After straightening of conduit by pulling very delicately over both sides, first fixation point we considered cervical anastomoses and second fixation point was made in subxiphoid space, taking two seromuscular stiches from the antimesenteric border of the colon to falciform ligament situated on the right side of the conduit. Results. There were 07 male and 18 female patients with M:F was 1:2.5; mean age was 29 years (range: 23-45 years) and mean hospital stay was 14 days (range: 10-23 days). In this study, we did not encounter any subjective or objective evidence of redundancy in any patients in follow-up barium swallow after 2.5 years of follow-up. Conclusion. Our Two-point fixation technique is refinement of already performed and tried fixation techniques to prevent redundancy of the colon conduit considering kinetics, anatomical alignment, and pathology.
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Affiliation(s)
- Praveen Sharma
- Department of Surgery, Government Medical College, India
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26
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Murata D, Arai K, Nakayama K. Scaffold-Free Bio-3D Printing Using Spheroids as "Bio-Inks" for Tissue (Re-)Construction and Drug Response Tests. Adv Healthc Mater 2020; 9:e1901831. [PMID: 32378363 DOI: 10.1002/adhm.201901831] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/21/2020] [Accepted: 03/04/2020] [Indexed: 02/06/2023]
Abstract
In recent years, scaffold-free bio-3D printing using cell aggregates (spheroids) as "bio-inks" has attracted increasing attention as a method for 3D cell construction. Bio-3D printing uses a technique called the Kenzan method, wherein spheroids are placed one-by-one in a microneedle array (the "Kenzan") using a bio-3D printer. The bio-3D printer is a machine that was developed to perform bio-3D printing automatically. Recently, it has been reported that cell constructs can be produced by a bio-3D printer using spheroids composed of many types of cells and that this can contribute to tissue (re-)construction. This progress report summarizes the production and effectiveness of various cell constructs prepared using bio-3D printers. It also considers the future issues and prospects of various cell constructs obtained by using this method for further development of scaffold-free 3D cell constructions.
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Affiliation(s)
- Daiki Murata
- Center for Regenerative Medicine ResearchFaculty of MedicineSaga University Honjo‐machi Saga 840‐8502 Japan
| | - Kenichi Arai
- Center for Regenerative Medicine ResearchFaculty of MedicineSaga University Honjo‐machi Saga 840‐8502 Japan
| | - Koichi Nakayama
- Center for Regenerative Medicine ResearchFaculty of MedicineSaga University Honjo‐machi Saga 840‐8502 Japan
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27
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Gao Y, Jin SZ. Strategies for treating oesophageal diseases with stem cells. World J Stem Cells 2020; 12:488-499. [PMID: 32742566 PMCID: PMC7360987 DOI: 10.4252/wjsc.v12.i6.488] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/02/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
There is a wide range of oesophageal diseases, the most general of which are inflammation, injury and tumours, and treatment methods are constantly being developed and updated. With an increasingly comprehensive understanding of stem cells and their characteristics of multilineage differentiation, self-renewal and homing as well as the combination of stem cells with regenerative medicine, tissue engineering and gene therapy, stem cells are playing an important role in the treatment of a variety of diseases. Mesenchymal stem cells have many advantages and are most commonly applied; however, most of these applications have been in experimental studies, with few related clinical trials for comparison. Therefore, the methods, positive significance and limitations of stem cells in the treatment of oesophageal diseases remain incompletely understood. Thus, the purpose of this paper is to review the current literature and summarize the efficacy of stem cells in the treatment of oesophageal diseases, including oesophageal ulceration, acute radiation-induced oesophageal injury, corrosive oesophageal injury, oesophageal stricture formation after endoscopic submucosal dissection and oesophageal reconstruction, as well as gene therapy for oesophageal cancer.
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Affiliation(s)
- Yang Gao
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
| | - Shi-Zhu Jin
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
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28
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Marzaro M, Algeri M, Tomao L, Tedesco S, Caldaro T, Balassone V, Contini AC, Guerra L, Federici D’Abriola G, Francalanci P, Caristo ME, Lupoi L, Boskoski I, Bozza A, Astori G, Pozzato G, Pozzato A, Costamagna G, Dall’Oglio L. Successful muscle regeneration by a homologous microperforated scaffold seeded with autologous mesenchymal stromal cells in a porcine esophageal substitution model. Therap Adv Gastroenterol 2020; 13:1756284820923220. [PMID: 32523626 PMCID: PMC7257852 DOI: 10.1177/1756284820923220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 04/06/2020] [Indexed: 02/04/2023] Open
Abstract
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.
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Affiliation(s)
| | - Mattia Algeri
- Hemato-Oncology, Ospedale Pediatrico Bambino
Gesù, Roma, Italy
| | - Luigi Tomao
- Hemato-Oncology, Ospedale Pediatrico Bambino
Gesù, Roma, Italy
| | | | - Tamara Caldaro
- Digestive Endoscopy and Surgical Unit, Ospedale
Pediatrico Bambino Gesù, Roma, Italy
| | - Valerio Balassone
- Digestive Endoscopy and Surgical Unit, Ospedale
Pediatrico Bambino Gesù, Roma, Italy
| | - Anna Chiara Contini
- Digestive Endoscopy and Surgical Unit, Ospedale
Pediatrico Bambino Gesù, Roma, Italy
| | - Luciano Guerra
- Digestive Endoscopy and Surgical Unit, Ospedale
Pediatrico Bambino Gesù, Roma, Italy
| | | | | | | | | | | | - Angela Bozza
- LTCA, ULSS 8 Berica, Vicenza, Italy,Laboratorio di Terapie Cellulari Avanzate,
Vicenza, Italy
| | - Giuseppe Astori
- LTCA, ULSS 8 Berica, Vicenza, Italy,Laboratorio di Terapie Cellulari Avanzate,
Vicenza, Italy
| | | | | | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione
Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luigi Dall’Oglio
- Digestive Endoscopy and Surgical Unit, Ospedale
Pediatrico Bambino Gesù, Roma, Italy
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Abstract
OBJECTIVE The aim of the study was to evaluate long-term QOL after caustic ingestion. BACKGROUND Caustic ingestion strongly affects patient's QOL but data on the topic is scarce in the literature. METHODS QOL evaluation was conducted in survivors from a large cohort of patients with caustic injuries. QOL was assessed using the EORTC QLQ-OG25 module, the SF12v2 score, and the hospital anxiety and depression scale questionnaire. One hundred thirty-four patients (59 men, median age 43) completed the survey; 72 (54%) patients underwent emergency digestive resection and in 99 (74%) patients underwent esophageal reconstruction. Results of QOL questionnaires were compared to average values determined in healthy volunteers and in patients with esophageal cancers. RESULTS The median QLQ-OG25 score was 44 (34, 62) and values were significantly lower when compared to a normal population (P < 0.0001). SF12v2 scores were significantly inferior to those expected in a normal population on both the physical component summary (PCS) (43.3 ± 10.8; P < 0.0001) and the mental component summary (44 ± 9.7; P < 0.0001) scales. Emergency esophageal resection was significantly associated with higher QLQ-OG25 scores (P < 0.0001), but not with mental component summary (P = 0.3), PCS (P = 0.76), HAD anxiety (P = 0.95), and HAD depression scores (P = 0.59); results were similar after extended emergency resection. When compared to esophagocoloplasty alone, pharyngeal reconstruction had a significant negative impact on QLQ-OG25 (P < 0.0001), PCS (P = 0.01), and HAD depression (P = 0.0008) scores. CONCLUSIONS QOL is significantly impaired after caustic ingestion. QOL issues should not influence the emergency surgical strategy but deserve discussion before esophageal reconstruction for caustic injuries.
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30
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Arakelian L, Caille C, Faivre L, Corté L, Bruneval P, Shamdani S, Flageollet C, Albanese P, Domet T, Jarraya M, Setterblad N, Kellouche S, Larghero J, Cattan P, Vanneaux V. A clinical-grade acellular matrix for esophageal replacement. J Tissue Eng Regen Med 2019; 13:2191-2203. [PMID: 31670903 DOI: 10.1002/term.2983] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/24/2019] [Accepted: 10/03/2019] [Indexed: 11/09/2022]
Abstract
In pathologies of the esophagus such as esophageal atresia, cancers, and caustic injuries, methods for full thickness esophageal replacement require the sacrifice of healthy intra-abdominal organs such as the stomach and the colon and are associated with high morbidity, mortality, and poor functional results. To overcome these problems, tissue engineering methods are developed to create a substitute with scaffolds and cells. The aim of this study was to develop a simple and safe decellularization process in order to obtain a clinical grade esophageal extracellular matrix. Following the decontamination step, porcine esophagi were decellularized in a bioreactor with sodium dodecyl sulfate and ethylenediaminetetraacetic acid for 3 days and were rinsed with deionized water. DNA was eliminated by a 3-hr DNase treatment. To remove any residual detergent, the matrix was then incubated with an absorbing resin. The resulting porcine esophageal matrix was characterized by the assessment of the efficiency of the decellularization process (DNA quantification), evaluation of sterility and absence of cytotoxicity, and its composition and biomechanical properties, as well as the possibility to be reseeded with mesenchymal stem cells. Complete decellularization with the preservation of the general structure, composition, and biomechanical properties of the native esophageal matrix was obtained. Sterility was maintained throughout the process, and the matrix showed no cytotoxicity. The resulting matrix met clinical grade criteria and was successfully reseeded with mesenchymal stem cells..
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Affiliation(s)
- Lousineh Arakelian
- Unité de Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France.,Institut de Recherche Saint Louis, INSERM, CIC-BT1427 and UMR-U976, Hôpital St-Louis, Paris, France
| | - Clémentine Caille
- Unité de Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France.,Institut de Recherche Saint Louis, INSERM, CIC-BT1427 and UMR-U976, Hôpital St-Louis, Paris, France
| | - Lionel Faivre
- Unité de Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France.,Institut de Recherche Saint Louis, INSERM, CIC-BT1427 and UMR-U976, Hôpital St-Louis, Paris, France
| | - Laurent Corté
- MAT-Centre des Matériaux, MINES ParisTech, PSL Research University, CNRS UMR 7633, France.,Laboratoire Matière Molle et Chimie, ESPCI Paris, PSL Research University, CNRS UMR 7167, Paris, France
| | - Patrick Bruneval
- Department of Pathology, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Sara Shamdani
- Laboratoire CRRET, Université Paris Est Créteil, Université Paris Est, EA 4397 ERL CNRS 9215, Créteil, France
| | - Camille Flageollet
- Laboratoire CRRET, Université Paris Est Créteil, Université Paris Est, EA 4397 ERL CNRS 9215, Créteil, France
| | - Patricia Albanese
- Laboratoire CRRET, Université Paris Est Créteil, Université Paris Est, EA 4397 ERL CNRS 9215, Créteil, France
| | - Thomas Domet
- Unité de Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France.,Institut de Recherche Saint Louis, INSERM, CIC-BT1427 and UMR-U976, Hôpital St-Louis, Paris, France
| | - Mohamed Jarraya
- Banque des Tissus Humains, Hôpital St-Louis, AP-HP, Paris, France
| | - Niclas Setterblad
- Technological Core facility of the Hematology Institute, Université Paris-Diderot and Inserm, Hôpital Saint-Louis, Paris, France
| | - Sabrina Kellouche
- Equipe de Recherche sur les Relations Matrice Extracellulaire-Cellules, ERRMECe (EA1391), Institut des Matériaux, I-MAT (FD4122), University of Cergy-Pontoise, MIR, France
| | - Jérôme Larghero
- Unité de Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France.,Institut de Recherche Saint Louis, INSERM, CIC-BT1427 and UMR-U976, Hôpital St-Louis, Paris, France
| | - Pierre Cattan
- Institut de Recherche Saint Louis, INSERM, CIC-BT1427 and UMR-U976, Hôpital St-Louis, Paris, France.,Department of Digestive Surgery, St-Louis Hospital-Paris 7 University, Paris, France
| | - Valérie Vanneaux
- Unité de Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France.,Institut de Recherche Saint Louis, INSERM, CIC-BT1427 and UMR-U976, Hôpital St-Louis, Paris, France
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31
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32
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Coevoet D, Van Daele E, Willaert W, Huvenne W, Van de Putte D, Ceelen W, Deron P, Pattyn P, Van Nieuwenhove Y. Quality of life of patients with a colonic interposition postoesophagectomy. Eur J Cardiothorac Surg 2019; 55:1113-1120. [PMID: 30544187 DOI: 10.1093/ejcts/ezy398] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/24/2018] [Accepted: 10/27/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES After oesophagectomy, stomach grafts are most frequently used to restore intestinal continuity. Less frequently, a colonic graft is used. There is quite a large body of literature addressing the functional outcome after gastric pull-up, but little is known about the functional results of colonic interposition (CI). The aim of this study was to assess the short-term outcomes and the long-term quality of life and function of the CI postoesophagectomy. METHODS Between 2002 and 2016, we retrospectively collected data on 80 patients with CI from personal health records at the Ghent University hospital. We prospectively compared the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, EORTC QLQ-OG25 and Swallowing Quality of Life (SWAL-QOL) questionnaire scores to the healthy reference group and the gastric tube (GT) group. RESULTS The 30-day mortality rate was 5%. Anastomotic leakage occurred in 37.5% and stenosis in 20% of the patients. The median overall survival of all patients was 33.9 months (95% confidence interval 8.3-59.4). The mean general health score of the CI patients was less than the healthy reference group but comparable to the GT group (CI = 62.1 vs healthy reference group = 71.2 vs GT = 60). Fifty percent of the patients reported their health as good and 15% as very good. The mean functional results with a CI were better than with a GT. Compared to GT patients, CI patients had less dyspnoea, reflux and dysphagia, but they reported more food selection, diarrhoea and weight loss. CONCLUSIONS Despite the high complication rate, the severity of the disease and the demanding operation, patients perceived themselves as being in good health and reported very good long-term functionality after CI. CLINICAL TRIAL REGISTRATION NUMBER B670201630635.
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Affiliation(s)
- Delfien Coevoet
- Department of Gastro-Intestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Elke Van Daele
- Department of Gastro-Intestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Wouter Willaert
- Department of Gastro-Intestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Wouter Huvenne
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
| | - Dirk Van de Putte
- Department of Gastro-Intestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Wim Ceelen
- Department of Gastro-Intestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Philippe Deron
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
| | - Piet Pattyn
- Department of Gastro-Intestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Yves Van Nieuwenhove
- Department of Gastro-Intestinal Surgery, Ghent University Hospital, Ghent, Belgium
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33
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Chirica M, Kelly MD, Siboni S, Aiolfi A, Riva CG, Asti E, Ferrari D, Leppäniemi A, ten Broek RPG, Brichon PY, Kluger Y, Fraga GP, Frey G, Andreollo NA, Coccolini F, Frattini C, Moore EE, Chiara O, Di Saverio S, Sartelli M, Weber D, Ansaloni L, Biffl W, Corte H, Wani I, Baiocchi G, Cattan P, Catena F, Bonavina L. Esophageal emergencies: WSES guidelines. World J Emerg Surg 2019; 14:26. [PMID: 31164915 PMCID: PMC6544956 DOI: 10.1186/s13017-019-0245-2] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/20/2019] [Indexed: 02/06/2023] Open
Abstract
The esophagus traverses three body compartments (neck, thorax, and abdomen) and is surrounded at each level by vital organs. Injuries to the esophagus may be classified as foreign body ingestion, caustic ingestion, esophageal perforation, and esophageal trauma. These lesions can be life-threatening either by digestive contamination of surrounding structures in case of esophageal wall breach or concomitant damage of surrounding organs. Early diagnosis and timely therapeutic intervention are the keys of successful management.
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Affiliation(s)
- Mircea Chirica
- Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Michael D. Kelly
- Department of General Surgery, Albury Hospital, Albury, NSW 2640 Australia
| | - Stefano Siboni
- Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Alberto Aiolfi
- Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Carlo Galdino Riva
- Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Emanuele Asti
- Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Davide Ferrari
- Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Ari Leppäniemi
- Department of Emergency Surgery, University Hospital Meilahti Abdominal Center, Helsinki, Finland
| | | | - Pierre Yves Brichon
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Campus, Haifa, Israel
| | - Gustavo Pereira Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
| | - Gil Frey
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Nelson Adami Andreollo
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Bufalini Hospital Cesena, Cesena, Italy
| | | | | | - Osvaldo Chiara
- General Surgery and Trauma Team, University of Milano, ASST Niguarda Milano, Milan, Italy
| | - Salomone Di Saverio
- Cambridge Colorectal Unit, Cambridge University Hospitals, Addenbrooke’s Hospital, Cambridge, UK
| | | | - Dieter Weber
- Trauma and General Surgery, Royal Perth Hospital, Perth, Australia
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital Cesena, Cesena, Italy
| | - Walter Biffl
- Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA USA
| | - Helene Corte
- Department of Surgery, Saint Louis Hospital, Paris, France
| | - Imtaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | | | - Pierre Cattan
- Department of Surgery, Saint Louis Hospital, Paris, France
| | - Fausto Catena
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Luigi Bonavina
- Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
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34
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Regeneration of esophagus using a scaffold-free biomimetic structure created with bio-three-dimensional printing. PLoS One 2019; 14:e0211339. [PMID: 30849123 PMCID: PMC6408002 DOI: 10.1371/journal.pone.0211339] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 01/11/2019] [Indexed: 02/07/2023] Open
Abstract
Various strategies have been attempted to replace esophageal defects with natural or artificial substitutes using tissue engineering. However, these methods have not yet reached clinical application because of the high risks related to their immunogenicity or insufficient biocompatibility. In this study, we developed a scaffold-free structure with a mixture of cell types using bio-three-dimensional (3D) printing technology and assessed its characteristics in vitro and in vivo after transplantation into rats. Normal human dermal fibroblasts, human esophageal smooth muscle cells, human bone marrow-derived mesenchymal stem cells, and human umbilical vein endothelial cells were purchased and used as a cell source. After the preparation of multicellular spheroids, esophageal-like tube structures were prepared by bio-3D printing. The structures were matured in a bioreactor and transplanted into 10-12-week-old F344 male rats as esophageal grafts under general anesthesia. Mechanical and histochemical assessment of the structures were performed. Among 4 types of structures evaluated, those with the larger proportion of mesenchymal stem cells tended to show greater strength and expansion on mechanical testing and highly expressed α-smooth muscle actin and vascular endothelial growth factor on immunohistochemistry. Therefore, the structure with the larger proportion of mesenchymal stem cells was selected for transplantation. The scaffold-free structures had sufficient strength for transplantation between the esophagus and stomach using silicon stents. The structures were maintained in vivo for 30 days after transplantation. Smooth muscle cells were maintained, and flat epithelium extended and covered the inner surface of the lumen. Food had also passed through the structure. These results suggested that the esophagus-like scaffold-free tubular structures created using bio-3D printing could hold promise as a substitute for the repair of esophageal defects.
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Catry J, Luong-Nguyen M, Arakelian L, Poghosyan T, Bruneval P, Domet T, Michaud L, Sfeir R, Gottrand F, Larghero J, Vanneaux V, Cattan P. Circumferential Esophageal Replacement by a Tissue-engineered Substitute Using Mesenchymal Stem Cells: An Experimental Study in Mini Pigs. Cell Transplant 2018; 26:1831-1839. [PMID: 29390879 PMCID: PMC5802636 DOI: 10.1177/0963689717741498] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Jonathan Catry
- 1 Cell Therapy Unit and CIC-BT, AP-HP, Saint-Louis Hospital, Paris, France.,2 Department of Digestive and Endocrine Surgery, AP-HP, Saint-Louis Hospital, Paris, France.,3 Inserm UMR 1160, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Minh Luong-Nguyen
- 1 Cell Therapy Unit and CIC-BT, AP-HP, Saint-Louis Hospital, Paris, France.,2 Department of Digestive and Endocrine Surgery, AP-HP, Saint-Louis Hospital, Paris, France.,3 Inserm UMR 1160, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Lousineh Arakelian
- 1 Cell Therapy Unit and CIC-BT, AP-HP, Saint-Louis Hospital, Paris, France
| | - Tigran Poghosyan
- 1 Cell Therapy Unit and CIC-BT, AP-HP, Saint-Louis Hospital, Paris, France.,2 Department of Digestive and Endocrine Surgery, AP-HP, Saint-Louis Hospital, Paris, France.,3 Inserm UMR 1160, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Patrick Bruneval
- 4 Department of Pathology, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Thomas Domet
- 1 Cell Therapy Unit and CIC-BT, AP-HP, Saint-Louis Hospital, Paris, France
| | - Laurent Michaud
- 5 Reference Center for Congenital and Malformative Esophageal Diseases, Department of Pediatric Gastroenterology and Nutrition, Jeanne de Flandre Hospital, Université Lille 2, Lille, France
| | - Rony Sfeir
- 6 Department of Pediatric Surgery, Jeanne de Flandre Hospital, University Lille 2, Lille, France
| | - Frederic Gottrand
- 5 Reference Center for Congenital and Malformative Esophageal Diseases, Department of Pediatric Gastroenterology and Nutrition, Jeanne de Flandre Hospital, Université Lille 2, Lille, France
| | - Jerome Larghero
- 1 Cell Therapy Unit and CIC-BT, AP-HP, Saint-Louis Hospital, Paris, France.,3 Inserm UMR 1160, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Valerie Vanneaux
- 1 Cell Therapy Unit and CIC-BT, AP-HP, Saint-Louis Hospital, Paris, France.,3 Inserm UMR 1160, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Pierre Cattan
- 1 Cell Therapy Unit and CIC-BT, AP-HP, Saint-Louis Hospital, Paris, France.,2 Department of Digestive and Endocrine Surgery, AP-HP, Saint-Louis Hospital, Paris, France.,3 Inserm UMR 1160, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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Arakelian L, Kanai N, Dua K, Durand M, Cattan P, Ohki T. Esophageal tissue engineering: from bench to bedside. Ann N Y Acad Sci 2018; 1434:156-163. [PMID: 30088660 DOI: 10.1111/nyas.13951] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/09/2018] [Accepted: 07/17/2018] [Indexed: 12/12/2022]
Abstract
For various esophageal diseases, the search for alternative techniques for tissue repair has led to significant developments in basic and translational research in the field of tissue engineering. Applied to the esophagus, this concept is based on the in vitro combination of elements judged necessary for in vivo implantation to promote esophageal tissue remodeling. Different methods are currently being explored to develop substitutes using cells, scaffolds, or a combination of both, according to the severity of lesions to be treated. In this review, we discuss recent advances in (1) cell sheet technology for preventing stricture after extended esophageal mucosectomy and (2) full-thickness circumferential esophageal replacement using tissue-engineered substitutes.
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Affiliation(s)
- Lousineh Arakelian
- Cell Therapy Unit, AP-HP, Saint-Louis Hospital, Paris Diderot University, Paris, France.,INSERM, Clinical Investigation Center in Biotherapies (CBT-501) and U1160, Institut Universitaire d'Hématologie, Saint-Louis Hospital, Paris, France
| | - Nobuo Kanai
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.,Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Kulwinder Dua
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marlène Durand
- University of Bordeaux, CHU Bordeaux, CIC1401 Inserm, Bordeaux, France.,Inserm, Bioingénierie Tissulaire, U1026, Bordeaux, France
| | - Pierre Cattan
- Cell Therapy Unit, AP-HP, Saint-Louis Hospital, Paris Diderot University, Paris, France.,INSERM, Clinical Investigation Center in Biotherapies (CBT-501) and U1160, Institut Universitaire d'Hématologie, Saint-Louis Hospital, Paris, France.,Department of Digestive and Endocrine Surgery, AP-HP, Saint-Louis Hospital, Paris Diderot University, Paris, France
| | - Takeshi Ohki
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.,Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
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Irino T, Tsekrekos A, Coppola A, Scandavini CM, Shetye A, Lundell L, Rouvelas I. Long-term functional outcomes after replacement of the esophagus with gastric, colonic, or jejunal conduits: a systematic literature review. Dis Esophagus 2017; 30:1-11. [PMID: 28881882 DOI: 10.1093/dote/dox083] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/30/2017] [Indexed: 12/11/2022]
Abstract
It is generally recognized that in patients with an intact stomach diagnosed with esophageal cancer, gastric tubulization and pull-up shall always be the preferred technique for reconstruction after an esophageal resection. However, in cases with extensive gastroesophageal junction (GEJ) cancer with aboral spread and after previous gastric surgery, alternative methods for reconstruction have to be pursued. Moreover, in benign cases as well as in those with early neoplastic lesions of the esophagus and the GEJ that are associated with long survival, it is basically unclear which conduit should be recommended. The aim of this study is to determine the long-term functional outcomes of different conduits used for esophageal replacement, based on a comprehensive literature review. Eligible were all clinical studies reporting outcomes after esophagectomy, which contained information on at least three years of follow-up after the operation in patients who were older than 18 years of age at the time of the operation. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic web-based search using MEDLINE, the Cochrane Library, and EMBASE databases was performed, reviewing medical literature published between January 2006 and December 2015. The scientific quality of the data was generally low, which allowed us to incorporate only 16 full text articles for the final analyses. After a gastric pull-up, the proportion of patients who suffered from dysphagia varied substantially but seemed to decrease over time with a mild dysphagia remaining during long-term follow-up. When reflux-related symptoms and complications were addressed, roughly two third of patients experienced mild to moderate reflux symptoms a long time after the resection. Following an isoperistaltic colonic graft, the functional long-term outcomes regarding swallowing difficulties were sparsely reported, while three studies reported reflux/regurgitation symptoms in the range of 5% to 16%, one of which reported the symptom severity as being mild. Only one report was available after the use of a long jejunal segment, which contained only six patients, who scored the severity of dysphagia and reflux as mild. Very few if any data were available on a structured assessment of dumping and disturbed bowel functions. Few high-quality data are available on the long-term functional outcomes after esophageal replacement irrespective of the use of a gastric tube, the right or left colon or a long jejunal segment. No firm conclusions regarding the advantages of one graft over the other can presently be drawn.
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Affiliation(s)
- T Irino
- Department of Upper Abdominal Surgery, Centre for Digestive Diseases, Karolinska University Hospital.,Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - A Tsekrekos
- Department of Upper Abdominal Surgery, Centre for Digestive Diseases, Karolinska University Hospital.,Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - A Coppola
- Department of Upper Abdominal Surgery, Centre for Digestive Diseases, Karolinska University Hospital.,Hepatobiliary Unit, Department of General Surgery, A. Gemelli Hospital, Università Cattolica del Sacro Cuore
| | - C M Scandavini
- Department of Upper Abdominal Surgery, Centre for Digestive Diseases, Karolinska University Hospital.,Emergency Surgery, Sant Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - A Shetye
- Department of Upper Abdominal Surgery, Centre for Digestive Diseases, Karolinska University Hospital
| | - L Lundell
- Department of Upper Abdominal Surgery, Centre for Digestive Diseases, Karolinska University Hospital.,Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - I Rouvelas
- Department of Upper Abdominal Surgery, Centre for Digestive Diseases, Karolinska University Hospital.,Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Adler DG, Siddiqui AA. Endoscopic management of esophageal strictures. Gastrointest Endosc 2017; 86:35-43. [PMID: 28288841 DOI: 10.1016/j.gie.2017.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/02/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Douglas G Adler
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ali A Siddiqui
- Department of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
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Le Naoures P, Hamy A, Lerolle N, Métivier E, Lermite E, Venara A. Risk factors for symptomatic esophageal stricture after caustic ingestion-a retrospective cohort study. Dis Esophagus 2017; 30:1-6. [PMID: 29207003 DOI: 10.1093/dote/dox029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 03/17/2017] [Indexed: 12/11/2022]
Abstract
Esophageal stricture is a major secondary complication of ingesting caustic agents. We examined our experiences with caustic injuries with a view to finding clinical and biological risk factors of esophageal strictures secondary to caustic ingestion. Records were retrieved for 58 adults admitted consecutively to our intensive care unit for caustic ingestion. Fifty cases were managed conservatively and therefore retained for analyses. Patients were grouped according to whether they developed strictures or not during the follow-up period. Mucosal damage was assessed by emergency endoscopy. Eleven patients (22%) developed a stricture. At referral, dysphagia, epigastric pain, and hematemesis were associated with secondary stricture (respectively P = 0.047, P = 0.008, P = 0.02). A high Zargar endoscopic grade (above IIa; P = 0.02), the ingestion of strong acids or alkalis (P = 0.006), hyperleukocytosis (P = 0.02), and a low prothrombin ratio (P = 0.002) were associated with a higher risk of developing a stricture. The median delay of stricture diagnosis was 12 (8;16) days after ingestion, with extreme values from 4 to 26 days. Initial symptoms such as dysphagia or hematemesis, early endoscopy showing >IIa grade esophagitis, and certain laboratory results should draw the physician's attention to a high risk of esophageal stricture.
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Affiliation(s)
- P Le Naoures
- Visceral Surgery Department, University Hospital of Angers
- LUNAM, University of Angers, Angers, France
| | - A Hamy
- Visceral Surgery Department, University Hospital of Angers
- LUNAM, University of Angers, Angers, France
| | - N Lerolle
- LUNAM, University of Angers, Angers, France
- Departments of Hepato-Gastroenterology, University Hospital of Angers
| | - E Métivier
- Medical Intensive Care and Hyperbaric Medicine, University Hospital of Angers
| | - E Lermite
- Visceral Surgery Department, University Hospital of Angers
- LUNAM, University of Angers, Angers, France
| | - A Venara
- Visceral Surgery Department, University Hospital of Angers
- LUNAM, University of Angers, Angers, France
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Abstract
Corrosive ingestion is a rare but potentially devastating event and, despite the availability of effective preventive public health strategies, injuries continue to occur. Most clinicians have limited personal experience and rely on guidelines; however, uncertainty persists about best clinical practice. Ingestions range from mild cases with no injury to severe cases with full thickness necrosis of the oesophagus and stomach. CT scan is superior to traditional endoscopy for stratification of patients to emergency resection or observation. Oesophageal stricture is a common consequence of ingestion and newer stents show some promise; however, the place of endoscopic stenting for corrosive strictures is yet to be defined. We summarise the evidence to provide a plan for managing these potentially life-threatening injuries and discuss the areas where further research is required to improve outcomes.
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Affiliation(s)
- Mircea Chirica
- Department of Digestive and Emergency Surgery, University Hospital of Grenoble, Grenoble Alpes University, Grenoble, France.
| | - Luigi Bonavina
- University of Milan Medical School, Division of General Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Michael D Kelly
- Acute Surgical Unit, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Emile Sarfati
- Department of Digestive and Endocrine Surgery, Saint-Louis Hospital AP-HP, Université Paris Diderot Sorbonne Paris Cité, Paris, France
| | - Pierre Cattan
- Department of Digestive and Endocrine Surgery, Saint-Louis Hospital AP-HP, Université Paris Diderot Sorbonne Paris Cité, Paris, France
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41
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De Lusong MAA, Timbol ABG, Tuazon DJS. Management of esophageal caustic injury. World J Gastrointest Pharmacol Ther 2017; 8:90-98. [PMID: 28533917 PMCID: PMC5421115 DOI: 10.4292/wjgpt.v8.i2.90] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 02/25/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023] Open
Abstract
Ingestion of caustic substances and its long-term effect on the gastrointestinal system maintain its place as an important public health issue in spite of the multiple efforts to educate the public and contain its growing number. This is due to the ready availability of caustic agents and the loose regulatory control on its production. Substances with extremes of pH are very corrosive and can create severe injury in the upper gastrointestinal tract. The severity of injury depends on several aspects: Concentration of the substance, amount ingested, length of time of tissue contact, and pH of the agent. Solid materials easily adhere to the mouth and pharynx, causing greatest damage to these regions while liquids pass through the mouth and pharynx more quickly consequently producing its maximum damage in the esophagus and stomach. Esophagogastroduodenoscopy is therefore a highly recommended diagnostic tool in the evaluation of caustic injury. It is considered the cornerstone not only in the diagnosis but also in the prognostication and guide to management of caustic ingestions. The degree of esophageal injury at endoscopy is a predictor of systemic complication and death with a 9-fold increase in morbidity and mortality for every increased injury grade. Because of this high rate of complication, prompt evaluation cannot be overemphasized in order to halt development and prevent progression of complications.
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The Damage Pattern to the Gastrointestinal Tract Depends on the Nature of the Ingested Caustic Agent. World J Surg 2017; 40:1638-44. [PMID: 26920407 DOI: 10.1007/s00268-016-3466-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The mechanisms of damage to the gastrointestinal tract after caustic ingestion are conditioned by the nature of the ingested agent. Whether the nature of the ingested agent has a direct influence on patient outcomes is unknown. METHODS From January 2013 to April 2015, 144 patients underwent emergency management for caustic injuries at the Saint Louis Hospital in Paris. There were 51 men (51 %) and the median age was 44 years [39, 48]. The ingested agents were soda-based strong alkali in 85 patients (59 %), strong acids in 36 patients (25 %), and bleach in 23 patients (16 %). Emergency and long-term outcomes were compared according to the nature of the ingested agent. RESULTS Four patients died (3 %) and 40 patients (28 %) experienced complications. After bleach ingestion, emergency morbidity and mortality were nil, no patient required esophageal reconstruction, and functional outcome was successful in all patients. Acids were more likely to induce transmural gastric (31 vs. 13 %, p =0.042) and duodenal (9 vs. 0 %, p = 0.04) necrosis than strong alkalis, but rates of transmural esophageal necrosis were similar (14 vs. 12 %, p = 0.98). No significant differences were recorded between emergency mortality (9 vs. 1 %, p = 0.15), morbidity (33 vs. 33 %, p = 0.92), the need for esophageal reconstruction (25 vs. 20 %, p = 0.88), and functional success rates (76 vs. 84 %, p = 0.31) after acid and alkali ingestion, respectively. CONCLUSION Bleach causes mild gastrointestinal injuries, while the ingestion of strong acids and alkalis may result in severe complications and death. Acids cause more severe damage to the stomach but similar damage to the esophagus when compared to alkalis.
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Hussain ST, Zhen-Yu Tong M, Raja S, Keshavamurthy S, Dietz DW. Substernal Colonic Interposition After Previous Coronary Artery Bypass Graft in a Patient With a Patent Left Internal Thoracic Artery Graft: A Surgical Challenge. Ann Thorac Surg 2016; 102:e403-e405. [PMID: 27772592 DOI: 10.1016/j.athoracsur.2016.04.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 11/24/2022]
Abstract
Esophageal reconstruction by a substernal route with a colonic conduit after previous esophagectomy and end-cervical esophagostomy in the presence of a patent left internal thoracic artery graft to the left anterior descending coronary artery is a technically challenging procedure. In this case report, we describe a safe approach to this difficult problem. With proper planning and careful dissection, substernal esophageal reconstruction after previous sternotomy in patients with a patent left internal thoracic artery graft is feasible and can be safely performed.
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Affiliation(s)
- Syed T Hussain
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Michael Zhen-Yu Tong
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Siva Raja
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Suresh Keshavamurthy
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - David W Dietz
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
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The cervicosternolaparotomy approach for the treatment of graft dysfunction after retrosternal esophageal reconstruction for caustic injuries. J Thorac Cardiovasc Surg 2016; 152:1378-1385. [PMID: 27650003 DOI: 10.1016/j.jtcvs.2016.07.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 06/19/2016] [Accepted: 07/24/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The study purpose was to report the indications, technical aspects, and outcomes of cervicosternolaparotomy during revision surgery after esophageal reconstruction for caustic injuries. METHODS Patients who underwent cervicosternolaparotomy during revision surgery for graft dysfunction between 1999 and 2015 were included. Cervicosternolaparotomy was performed to mobilize and pull up the primary conduit during surgery for strictures (rescue cervicosternolaparotomy) or to allow retrosternal access for management of other graft-related complications (exposure cervicosternolaparotomy). Statistical tests were performed to identify factors associated with primary conduit preservation during rescue cervicosternolaparotomy. RESULTS Fifty-five patients were included (28 men; median age, 43 years). Median delay between primary reconstruction and cervicosternolaparotomy was 15 months. Exposure cervicosternolaparotomy was performed in 12 patients (22%) for redundancy (n = 8), spontaneous perforation (n = 2), and caustic reingestion (n = 2). Rescue cervicosternolaparotomy was performed in 43 patients (78%) to treat supra-anastomotic (n = 11), anastomotic (n = 23), and diffuse (n = 9) stenosis. During rescue cervicosternolaparotomy, the primary conduit was preserved in 32 patients; median length gain obtained by transplant release was 8 cm. Failure to preserve the primary conduit was associated with previous surgical repair attempts (P = .003) and lack of initial concomitant pharyngeal reconstruction (P = .039). Two patients died (4%), and 35 patients (64%) experienced operative complications. Operative outcomes were similar after rescue and exposure cervicosternolaparotomy. With a median follow-up of 4.4 years, the functional success rate was 85%. CONCLUSIONS Cervicosternolaparotomy during revision surgery for graft dysfunction is reliable, is associated with low morbidity and mortality, and has good results.
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Abstract
OBJECTIVE The aim of this study was to describe the management and outcome of tracheobronchial necrosis (TBN) after caustic ingestion. BACKGROUND Emergency pulmonary patch repair has been reported to be lifesaving in patients with caustic TBN. METHODS Patients who underwent management of caustic TBN between 1989 and 2013, were included. TBN was defined as early if present on admission and late if occurring thereafter. Operative outcomes, long-term survival, and functional outcomes were compared with those of 269 patients without TBN who underwent esophagectomy for caustic injuries. RESULTS Twenty patients were included (10 men; median age = 39 years). Early TBN was detected in 14 patients, and late TBN occurred in 7 patients, 8 days (range:: 6-10 days) after admission. TBN involved the left bronchus (n = 17; 85%), the carina (n = 10; 50%), the supracarinal trachea (n = 9; 45%), the right bronchus (n = 4; 20%), and the cervical trachea (n = 3; 15%). Seventeen patients underwent esophagogastrectomy, 2 underwent esophagectomy, and in 1 patient, resection was eventually abandoned. Pulmonary patch repair was performed in 16 patients (80%). Nine patients (45%) died and morbidity was 100%. In univariate analysis, late TBN (P = 0.017) and acid ingestion (P = 0.002) were predictors of mortality. All survivors underwent restoring colopharyngoplasty. Five-year survival (28%) and functional success (25%) rates were significantly impaired when compared with esophagectomy patients without TBN. CONCLUSIONS TBN is one of the most devastating complications of caustic ingestion. Pulmonary patch repair is technically simple and can be lifesaving in this difficult situation.
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48
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Weiss ARR, Hackl C, Soeder Y, Schlitt HJ, Dahlke MH. Ileo-right hemi-colonic cervical pull-up on a non-supercharged ileocolic arterial pedicle: A technical and case report. World J Gastroenterol 2016; 22:3869-3874. [PMID: 27076773 PMCID: PMC4814751 DOI: 10.3748/wjg.v22.i14.3869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 01/04/2016] [Accepted: 01/30/2016] [Indexed: 02/06/2023] Open
Abstract
Esophageal reconstruction can be challenging when stomach and colon are not anatomically intact and their use as esophageal substitutes is therefore limited. Innovative individual approaches are then necessary to restore the intestinal passage. We describe a technique in which a short stump of the right hemicolon and 25 cm of ileum on a long, non-supercharged, fully mobilized ileocolic arterial pedicle were used for esophageal reconstruction to the neck. In this case, a 65 year-old male patient had accidentally indigested hydrochloric acid which caused necrosis of his upper digestive tract. An emergency esophagectomy, gastrectomy, duodenectomy, pancreatectomy and splenectomy had been performed in an outside hospital. A cervical esophagostomy and a biliodigestive anastomosis had been created and a jejunal catheter for enteral feeding had been placed. After the patient had recovered, a reconstruction of his food passage via the left and transverse colon failed for technical reasons due to an intraoperative necrotic demarcation of the colon. Our team then faced the situation that only a short stump of the right hemi-colon was left in situ when the patient was referred to our center. After intensified nutritional therapy, we reconstructed this patient’s food passage with the right hemicolon-approach described herein. After treatment of a postoperative pneumonia, the patient was discharged from hospital on the 26th postoperative day in a good clinical condition on an oral-only diet. In conclusion, individual approaches for long-segment reconstruction of the esophagus can be technically feasible in experienced hands. They do not always require arterial supercharging or free intestinal transplantation.
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Reslinger V, Tranchart H, D'Annunzio E, Poghosyan T, Quero L, Munoz-Bongrand N, Corte H, Sarfati E, Cattan P, Chirica M. Esophageal reconstruction by colon interposition after esophagectomy for cancer analysis of current indications, operative outcomes, and long-term survival. J Surg Oncol 2015; 113:159-64. [PMID: 26699417 DOI: 10.1002/jso.24118] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/18/2015] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Colon interposition is an alternative solution for esophageal reconstruction if the stomach cannot be used. The study reviews current indications and results of coloplasty for cancer. METHODS Patients who underwent colon interposition for gastro-esophageal malignancy were included. Primary coloplasty was defined as upfront colon interposition. Salvage coloplasty was defined as colon interposition after primary reconstruction failure. Mortality, morbidity, function, and survival were evaluated. RESULTS We included 28 patients (24 men, median age 61 years). Ten (36%) patients underwent primary coloplasty due to previous gastrectomy (n = 5), conduit gastric cancer (n = 2), extensive gastroesophageal involvement (n = 2), and gastric cancer recurrence (n = 1). Salvage coloplasty was performed in 18 (64%) patients for postoperative graft necrosis (n = 5) and intractable strictures (n = 3). Operative mortality, morbidity, and graft necrosis rates were 14% (4/28), 86% (24/28), and 14% (4/28), respectively; there were no significant differences between primary and salvage coloplasty. Survival rates at 1-, 3-, and 5 years were 81%, 51%, and 38%, respectively. Survival was decreased after primary coloplasty when compared to salvage coloplasty (P = 0.03). Nine patients experienced tumor recurrence (primary: n = 6, salvage: n = 3) after coloplasty and eight of them died. CONCLUSION Colon interposition after esophagectomy is a useful but morbid endeavor. Colon interposition as salvage therapy is associated with improved survival compared to its use as primary esophageal replacement, and colon interposition in the latter cohort should be used with caution due to poor cancer-specific survival in this patient population.
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Affiliation(s)
- Vincent Reslinger
- Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France
| | - Hadrien Tranchart
- Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France
| | - Elsa D'Annunzio
- Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France
| | - Tigran Poghosyan
- Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France
| | - Laurent Quero
- Department of Radiotherapy, Saint-Louis Hospital, Paris, France
| | - Nicolas Munoz-Bongrand
- Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France
| | - Helene Corte
- Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France
| | - Emile Sarfati
- Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France
| | - Pierre Cattan
- Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France
| | - Mircea Chirica
- Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France
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Poghosyan T, Catry J, Luong-Nguyen M, Bruneval P, Domet T, Arakelian L, Sfeir R, Michaud L, Vanneaux V, Gottrand F, Larghero J, Cattan P. Esophageal tissue engineering: Current status and perspectives. J Visc Surg 2015; 153:21-9. [PMID: 26711880 DOI: 10.1016/j.jviscsurg.2015.11.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Tissue engineering, which consists of the combination and in vivo implantation of elements required for tissue remodeling toward a specific organ phenotype, could be an alternative for classical techniques of esophageal replacement. The current hybrid approach entails creation of an esophageal substitute composed of an acellular matrix and autologous epithelial and muscle cells provides the most successful results. Current research is based on the use of mesenchymal stem cells, whose potential for differentiation and proangioogenic, immune-modulator and anti-inflammatory properties are important assets. In the near future, esophageal substitutes could be constructed from acellular "intelligent matrices" that contain the molecules necessary for tissue regeneration; this should allow circumvention of the implantation step and still obtain standardized in vivo biological responses. At present, tissue engineering applications to esophageal replacement are limited to enlargement plasties with absorbable, non-cellular matrices. Nevertheless, the application of existing clinical techniques for replacement of other organs by tissue engineering in combination with a multiplication of translational research protocols for esophageal replacement in large animals should soon pave the way for health agencies to authorize clinical trials.
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Affiliation(s)
- T Poghosyan
- Service de chirurgie digestive, oncologique et métabolique, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France; CIC de biothérapies, Inserm UMR 1160, institut universitaire d'hématologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - J Catry
- CIC de biothérapies, Inserm UMR 1160, institut universitaire d'hématologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Service de chirurgie générale, digestive et endocrinienne, hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - M Luong-Nguyen
- CIC de biothérapies, Inserm UMR 1160, institut universitaire d'hématologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Service de chirurgie générale, digestive et endocrinienne, hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - P Bruneval
- Service d'anatomopathologie, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - T Domet
- CIC de biothérapies, Inserm UMR 1160, institut universitaire d'hématologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Unité de thérapie cellulaire, hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - L Arakelian
- CIC de biothérapies, Inserm UMR 1160, institut universitaire d'hématologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - R Sfeir
- Centre de référence des affections congénitales et malformatives de l'œsophage, CHRU de Lille, 59000 Lille, France
| | - L Michaud
- Centre de référence des affections congénitales et malformatives de l'œsophage, CHRU de Lille, 59000 Lille, France
| | - V Vanneaux
- CIC de biothérapies, Inserm UMR 1160, institut universitaire d'hématologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Unité de thérapie cellulaire, hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - F Gottrand
- Centre de référence des affections congénitales et malformatives de l'œsophage, CHRU de Lille, 59000 Lille, France
| | - J Larghero
- CIC de biothérapies, Inserm UMR 1160, institut universitaire d'hématologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Unité de thérapie cellulaire, hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - P Cattan
- CIC de biothérapies, Inserm UMR 1160, institut universitaire d'hématologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Service de chirurgie générale, digestive et endocrinienne, hôpital Saint-Louis, AP-HP, 75010 Paris, France.
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