Esophageal replacement in rat using porcine intestinal submucosa as a patch or a tube-shaped graft

Abstract

This study compares the efficacy of porcine intestinal submucosa (SIS) patch graft versus SIS-tube graft in esophageal replacement, using a novel esophageal regeneration model. Clinical function, as well as macroscopic and microscopic morphology were evaluated in both SIS-treated groups. We performed semi-circumferential esophageal excision followed by repair of the defect using either a SIS-patch graft (group I) or segmental esophageal excision followed by a SIS-tube interposition graft (group II) in rats. The 28-day survival rate was significantly different between the SIS-treated groups (100% in group I vs. 0% in group II). Unlike the rats in group II, which died within the first postoperative month due to esophageal dysfunction, all surviving animals in group I resumed a normal solid diet within a few days after surgery, without signs of esophageal dysfunction and gained weight. Barium swallow studies showed no evidence of fistula, significant stenosis or diverticula. No hematological or serum biochemistry abnormalities were found. By day 150 the SIS patch was replaced by esophageal-derived tissues. In the rat model, a patch graft technique using SIS appeared to induce esophageal regrowth and provided an initial and long-term satisfactory function, while a tube-shaped graft technique using SIS was unsuccessful.

Piglet Model for Studying Esophageal Regrowth after Resection and Interposition of a Silicone Stented Small Intestinal Submucosa Tube

“…Previous experiments have shown that circumferential resection of the esophagus and surgical replacement with a collagen tube induced total stricture as early as the first 2 weeks [15,16,17,18]. Such studies have been performed in rats, dogs and piglets.…”

Circumferential esophageal replacement using a tube-shaped tissue-engineered substitute: An experimental study in minipigs

“…Indeed, circumferential replacement of the esophagus by acellular scaffolds without cell seeding invariably leads to stricture and lack of function. [24][25][26][27][28][29] In patch esophagoplasty models, the addition of muscle cells to the matrix lowers the inflammatory process, accelerates tissue regeneration and restores a better function. 30 Badylak et al 31 showed that covering an acellular scaffold with autologous muscle tissue avoids stricture formation after circumferential esophageal replacement.…”

Acellular bi-layer silk fibroin scaffolds support functional tissue regeneration in a rat model of onlay esophagoplasty

“…Cell-free grafts derived from extracellular matrices (ECM) such as decellularized esophagus [12], decellularized urinary bladder submucosa (UBS) [13], acellular dermis [14], gastric acellular matrix [15], small intestinal submucosa (SIS) [16–19], decellularized aorta [20] and collagen-based sponges [21–24] have been shown to promote host tissue ingrowth and constructive tissue remodeling in a number of animal models of esophageal reconstruction. In addition, small-scale clinical trials have also demonstrated the feasibility of SIS and UBS implants for the repair of esophageal defects [25–27].…”