FIRST SUCCESSFUL SCAR EXCISION, RE-VASCULARIZATION AND TRANSPLATATION OF SMALL INTESTINAL MUCOSA TO THE CERVICAL ESOPHAGUS IN MAN

A 62 year old man had undergone a curative circumferential tubular endoscopic submucosal dissection (ESD) from 20 – 27 cm aborally in july 2015 due to an early SCC located in the upper esophageal sphincter area.

Different measures to prevent stricture formation failed and one year later the patient had to return every 10 days to the hospital for dilatation. Due to poor surgical alternatives an experimental concept was carried out after acute and chronic animal experiments in the pig. The scar was first excised in a tubular fashion from the upper esophageal sphincter over 7 centimeters and a PEG tube placed into the stomach. Two polyurethan vacuum sponges were implanted into the cervical esophagus and changed every 3 – 4 days over 20 days in order to stimulate neovascularization.

In a second intervention a 30 cm segment of small intestine was harvested surgically, specially prepared and transplanted to the priorly conditioned scar area. The specimen was temporarily fixed against the wall using a non-covered nitinol stent.

Two month after the second procedure several islands of histologically proven vital PAS positive small intestinal mucosa could be observed. In the meantime, small intestinal mucosa can clearly be visualized at the transplantation site. Clinically the patient has recovered completely from the intervention and works full time as engineer.

Our case shows the feasibility of a new concept: endoscopic scar excision, induction of neo-vascularization in analogy to plastic surgery over 3 weeks and transplantation of surgically harvested and specially prepared small intestinal mucosa the pretreated area. The concept offers a new perspective for the treatment and potentially the prevention of scar formation after primary tubular mucosal excision in the esophagus.