Looking forwards to esophageal regeneration
Published online:07 March 2018
Successful esophageal regeneration
Large-animal study results published in Nature Scientific Reports show successful esophageal regeneration
While endoscopic mucosal resection (EMR) has become an accepted treatment for early stage esophageal cancer and high-grade dysplasia associated with Barrett’s esophagus, higher grade, more invasive lesions typically require esophageal resection. These treatment modalities result in either a partial thickness or full thickness defect which cannot be left untreated.
The major problem with esophagectomy for treatment of esophageal pathology is not the resection itself, but rather the reconstruction. Results from these animals showed gradual structural regrowth of endogenous esophageal tissue, including squamous esophageal mucosa, submucosa and smooth muscle layers with blood vessel formation. The study results indicate that scaffolds seeded with the patient’s own mesenchymal stem cells may provide a safer alternative for some patients compared to the gastro-intestinal conduit technique used today following resection of the esophagus.
Currently, reconstruction of the native esophagus is often impossible over the defects resulting from the treatment of esophageal disease. The resection length precludes repair using an end to end esophageal anastomosis because of the inability to mobilize the esophagus without devascularization since vascularity arises posteriorly from the thoracic wall. Poor redundancy of esophageal tissue further limits reconstruction. Therefore, reconstruction typically utilizes an alternative autologous tissue, either gastric, small bowel, or colon, as a conduit with the removal of the esophagus distal to the diseased segment.
These treatment modalities are associated with high morbidity and mortality. Given these limitations in treatment, there is a critical need for an alternative approach to esophageal reconstruction.
very interesting with a lot more info on this click below
New Idea for Esophageal Atresia
Robot Lengthens Disconnected Bowels to Restore a Contiguous Gut
JANUARY 17th, 2018
A number of congenital conditions result in missing parts of the gastrointestinal tract, such as esophageal atresia, while a few others can necessitate surgical removal of a part of the bowel that then has to be reconnected. Fragile and precious newborns are perhaps the most common patients for procedures requiring bowel regeneration and reconnection. In terms of esophageal atresia, the current standard of care, known as Foker Process, puts the child into an induced coma so that body movement doesn’t hamper the disconnected ends of a malformed esophagus from being pulled together by sutures attached to the back.
Now a team at Boston Children’s Hospital has developed a robot that can be implanted into a small child, connected to the parts of the gut requiring connectivity, and left alone to gently pull the disconnected segments toward each other. The new procedure doesn’t require the child to be placed in a coma because, unlike in the Foker process, there are no sutures connecting the guts to the back that create too much motion for healing if the child would be awake. The new robot grabs on only to the disconnected ends of the bowel being connected.
Because a comma is no longer necessary, potentially traumatic side effects such as clot formation are no longer an issue. Moreover, overall costs are significantly reduced due to simpler clinical care that treated children would require.
According to Vector, Boston Children’s blog, the robotic implant has two rings that are sutured around the disjointed parts of a bowel. An external power deliver device controls the amount of force that the two rings placed on the tissues they’re connected to. So far this technology has been tested on pigs, as a proof of concept, demonstrating that the animals seemingly had no discomfort after the implantation of the robot and during its working phase when it increased the length of the affected bowel by 2.5 millimeters a day.
There’s already talk about trialing the same on human children, but in the meantime, the same technology is to be tested on animals with short bowel syndrome, which can be caused by cancer, necrotizing enterocolitis, and other diseases.
Here’s a fluoroscopy video showing the robotic implant at work: For more photos etc
Robotic implant could help children with rare disorder eat again
17 January 2018
- Engineers from the University of Sheffield’s Engineering Faculty and Boston’s Children Hospital, Harvard Medical School have created a robot that can be used to help treat babies with a rare birth defect that affects an infant’s oesophagus
- The robot stimulates cells by gently pulling on tissue using sensors
- The robot is inspired by the Foker procedure but is less invasive and more accurate and will enable babies to move more freely during this delicate procedure.
Researchers at the University of Sheffield and Boston’s Children Hospital, Harvard Medical School have created a robot that can be implanted into the body to aid the treatment of oesophageal atresia, a rare birth defect that affects a baby’s oesophagus.
Dr. Dana Damian from the Department of Automatic Control and Systems Engineering at the University of Sheffield and her team from Boston Children’s Hospital have created the revolutionary prototype robotic implant which encourages tissue growth in babies.
The robot is a small device which is attached to the oesophagus by two rings. An incorporated motor then stimulates the cells by gently pulling the tissue. Using two types of sensors – one to measure the tension in the tissue and another to measure tissue displacement – the robot monitors and applies tissue traction depending on the tissue properties.
The robot’s function is inspired by the Foker technique of correcting the oesophageal atresia which involves manually pulling the tissue slowly using sutures over a period of time.
Dr Dana Damian said: “Doctors have been performing the Foker procedure as they realised that tissue lengthening can be achieved by pulling on the tissue. However, it is unknown how much force should be applied to produce tissue lengthening. Although the technique is one of the best standards, sometimes the sutures surgeons attach to the oesophagus can tear which can result in repetitive surgeries or scar tissue can form that can cause problems for the patient in the future.
“The robot we developed addresses this issue because it measures the force being applied and can be adapted at any time throughout the treatment. With it being implanted in the patient, it means they have – in effect – a doctor by their side all the time, monitoring them and changing their treatment when needed.”
Oesophageal atresia is a rare genetic disease which affects about one in 4000 babies born in the US and Europe. It occurs when the upper and lower parts of the oesophagus don’t connect, which means food can’t reach the stomach. Some of these cases are characterized by a gap between three and 10 cm between the oesophageal stubs, called long gap oesophageal atresia. The treatment of these cases using Foker technique can start as early as three months old and can take months. Usually, the patient is sedated during the treatment to ensure the sutures in place do not tear.
The study suggests that with this robot, babies would be free to move around and be allowed to interact with their parents while undergoing treatment, taking away some of the stress from both parties.
The implant is powered by a control unit which remains outside of the body, attached to a vest. This means that doctors can monitor the patient without impacting on the baby’s routine.
Dr. Damian said: “The biggest challenge we faced was to design a robot that works in a technology-hostile environment and to develop a robust physiologically-relevant interaction with the tissue that promotes its growth when there are so many unknowns about the underlying mechanisms. The robot we designed had to be soft and durable, air and water impermeable, abrasion resistant, non-corrosive and be able to be implanted for long-term treatment.
“This is the first step in adaptive regenerative-based treatments of tissues. We have made a device that can provide long-term control of the tissue growth using onboard medical expertise. We further want to look at other tubular tissues, such as the intestine and the vascular system, to see if this sort of technology can be used to help with other conditions, such as Short Bowel Syndrome.”
Tissue growth has been an issue in the bioengineering field for many years, however, this research is a stepping stone to understanding how mechanical stimulation at the tissue level helps the cells multiply and how doctors can stimulate cells to grow using intuitive tools.
The research has shown cells will multiply in response to being pulled rather than stretching out of shape or scarring. Using the robot’s monitoring and control abilities, the treatment can be changed to suit the patient and to optimize the cells’ growth.
Professor Sheila MacNeil, Professor of Tissue Engineering in the Department of Materials Science and Engineering at the University of Sheffield, said: “Increasing knowledge of how tissues respond to mechanical strain with the production of new tissue has been needed for a long while.
Doctors and researchers understand that tissues will normally grow in response to traction forces, for example, this occurs naturally during pregnancy as the growing baby increases the pressure inside the mother, the abdominal wall and skin increase in area to relieve the tension generated from stretching these tissues. Plastic-surgeons have copied this trick by placing an inflatable balloon under the skin and inflating it over a period of weeks to expand skin and they then use this “extra skin” for reconstructive surgery for the patient.
“The development of this robotic implant is a breakthrough in applying the knowledge that tissues respond to strain with the production of new tissue in a practical and clinically useful manner.”
CLICK ON BOTH LINKS
New Clinical Trial for Severe GERD
posted June 2017
See if the LESS GERD Trial is right for you, Click on the link below.
Gastroesophageal reflux disease (GERD) is a chronic condition that causes uncomfortable heartburn and regurgitation for millions of Americans. Most people with GERD receive relief through daily acid blocking medications called proton pump inhibitors (PPI). However, nearly 30% of PPI users continue to struggle with such burdensome symptoms as regurgitation and nighttime reflux.
If you struggle with GERD and are not getting complete relief from your daily heartburn medications, you may be a candidate for the LESS GERD Clinical Trial. The trial is for EndoStim – an investigational, minimally-invasive procedure that may help improve GERD symptoms.
What is EndoStim?
EndoStim is a new, minimally-invasive approach to GERD treatment, designed to restore normal function to the lower esophageal sphincter (LES).
The EndoStim system uses a technology called neurostimulation in which two small electrodes connected to a “lead” are placed on the LES. The lead is connected to a small device called a neurostimulator. The neurostimulator and lead deliver mild electrical signals to the LES automatically throughout the day (not normally felt or sensed by the patient). This gentle stimulation is designed to restore normal function to the LES.
The EndoStim system is placed through a minimally-invasive procedure. The device is implanted below the skin. And unlike traditional anti-reflux surgery, the EndoStim procedure is designed to preserve the body’s natural anatomy in order to reduce or avoid gastro-intestinal side effects.
The EndoStim system is currently being offered at select centers through the LESS GERD Clinical Trial.
New Esophageal Atresia Clinic in New York
Second behind Boston USA
Esophageal atresia (EA) is a congenital condition (present at birth) in which the esophagus is interrupted and fails to connect the mouth to the stomach as it should. The upper part of the esophagus ends in a blind pouch, and, in the most common form, the lower esophagus connects the airway (trachea) to the stomach (a trachehoesophageal fistula, or TEF). These conditions (EA and TEF) can occur separately, but most often occur together. Babies with EA, TEF, or EA-TEF must undergo surgical repair, often very soon after birth. Without treatment, attempting to eat could cause babies to aspirate milk and stomach acid into the trachea and lungs.
Esophageal Disorders Program
at NewYork-Presbyterian/Columbia University Medical Center
630 West 168th Street
New York, NY 10032
ESOPHAGEAL DISORDERS PROGRAM
The two most common types of esophageal cancer are squamous cell carcinoma, most often occurring in the upper and middle portions of the esophagus, and adenocarcinoma, affecting the mucous-secreting cells in the lower portion near the stomach. Other rare forms of the disease include sarcoma, lymphoma, small cell carcinoma and spindle cell carcinoma. In addition, breast and lung cancers can metastasize (spread) to the esophagus. Achalasia is a rare disorder of the smooth muscle layer of the esophagus in which muscular ability to move food down the esophagus (peristalsis) is impaired, and the entry to the stomach or the lower esophageal sphincter (LES) fails to relax properly in response to swallowing. Barrett’s esophagus is a condition in which repeated contact with gastric acid (gastroesophageal reflux, or GERD) transforms a patient’s esophageal cells from normal squamous epithelium to abnormal intestinalized columnar epithelium. Esophageal atresia (EA) is a rare congenital condition (present at birth) in which the esophagus fails to connect to the stomach as it should and ends in a blind pouch instead. Gastroesophageal reflux disease (GERD), also called acid reflux, is a common digestive disorder in which stomach contents regurgitate (reflux) into the esophagus. Also called heartburn, GERD often causes inflammation and damage to the esophagus and occasionally to the lungs and vocal cords. Prolonged untreated GERD can lead to Barrett’s esophagus, a dangerous precancerous condition. Hiatal Hernia In a hiatal hernia (also called hiatus or diaphragmatic hernia), a portion of the stomach penetrates (herniates) through a weakness or tear in the hiatus of the diaphragm, the small opening that allows the esophagus to pass from the neck and chest to its connection with the stomach. Difficulty swallowing, also called dysphagia, may indicate a problem in the throat or esophagus. There are many causes of dysphagia, including the following:
New Idea in the USA for treating Gastroparesis
New Program Offers Multidisciplinary Treatment and Hope to Patients with Gastroparesis.
The innovative POP procedure helps alleviate symptoms without surgery.
For patients with gastroparesis, long-term relief from nausea, vomiting and bloating may have seemed like an impossible dream. However, medical experts have discovered the secret to conquering this chronic condition. Effective patient care for gastroparesis requires innovative treatment combined with the expertise of physicians from multiple disciplines.
Challenges of traditional treatment
The most common treatments for gastroparesis include pain management, medication and surgery. However, using just one of these treatments is unlikely to relieve the patient’s symptoms. Physicians must consider the patient’s overall health, including diet, psychology and pain levels. When patients receive treatments from physicians in multiple disciplines, the overall treatment plan usually lacks cohesion and focus.
Because gastroparesis is such a rare disorder, few medical centres have had enough exposure to patients with this condition to develop effective treatment plans. Plus, the therapies are evolving so rapidly that many hospitals are struggling to keep up with the changes.
Click here to read full report
FDA approves use of new Flourish device to treat infants born with esophageal atresia
May 12, 2017
The U.S. Food and Drug Administration today authorized the use of the Flourish Pediatric Esophageal Atresia Anastomosis, a first-of-its-kind medical device to treat infants up to one-year-old for a birth defect that causes a gap in their esophagus, called esophageal atresia. An estimated 1 in every 2,500 babies in the U.S. is born with esophageal atresia. Babies with this condition cannot feed normally, and they require a feeding tube until surgery can be performed to attach the esophagus to the stomach. Most babies born with esophageal atresia also have a tracheoesophageal fistula, which also needs to be repaired surgically, since fluids from the esophagus can get into the airways and interfere with breathing.
“This new device provides a non-surgical option for doctors to treat esophageal atresia in babies born with this condition,” said William Maisel, M.D., M.P.H., acting director of the Office of Device Evaluation in the FDA’s Center for Devices and Radiological Health. “But it is only intended for infants who do not have a tracheoesophageal fistula or who have had the fistula repaired in a prior surgery.” The device uses magnets to pull the upper and lower esophagus together, closing the gap and allowing food to enter the stomach. It is not for use in infants who also have a tracheoesophageal fistula, an abnormal connection between the esophagus and the windpipe (trachea).
During the procedure to insert the Flourish device, doctors insert two catheters, one through the mouth and one through the stomach. The magnetic ends of the two catheters attract each other, and this attraction pulls the two ends of the esophagus together over several days, closing the gap and forming a connection. Once the catheters are removed, the infant can begin to feed by mouth. The FDA reviewed data for the Flourish device through the humanitarian device exemption (HDE) process. A Humanitarian Use Device (HUD) is a device that is intended to benefit patients by treating or diagnosing a disease or condition that affects not more than 8,000 individuals in the U.S. per year.
Breaking news for dysphagia
Breaking news – A potential game changer for patients with profound oropharyngeal dysphagia
Swallow: A Documentary Dysphagia
Please watch to understand
Speech pathologist Tiffany Turner explains how swallowing works, what causes dysphagia, and how dysphagia can be treated. For more information and free resources
SWALLOWING VIDEO shows how they look into this
This video gives an overview of how swallowing works, how it can sometimes go wrong, and possible ways to treat those problems.
Reflux Infants Support
If you have any questions, or would like further information, please contact the Reflux Infants Support Association at
New idea to treat GORD
19th July 2016
Now acid reflux can be banished for good without surgery: New technique using electric needle toughens up your insides
Many people suffer from occasional acid reflux, but for some it becomes a chronic problem that can lead to ulcers and potentially cancer. Matthew Foster, 28, a Royal Engineer who lives near Ripon, North Yorkshire, underwent a new NHS procedure, as he tells CAROL DAVIS.
All my life I’ve kept pretty fit, eaten healthily and had no health worries. But around five years ago I started having a painful burning feeling in my throat after I’d been hurtling around the rugby field, or if I’d been for a jog. I knew it was heartburn, though didn’t think much could be done so I just bought over-the-counter remedies — Gaviscon liquid helped, and so did Rennie tablets, which I’d take after food or exercise. But I was gradually having to take more and more — in just one day I’d get through a packet of Rennies and a whole bottle of Gaviscon.
Matthew suffered from chronic heartburn, presumably due to a small hernia, and underwent the new procedure If I went for a pint with my mates I’d have to take a sip of Gaviscon before going out, and then again as soon as I got back to stop the painful burning. Two years ago — around three years after the problem first started — I went to my GP, who confirmed that it was acid reflux causing my symptoms. He explained that acidic juices from my stomach were rising up into my throat because the valve separating the gullet and stomach was too weak to keep them down.
He suspected that this had been partly caused by a small hiatus hernia he said I had — basically part of my stomach was being squeezed, pushing the stomach contents up the gullet. I was prescribed lansoprazole, which reduces the amount of acid your stomach produces and referred to the James Cook University Hospital in Middlesbrough for more tests.
Two months later I had an endoscopy — where they put a flexible tube with a camera on the end down your throat — and a special X-ray called a barium swallow to see where the stomach acid was in my gullet. These confirmed I had a hiatus hernia and acid reflux which needed treatment with surgery. The doctors told me they could operate to wrap part of my stomach around the bottom of the gullet — this would strengthen the valve and stop acid washing back up. But that sounded like a major operation, and I really didn’t want that. So I went on taking the lansoprazole daily.
I even tried avoiding things that made it worse, such as pastry and lager. It wasn’t enough though, and the heartburn got unbearable. After training, I’d be sick as acid washed back up my throat — exercise clearly put extra strain on my stomach. I also didn’t like the idea of being on pills for life, so I got referred back to the James Cook.
This time I saw Dr Y.K.S. Viswanath, who said they was a new procedure to end acid reflux without surgery. It involves putting a tube with electrodes at the end down my throat and onto the faulty valve. The electrodes fire radiofrequency waves at the valve to strengthen it and help it close properly. I had the hour-long procedure in April this year, under local anaesthetic. I could feel the tube going down my throat, and it hurt each time a blast of radiofrequency burnt the tissue.
I went home that afternoon, with instructions to keep to a liquid diet for two weeks while my throat healed. I took co-codamol for a few days, then I was fine. Now I can eat and drink what I want, and I don’t need to take anything. It’s a miracle operation — there is no more heartburn, even when I train hard or go out for a pint, which is wonderful.
Y.K.S. Viswanath is a consultant upper gastrointestinal and laparoscopic surgeon at the James Cook University Hospital.
Acid reflux or gastro-oesophageal reflux disease (GORD) is very common, affecting one in three of us. It occurs when the sphincter, a valve between the stomach and gullet, doesn’t work properly, allowing stomach acid to wash back up the gullet and causing heartburn. Normally the valve opens to allow fluid and food to pass into the stomach and closes to prevent these flowing back up the oesophagus. In GORD, the muscles in the valve are weakened, often as a result of lifestyle factors such as obesity, smoking or diet — spicy food and caffeine can irritate it — so it doesn’t close as it should. Some patients have acid reflux that’s made worse by a hiatus hernia — where part of the stomach protrudes above the diaphragm into the chest, squeezing the stomach contents back up.
Acid reflux occurs when the sphincter, a valve between the stomach and gullet, doesn’t work properly, allowing stomach acid to wash back up the gullet and causing heartburn.
This is problematic as chronic acid reflux can lead to ulcers, bleeding and the pre-cancerous condition Barrett’s oesophagus. Lifestyle changes, for instance, avoiding caffeine and citrus fruit (which can increase the amount of stomach acid) can help.
Antacids such as Gaviscon, which coats the stomach lining to stop acid rising, are also worth trying, or doctors can prescribe drugs to reduce stomach acid, which patients usually have to take for life. When these fail, we can offer surgery. Conventionally this means a keyhole procedure to wrap part of the stomach around the gullet, which strengthens the valve. But not all patients are suitable for or want surgery, so a newer option, called Stretta, is better. It has been approved for use in the NHS and is now available at two NHS trusts (at South Tees Hospitals NHS Foundation Trust and the Royal Liverpool And Broadgreen University Hospitals NHS Trust) as well as privately.
It involves passing a catheter, a tube which is roughly 16-18 mm in diameter, down the throat. At the end of the catheter are tiny prongs that fire radiofrequency waves — a low voltage electrical current — at the valve.
The procedure involves passing a catheter, a tube which is roughly 16-18 mm in diameter, down the throat. At the end of the catheter are tiny prongs that fire a low voltage electrical current at the valve
This damages the tissue and causes tiny scars — as these heal, new tissue forms and the valve becomes bulkier and stronger. The procedure takes up to 60 minutes, usually with the patient under sedation. First, we spray local anaesthetic down the throat. Then we pass a camera down so we can identify exactly where the valve is.
We pass a guide wire down to the sphincter, and over that, we feed the Stretta catheter until the prongs are in the right place. We fire for two one-minute spells on one side, and then move it down and give more cycles — 14 in all. Then we withdraw the catheter. We give the patient a drink straight after to check the swallowing reflex works and that we haven’t damaged any tissue. The patient goes home that afternoon. They need to stick to a liquid diet for two weeks to allow the area to heal. They can also take Calpol liquid if they need painkillers.
Thanks to NICE approving Stretta for use three years ago, it is available on the NHS and will be adopted by more NHS trusts. Although it is not suitable for everyone, it is a solution to heartburn without the need for surgery or patients being on long-term medication.
The procedure costs around £5,000-£5,500 privately, or £3,000 to the NHS. UK (England)
WHAT ARE THE RISKS?
There is a small risk of bleeding and perforation of the gullet, although this is the same with any endoscopic procedure. There may be some pain during the procedure. Painful swallowing and sore throat for a few weeks.
‘This is a low-risk procedure and is very effective,’ says Chris Sutton, a consultant general and upper gastrointestinal surgeon at the University Hospitals of Leicester NHS Trust. It could be offered to many more patients, but since the catheter costs £2,500-3,000 and is single-use, so goes in the bin afterwards, it is more expensive than medication.
‘It even costs more than some types of keyhole surgery, which I suspect is why it’s not more widely available.