Journal of Gastroenterology

, Volume 48, Issue 7, pp 822–829

A bioabsorbable polymer patch for the treatment of esophageal defect in a porcine model

  • Masayasu Aikawa
  • Mitsuo Miyazawa
  • Kojun Okamoto
  • Katsuya Okada
  • Naoe Akimoto
  • Hiroshi Sato
  • Isamu Koyama
  • Shigeki Yamaguchi
  • Yoshito Ikada
Original Article—Alimentary Tract



Although several materials have been used to replace the esophagus, none of the materials appears to be feasible for clinical use. Our group has developed a bioabsorbable polymer that can be used to repair the defects of stomach, small intestine, biliary tract, and veins. In this study, we implanted a bioabsorbable polymer patch (BAPP) into an esophageal defect and we investigated the clinical utility of BAPP and evaluated the process of esophageal regeneration.


Pigs (n = 9) underwent right thoracotomy under general anesthesia. A 4 × 2-cm oval-shaped portion of the esophageal wall was excised, and a BAPP was implanted at the excision site. Esophageal endoscopy was performed at 2 weeks after the implantation. At 4, 8, and 12 weeks after implantation, the whole esophagus was resected for gross and histological examinations of the graft sites.


Esophageal endoscopy at 2 weeks revealed a tiny ulceration at the implantation site with no stenosis. At 4 weeks, the epithelium at the graft site was similar to that of the native esophagus, but it lacked a proper muscle layer. At 8 weeks, a rough muscle layer had developed. At 12 weeks, normal mucosa and a proper muscle layer similar to that of the native wall were confirmed.


BAPP repaired the defective esophageal wall without complications, and a neo esophageal wall identical to the native esophageal wall had formed by 12 weeks after implantation. Hence, this newly designed substitute has the potential for application as a novel treatment for defective esophagus.


Bioabsorbable material Tissue engineering Esophageal defect Esophageal reconstruction 


  1. 1.
    Aikawa M, Miyazawa M, Okada K, Torii T, Toshimitsu Y, Okamoto K, et al. Gastric wall regeneration using bioabsorbable polymer. Jpn J Gastroenterol Surg. 2009;42:139.CrossRefGoogle Scholar
  2. 2.
    Aikawa M, Miyazawa M, Okamoto K, Toshimitsu Y, Torii T, Okada K, et al. A novel treatment for bile duct injury with a tissue-engineered bioabsorbable polymer patch. Surgery. 2010;147:575–80.PubMedCrossRefGoogle Scholar
  3. 3.
    Miyazawa M, Aikawa M, Okada K, Toshimitsu Y, Okamoto K, Koyama I, et al. Regeneration of extrahepatic bile ducts by tissue engineering with a bioabsorbable polymer. J Artif Organs. 2012;15:26–31.PubMedCrossRefGoogle Scholar
  4. 4.
    Toshimitsu Y, Miyazawa M, Torii T, Koyama I, Ikada Y. Tissue-engineered patch for the reconstruction of inferior vena cava during living-donor liver transplantation. J Gastrointest Surg. 2005;9:789–93.PubMedCrossRefGoogle Scholar
  5. 5.
    Shin’oka T, Imai Y, Ikada Y. Transplantation of a tissue-engineered pulmonary artery. N Engl J Med. 2001;344:532–3.PubMedCrossRefGoogle Scholar
  6. 6.
    Linden PA, Bueno R, Mentzer SJ, Zellos L, Lebenthal A, Colson YL, et al. Modified T-tube repair of delayed esophageal perforation results in a low mortality rate similar to that seen with acute perforations. Ann Thorac Surg. 2007;83:1129–33.PubMedCrossRefGoogle Scholar
  7. 7.
    Wright CD, Mathisen DJ, Wain JC, Moncure AC, Hilgenberg AD, Grillo HC. Reinforced primary repair of thoracic esophageal perforation. Ann Thorac Surg. 1995;60:245–8 (discussion 48–9).Google Scholar
  8. 8.
    Coran AG. Pericardioesophagoplasty. A new operation for partial esophageal replacement. Am J Surg. 1973;125:294–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Grillo HC, Wilkins EW Jr. Esophageal repair following late diagnosis of intrathoracic perforation. Ann Thorac Surg. 1975;20:387–99.PubMedCrossRefGoogle Scholar
  10. 10.
    Jara FM. Diaphragmatic pedicle flap for treatment of Boerhaave’s syndrome. J Thorac Cardiovasc Surg. 1979;78:931–3.PubMedGoogle Scholar
  11. 11.
    Dooling JA, Zick HR. Closure of an esophagopleural fistula using onlay intercostal pedicle graft. Ann Thorac Surg. 1967;3:553–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Iannettoni MD, Vlessis AA, Whyte RI, Orringer MB. Functional outcome after surgical treatment of esophageal perforation. Ann Thorac Surg. 1997;64:1606–9 (discussion 9–10).Google Scholar
  13. 13.
    Richardson JD. Management of esophageal perforations: the value of aggressive surgical treatment. Am J Surg. 2005;190:161–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Fuchs JR, Nasseri BA, Vacanti JP. Tissue engineering: a 21st century solution to surgical reconstruction. Ann Thorac Surg. 2001;72:577–91.PubMedCrossRefGoogle Scholar
  15. 15.
    Berman EF. The experimental replacement of portions of the esophagus by a plastic tube. Ann Surg. 1952;135:337–43.PubMedCrossRefGoogle Scholar
  16. 16.
    Fukushima M, Kako N, Chiba K, Kawaguchi T, Kimura Y, Sato M, et al. Seven-year follow-up study after the replacement of the esophagus with an artificial esophagus in the dog. Surgery. 1983;93:70–7.PubMedGoogle Scholar
  17. 17.
    Gonzalez Saez LA, Arnal Monreal F, Pita Fernandez S, Machuca Santa Cruz J. Experimental study using PTFE (Goretex) patches for replacement of the oesophageal wall. Eur Surg Res. 2003;35:372–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Lopes MF, Cabrita A, Ilharco J, Pessa P, Paiva-Carvalho J, Pires A, et al. Esophageal replacement in rat using porcine intestinal submucosa as a patch or a tube-shaped graft. Dis Esophagus. 2006;19:254–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Jonsson L, Gatzinsky V, Jennische E, Johansson C, Nannmark U, Friberg LG. Piglet model for studying esophageal regrowth after resection and interposition of a silicone stented small intestinal submucosa tube. Eur Surg Res. 2011;46:169–79.PubMedCrossRefGoogle Scholar
  20. 20.
    Nakase Y, Nakamura T, Kin S, Nakashima S, Yoshikawa T, Kuriu Y, et al. Intrathoracic esophageal replacement by in situ tissue-engineered esophagus. J Thorac Cardiovasc Surg. 2008;136:850–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Freud E, Greif M, Rozner M, Finaly R, Efrati I, Kidron D, et al. Bridging of esophageal defects with lyophilized dura mater: an experimental study. J Pediatr Surg. 1993;28:986–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Purushotham AD, Carachi R, Gorham SD, French DA, Shivas AA. Use of a collagen coated vicryl tube in reconstruction of the porcine esophagus. Eur J Pediatr Surg. 1991;1:80–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Yamamoto Y, Nakamura T, Shimizu Y, Matsumoto K, Takimoto Y, Kiyotani T, et al. Intrathoracic esophageal replacement in the dog with the use of an artificial esophagus composed of a collagen sponge with a double-layered silicone tube. J Thorac Cardiovasc Surg. 1999;118:276–86.PubMedCrossRefGoogle Scholar
  24. 24.
    Yamamoto Y, Nakamura T, Shimizu Y, Takimoto Y, Matsumoto K, Kiyotani T, et al. Experimental replacement of the thoracic esophagus with a bioabsorbable collagen sponge scaffold supported by a silicone stent in dogs. ASAIO J. 1999;45:311–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Badylak SF, Vorp DA, Spievack AR, Simmons-Byrd A, Hanke J, Freytes DO, et al. Esophageal reconstruction with ECM and muscle tissue in a dog model. J Surg Res. 2005;128:87–97.PubMedCrossRefGoogle Scholar
  26. 26.
    Grikscheit T, Ochoa ER, Srinivasan A, Gaissert H, Vacanti JP. Tissue-engineered esophagus: experimental substitution by onlay patch or interposition. J Thorac Cardiovasc Surg. 2003;126:537–44.PubMedCrossRefGoogle Scholar
  27. 27.
    Nonaka K, Miyazawa M, Aikawa M, Akimoto N, Koyama I, Ikada Y, et al. Experimental trial for perforation caused by esophageal endoscopic submucosal dissection using a biodegradable polymer stent in an animal model. Dig Endosc. 2012;24:286.PubMedCrossRefGoogle Scholar
  28. 28.
    Andoh A, Bamba S, Brittan M, Fujiyama Y, Wright NA. Role of intestinal subepithelial myofibroblasts in inflammation and regenerative response in the gut. Pharmacol Ther. 2007;114:94–106.PubMedCrossRefGoogle Scholar
  29. 29.
    Powell DW, Mifflin RC, Valentich JD, Crowe SE, Saada JI, West AB. Myofibroblasts. II. Intestinal subepithelial myofibroblasts. Am J Physiol. 1999;277:C183–201.PubMedGoogle Scholar
  30. 30.
    Langer R, Vacanti JP. Tissue engineering. Science. 1993;260:920–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2012

Authors and Affiliations

  • Masayasu Aikawa
    • 1
  • Mitsuo Miyazawa
    • 1
  • Kojun Okamoto
    • 1
  • Katsuya Okada
    • 1
  • Naoe Akimoto
    • 1
  • Hiroshi Sato
    • 1
  • Isamu Koyama
    • 1
  • Shigeki Yamaguchi
    • 1
  • Yoshito Ikada
    • 2
  1. 1.Department of Surgery, Gastrointestinal CenterSaitama Medical University, International Medical CenterHidakaJapan
  2. 2.Division of Life ScienceNara Medical UniversityNaraJapan

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