Most people take eating, drinking and swallowing for granted. But when that ability is taken away, because of cancer or surgery, the results are devastating. Patients who lose all or part of their esophagus must rely on a feeding tube implanted into the abdomen for nourishment, which can lead to infection, social isolation and undernourishment.
Many of these patients are candidates for esophageal reconstruction, which uses tissue from one part of the body to replace the absent esophagus, thereby repairing the conduit from the throat to the stomach and giving patients the ability to eat and swallow again. Historically, gastric pull up and colonic interposition have served as the primary reconstructive choices in the face of major esophageal defects. But some patients are not candidates for these procedures, and others suffer post-surgical complications such as loss of blood supply to the transplanted tissue and leakage due to poor connections.
But a collaborative Stanford team with a long track record of successful esophageal transplant is using an unlikely approach, the small intestine, over more commonly used procedures.
"We use the small intestine, which is a much better size match, and we use microsurgery to augment the blood supply," says Gordon Lee, MD, director of microsurgery in the division of plastic and reconstructive surgery. And with that approach, Stanford has been getting excellent results. "All of our patients initially came to us unable to eat, drink or even swallow sometimes for months, even years, as a result of cancer or surgery," Lee says. "And all of the patients we've done have resumed a normal, regular diet and are maintaining their weight."
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