Esophageal Reconstruction by Endoscopic Transplantation of Autologous Oral Mucosal Epithelial Cell Sheets(The 21st COE Symposium on the Frontier Regenerative Medicine)

Significant advancement to the treatment of early esophageal cancers has combined the conventional endoscopic mucosal resection (EMR) with the recent endoscopic submucosal dissection (ESD). ESD enables precise diagnosis and a more extensive en-bloc resection, leading to a reduced risk of recurrence. However, ulcerative esophageal constriction from extensive esophageal ESD can severely affect the quality of life (QOL) of patients. Aim : We endoscopically transplanted autologous oral mucosal epithelial cell sheets of beagle dogs onto an artificial ulcerative area of esophagus to examine whether there is a decrease in post ESD stricture. Materials and Methods : Specimens of oral mucosa harvested from beagle dogs were seeded on temperature-responsive culture dishes and cultured for 2 weeks at 37℃. Oral mucosal sheets (24x24 mm^2) were harvested by reducing the culture temperature to 20℃. Using upper endoscopy, two autologous cell sheets were transplanted onto the circumferential artificial ulceration of esophagus without any sutures. The transplanted areas were observed for 3 weeks. Results : Stratified sheets of cultured oral mucosal epithelial cells were harvested without any enzyme treatments. Using temperature responsive culture dishes, we were able to harvest autologous oral mucosal epithelial sheets at a low-temperature, by which we maintained the structure of cells without using protein enzymes. The transplantation method allowed cell sheets to adhere directly to the host tissues or wound beds and remain at the transplant site without sutures. Endoscopic findings of transplanted animals revealed that belag and esophageal constriction diminished after 3 weeks. Conclusion : Our endoscopic esophageal reconstruction method in dogs using autologous oral mucosal epithelial cell sheets required only a small amount of cell source and could prevent ulcerative constriction. We conclude that this new method could promote better healing and could be applied to patients who undergo ESD, thereby improving post operative QOL