RESEARCH

ESOPHAGEAL ATRESIA OPTIONS


Ben has some options for repairing his Esophageal Atresia. We are researching two.

  1. Foker Procedure: Involves growth induction of the esophagus. The Foker process uses tension-induced growth to enable primary esophageal reconstruction in patients with long gap OA. Sutures are placed on the upper and lower ends of the esophagus and brought out onto the infant's chest wall.  Tension is applied to the sutures by placing short pieces of elastic tubing under the suture loops, with the tension usually increased each day over a 1-3 week period. When enough growth in the esophageal ends has been achieved, the baby returns to theatre for an esophageal atresia repair (esophageal anastomosis). The Foker procedure may also include the placement of internal sutures on the upper and lower esophageal segments.[i]
  2. The other option is called the Kimura Method of external traction. This method stretches the esophagus subcutaneously and relocates the spit fistula in 2-3 cm increments two to four times to encourage growth until the desired length is achieved. The lower esophagus may also be stretched using the Foker Process in conjunction with this method if the lower esophagus isn’t long enough.
  3. There is a third option: wait and leave well enough alone for a while, hoping for medical technology to advance and present more options. At this stage, Benjamin has the abilities and resources needed to keep him alive and healthy. He can swallow with his spit fistula which the surgeon cleverly concealed in the fold of his neck, and he can receive nutrition through the Mic-Key button in his stomach. He is learning to eat by mouth and will hopefully learn to enjoy the taste of food and satisfy thirst. I don’t want to put him through anything that isn’t necessary just to achieve what is deemed “normal.”

[i] Clinical Guidelines (Nursing) Replogle tube management The Royal Children’s Hospital Melbourne AU http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Replogle_Tube_Management/

Lab-Grown Esophagus Could Aid Cancer Patients By Jesse Emspak, Live Science Contributor | April 15, 2014 02:23pm ET

[Lab-Grown Esophagus Could Aid Cancer Patients]
Researchers have grown an esophagus in a lab.

Doctors have implanted bio-engineered tracheas in patients, and researchers have experimented with growing bladders and kidneys. Now, another organ joins that list: the esophagus, which brings food and water to the stomach.
An international team of scientists working at Kuban State Medical University in Krasnodar, Russia, has built a working esophagus from stem cells, and implanted the organ into rats, the researchers say. The new esophagus functioned just as well as the rats' natural organs, said the researchers, who detailed their work today (April 15) in the journal Nature Communications.

Although this technique for building an esophagus seems to work in rats, there is still a long way to go before it could be tested in people. Differences between rats and humans could complicate the translation. For example, rat and human esophagi don't have exactly the same types of muscles and structure.
There's also the question of whether growing an esophagus could be scaled up, as a rat esophagus is much smaller than a person's.
In the next steps, Macchiarini said, researchers will need to move to experiments in larger animals, as well as with other organs, to see if the concept they tried in this study is broadly applicable.