Abstract
Chronic non-healing gastrointestinal defects remain difficult to manage. Existing techniques for endoscopic closure rely heavily on mechanical tissue approximation and may fail when the surrounding tissue is ischemic, indurated, fibrotic or chronically inflamed. Endoscopic autologous mucosal transplantation (EAMT) is a novel approach in which viable mucosal tissue is harvested from the same patient and transplanted onto the chronic defect to promote tissue regeneration.
We conducted a study at two tertiary care centers, involving adult patients that underwent EAMT. A standardized procedural protocol was used for consistent reproducibility and reporting, and outcomes were recorded.
A total of 8 patients underwent EAMT. Mean age was 64.6 ± 10.0 years and 6 patients (75%) were male. All defects treated were chronic. Indications included a non-healing gastro-jejunal marginal ulcer (n=1), jejunal pouch fistula (n=1), gastric fistula after surgical repair of a gastric perforation (n=1), gastro-gastric fistula after roux-en-y bypass (n=1), duodenal bulb fistula after surgical repair (n=1), ischemic gastro-duodenal ulcer (n=1) and post-operative broncho-esophageal fistulae (n=2). The median defect size was 15.0 mm (range=80-5). The median procedure time was 73 minutes (range=135-45). Technical success was achieved in all 8 cases (100%). Same-session complete closure of the recipient site was achieved in all patients except one with a large defect (80mm) that required an additional procedure. All grafts were viable on repeat endoscopy. The median follow-up duration was 12.7 weeks (range=26-8). Clinical success was observed in 7 patients (87.5%). One patient (12.5%), with underlying inflammatory bowel disease, experienced symptom recurrence at 6 months. There were no procedure-related early or late adverse events recorded.
EAMT appears to be technically feasible and safe for the management of chronic gastrointestinal luminal defects in carefully selected patients that have failed conventional therapy. EMAT offers a novel restorative approach that differs conceptually from conventional closure techniques and may expand therapeutic options for patients with complex non-healing defects. Further studies are needed.