An active esophageal prosthesis

Abstract

Resection of carcinoma of the esophagus may be curative or palliative and usually results in either total esophagectomy or esophagogastrectomy. Continuity of the upper gastrointestinal tract is maintained via a gastric pull-up procedure or, when feasible, by primary reanastomosis of the gastric remnant to the proximal esophagus. 1 If a large part of the stomach has been previously resected or is unsuitable for use, colonic or jejunal interposition may be utilized to maintain continuity. However, these operations are associated with substantial surgical morbidity and mortality and a myriad of postoperative complications, including luminal narrowing caused by edema or ischemia, anastomotic leaks, formation of fistulae and strictures, and development of graft ischemia. 2, 3 These procedures may be precluded in the elderly or in patients with complex medical problems who are poor surgical risks. In these patients and in those with unresectable esophageal carcinoma, palliative cervical esophagostomies are sometimes performed to reduce the discomfort of dysphagia and lessen the at tendant risk for aspiration pneumonia. Nutrition is maintained through surgically placed gastrostomies or jejunostomies and, in rare instances when feeding tube place: ment is not possible or the distal gastrointestinal tract is obstructed, total parenteral nutrition. 2 Although these procedures are palliative, patients usually remain uncomfortable, are unable to eat, and have the extra burden of repeatedly emptying the esophagostomy bag, in which saliva accumulates. They also have the problem of administering enteral feedings and fluids to replace the salivary losses. We have developed an active esophageal prosthesis (AESOP) that, via a small pneumatically driven extracorporeal pump, can maintain a functioning conduit between a cervical esophagostomy and the remainder of the gastrointestinal tract in a closed circuit.