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Esophageal Transplant

What is Esophagus?
The esophagus is a muscular tube that extends from the mouth to the stomach. Also known as the food pipe, it performs the vital function of transferring the food from mouth to the stomach. It is about 8 inches in length and is located behind the windpipe and heart but in front of the spine. The walls of the esophagus propel the food to the stomach using rhythmic movements called peristalsis.

Why is Esophagus removed?
Esophagus is susceptible to the growth of malignant cancerous cells. Cancer starts from the inner layer and can then spread to other parts of the esophagus. There are two major types of esophageal cancers: -

It is hard to detect esophageal cancer as the onset of symptoms is very late, by then cancer becomes untreatable. In such cases, the surgeon has to remove the entire or part of the esophagus to remove the tumours and treat cancer.  How much of the esophagus has to be removed, depends on the size and location of the tumours. If the cancer is close to the stomach, then some part of the upper stomach may also be removed.

Redundant Treatment Techniques
After the removal of the esophagus, the connection between mouth and stomach is permanently gone, making it impossible to process food naturally. Following techniques have been used by doctors to help the patients after oesophageal removal, but they all have their set of problems: -

  • Food Bag: - In this technique, an opening is created in the neck of the patient and with the help of an external pipe, food and saliva would travel from mouth to an outer bag.
  • Gastric Pull Up: - In this technique, the stomach is pulled up to abdomen and mouth. However, as the stomach does not belong in the chest, it can lead to issues like indigestion and acid reflux. This surgery involves cutting off blood supply to stomach, which can also cause the stomach to die.
  • Using Colon: - In this technique, part of the large intestine is used to connect stomach to mouth. The large intestine is not an ideal option as it can be suffering from many underlying conditions leading to further problems.

Esophageal Transplant
In this procedure, the surgeons take a small section of the small intestine, which is brought up through the chest and is used it as a conduit to connect the remaining esophagus to the stomach, working as a new food pipe.  It is also known as Esophageal Auto Transplant.  Additionally, a microvascular surgery is also performed for reconnection of blood vessels to ensure steady blood flow to the transplanted intestine.

Advantages
This procedure enjoys various advantages over other prevalent treatment methods, such as: -

  • The transplanted small intestine is a part of the body and as such it will not be attacked by the immune system.
  • Being of almost similar size as the esophagus, the small intestine is a better match for reconnecting remaining esophagus and the stomach.
  • Patients can resume eating like they did before removal of the esophagus. It is in itself an amazing feeling, to be able to eat and drink normally, without having to carry an external pouch.
  • The quality of life is significantly improved in patients as they can get proper nutrition.
  • Patients start feeling more confident about themselves.

 

Post-Transplant Care
Most patients are discharged within 7-10 days after the transplant. Initially, food is given through feeding tube directly connected to the intestine, to allow the body to heal completely and the digestive system to accept the transplanted intestine.
Once the body has healed, usually after 6-7 days, the feeding tube is removed, and the patient can eat and swallow food normally.
Medications, as prescribed by the doctors, have to be taken regularly. If there are any side-effects, they should be discussed with a physician for required changes in the medication.

Follow Up
Regular follow-up is required after Esophageal Transplant by patients for monitoring of health status and the functioning of transplanted intestine. Initially, the patient needs to visit the doctor after every six months and after that, a yearly visit is recommended. During the visit diagnostic tests and blood test will be performed along with counseling on side-effects of the treatment, nutritional problems, etc.

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