Decellularization Protocols for Esophagus Bioengineering: A Systematic Review

Background: Numerous protocols exist concerning the decellularization of the esophagus, a potential alternative to the classical surgical approach for the reconstruction of the digestive tract after esophagectomy. This systematic literature review (SLR) aimed to provide an overview of the effectiveness of the current protocols. Methods: This SLR was conducted in PubMed, EMBASE, and Scopus until September 2025. Study selection, data extraction, and quality assessment were performed by two independent reviewers according to the inclusion/exclusion criteria. Results: A total of 2494 references were screened after removing duplicates. Among these references, 26 articles were included. The large majority of studies (24/26) used Sodium Dodecyl Sulfate (SDS) or Sodium DeoxyCholate (SDC), and the most common physical method was the cannulation of the esophagus (17/26). The animal model was very heterogenous. All protocols except one showed no residual cell nuclei, with only 5/19 papers confirming a satisfactory residual amount of DNA. The assessment of the extracellular matrix (ECM)—mostly qualitative—revealed global preservation but with a systematic loss of glycosaminoglycans (GAGs). Conclusions: The decellularization of the esophagus is feasible, but the definition of the optimal protocol to achieve this goal remains difficult because of the important heterogeneity among the different studies.