Endoscopic autologous mucosal transplantation for management of chronic nonhealing luminal defects (with video)

BACKGROUND AND AIMS: Chronic nonhealing GI 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. METHODS: We conducted a study at 2 tertiary care centers, involving adult patients who underwent EAMT. A standardized procedural protocol was used for consistent reproducibility and reporting, and outcomes were recorded. RESULTS: A total of 8 patients underwent EAMT. The mean age was 64.6 ± 10.0 years, and 6 patients (75%) were male. All treated defects were chronic. Indications included a nonhealing gastrojejunal marginal ulcer (n = 1), jejunal pouch fistula (n = 1), gastric fistula after surgical repair of a gastric perforation (n = 1), gastrogastric fistula after Roux-en-Y bypass (n = 1), duodenal bulb fistula after surgical repair (n = 1), ischemic gastroduodenal ulcer (n = 1), and postoperative bronchoesophageal fistulae (n = 2). The median defect size was 15.0 mm (range, 80-85). The median procedure time was 73 minutes (range, 135-145). The technical success rate was achieved in all 8 cases (100%). Same-session complete closure of the recipient site was achieved in all patients except 1 with a large defect (80 mm), who required an additional procedure. All grafts were viable on repeat endoscopy. The median follow-up duration was 12.7 weeks (range, 26-28). The clinical success rate 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. CONCLUSIONS: EAMT appears to be technically feasible and safe for the management of chronic GI luminal defects in carefully selected patients who 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 nonhealing defects. Further studies are needed.