Extracellular matrix based gastroesophageal junction reinforcement device
Provided are medical devices for implantation in patients having suffered the loss of or damage to at least part of their esophagus. The medical device connects the esophagus or remaining part thereof with the stomach to form a gastro-esophageal junction that promotes healing and encourages new host tissue growth while distributing the load and decreasing tension at the anastomotic site. The medical device comprises extracellular matrix shaped into a conformation that more closely approximates the geometry of the native gastro-esophageal junction than does direct attachment of the stomach to the shortened esophagus. Molds useful in manufacturing the medical device and methods of use of the device are also described herein.
1. A method of reinforcing a gastroesophageal anastomotic site in a patient comprising
implanting a device comprising one or more layers of extracellular matrix tissue and comprising:
a) a tubular esophageal portion having essentially a constant diameter; and
b) a tubular gastric portion attached to the esophageal portion at a junction having a diameter that increases from the junction to a distal tip of the gastric portion
at an anastomosis between a portion of the patient's esophagus and stomach.
2. The method of claim 1 , wherein the device is attached externally to the patient's remaining esophagus and stomach.
3. The method of claim 1 , wherein the device is attached internally to the patient's remaining esophagus and stomach.
4. The method of claim 3 , in which endomucosa is removed from the patient's esophagus and/or stomach where the device is implanted.
5. The method of claim 1 , wherein the diameter of the gastric portion of the device increases in an essentially uniform manner from the junction to the distal tip of the gastric portion.
6. The method of claim 1 , wherein the gastric portion of the device is modeled to conform with a portion of a patient's stomach.
7. The method of claim 6 , wherein the gastric portion of the device is modeled to conform with a cardiac region of a stomach adjacent to a cardiac opening of the stomach.
8. The method of claim 1 , wherein
a) the esophageal portion of the device has a length of between 1 to 30 cm and a diameter of between 0.5 to 5 cm; and
b) the gastric portion of the device has a length of between 1 to 8 cm and the distal tip of the gastric portion has a diameter of between 1-12 cm.
9. The method of claim 8 , wherein
a) the esophageal portion of the device has a length of about 3 cm and a diameter of about 2.3 cm; and
b) the gastric portion of the device has a length of about 3-4 cm and a diameter of the distal tip of about 7 cm.
10. The method of claim 1 , wherein the extracellular matrix tissue is isolated from urinary bladder tissue.
11. The method of claim 1 , wherein the extracellular matrix tissue is isolated from intestinal submucosa.
12. The method of claim 11 , wherein the extracellular matrix tissue is isolated from small intestinal submucosa.
13. The method of claim 1 , wherein the extracellular matrix tissue is isolated from dermis of skin.
14. The method of claim 1 , wherein the extracellular matrix tissue is isolated from the esophagus.
15. The method of claim 1 , wherein the device comprises 2-10 layers of extracellular matrix tissue.
16. The method of claim 1 , wherein the device is seeded with cells.
17. The method of claim 16 , wherein the cells are human.
18. The method of claim 17 , wherein the cells are obtained from a patient into whom the device is to be implanted.
19. A method of joining a resected gastroesophageal junction in a patient comprising
attaching a device comprising one or more layers of extracellular matrix tissue and comprising:
a) a tubular esophageal portion having essentially a constant diameter; and
b) a conical gastric portion attached to the esophageal portion at a junction having a diameter that increases from the junction to a distal tip of the gastric portion
to at least a portion of the patient's esophagus and at least a portion of the patient's gastric wall, wherein the tubular portion is attached to at least a portion of the patient's esophagus and the conical portion is attached to at least a portion of the patient's gastric wall.