The gastroesophageal junction – A gap in tissue engineering

The gastroesophageal junction (GEJ) plays a critical role in preventing reflux of stomach contents into the esophagus and airways, but currently there are no options for replacement. Surgical resection of the GEJ or lower esophagus requires reanastomosis through a gastric conduit or intestinal interposition, but these surgeries are associated with significant morbidity and mortality related to loss of the one-way valve function. Despite significant progress made in tissue-engineering for the body of the esophagus, little has been done for the stomach and no attempts have been made to reconstruct a GEJ. A detailed understanding of the GEJ anatomy and physiology complemented by knowledge of approaches used in tissue engineering of the esophagus and stomach is foundational to future attempts to address this gap in the field. These topics, as well as anticipated obstacles, are addressed in this review.