Esophageal tissue engineering and 3D bioprinting: Materials, vascularization, and functional reconstruction

Replacement of the esophagus remains one of the most formidable challenges in reconstructive surgery due to its unique anatomical and functional demands. Conventional approaches such as gastric pull-up or colonic interposition frequently fail to restore peristalsis and often result in significant morbidity, underscoring the need for innovative strategies. Esophageal tissue engineering and 3D bioprinting have emerged as promising alternatives, leveraging biodegradable polymers, decellularized matrices, and hybrid scaffolds to mimic the multilayered architecture of the native esophagus. Recent advances in scaffold design, including electrospinning and spatially organized bioprinting, have enabled the development of constructs that promote epithelialization, smooth muscle regeneration, and biomechanical integrity. However, achieving robust vascularization remains a critical hurdle, with strategies ranging from bioactive coatings and endothelial co-culture to in vivo bioreactor techniques and omentopexy-assisted grafting. Functional restoration is further complicated by the need for organized muscle orientation, innervation, and peristaltic coordination, which are only partially realized in current models. Despite these challenges, preclinical studies and pioneering clinical applications have demonstrated the feasibility of restoring esophageal continuity, epithelial barrier function, and partial contractility. This review consolidates progress over the past decade, evaluates ongoing controversies regarding scaffold composition, vascularization strategies, and the role of cellularization, and highlights future directions toward reproducible, patient-specific, and clinically translatable constructs. With continued interdisciplinary innovations, bioengineered esophageal grafts hold the potential to transform treatment paradigms for esophageal atresia, caustic injury, and malignancy, ultimately moving closer to functional replacements that replicate the complexity of the native organ.