Distraction enterogenesis may provide a novel therapy for short bowel syndrome. Previously described methods have relied on isolated intestinal segments or transmural fixation because of ineffective endoluminal attachment. We hypothesized that a novel approach of geometric coupling between a tapering device and the mesenteric curvature would allow trans-stomal distraction enterogenesis.
A catheter device was designed with tapering stiffness, consisting of a stiff catheter with a taper to a flexible latex tip to prevent perforation. Yorkshire pigs underwent creation of a jejunal Roux limb with device placed via jejunostomy. Intestinal attachment was achieved without a substantial decrease in bowel perfusion as measured by laser Doppler. An external clamp was secured at the stoma to provide external fixation of the device. The catheter was advanced 1 cm/day for either 7 or 14 days before explant.
After 7 days, the distracted segment achieved a mean ± SD increase in length of 37 ± 6% versus fed, nondistracted bowel, corresponding to an absolute gain of 10.6 ± 1.7 cm (1.5 cm/day). After 14 days, the Roux limb achieved an 80 ± 2% increase in length versus fed control bowel, corresponding to an absolute gain of 16.8 ± 3.0 cm (1.2 cm/day). No perforation or stoma-related complication occurred.
We describe a novel catheter device with tapering stiffness allowing for endoluminal distraction enterogenesis via geometric coupling. This approach may allow development of clinically applicable technology for the treatment of patients with short bowel syndrome.
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- Natural History of Pediatric Intestinal Failure: Initial Report from the Pediatric Intestinal Failure Consortium.J Pediatr. 2012; 161: 723-728
- Pediatric short bowel syndrome: redefining predictors of success.Ann Surg. 2005; 242: 403-409
- Neonates with short bowel syndrome: an optimistic future for weaning from parenteral nutrition.JAMA Surg. 2014; 149: 663-670
- Intestinal loop lengthening—a technique for increasing small intestinal length.J Pediatr Surg. 1980; 15: 145-151
- Isolated bowel segment (model 1): creation by myoenteropexy.J Pediatr Surg. 1990; 25: 512-513
- Serial transverse enteroplasty for short bowel syndrome: a case report.J Pediatr Surg. 2003; 38: 881-885
- Comparison of intestinal lengthening procedures for patients with short bowel syndrome.Ann Surg. 2007; 246: 593-601
- Staple line ulcers: a cause of chronic GI bleeding following STEP procedure.J Pediatr Surg. 2013; 48: E1-3
- Redilation of bowel after intestinal lengthening procedures–an indicator for poor outcome.J Pediatr Surg. 2011; 46: 145-149
- Outcomes in children after intestinal transplant.Pediatrics. 2010; 125: e550-e558
- Intestinal transplant registry report: global activity and trends.Am J Transplant. 2015; 15: 210-219
- Enterogenesis by mechanical lengthening: morphology and function of the lengthened small intestine.J Pediatr Surg. 2004; 39: 1823-1827
- Longitudinal mechanical tension induces growth in the small bowel of juvenile rats.Gut. 2005; 54: 1085-1090
- Enterogenesis in a clinically feasible model of mechanical small-bowel lengthening.Surgery. 2006; 140: 212-220
- Application of distractive forces to the small intestine: defining safe limits.J Surg Res. 2010; 163: 169-175
- Distraction-induced intestinal enterogenesis: preservation of intestinal function and lengthening after reimplantation into normal jejunum.Ann Surg. 2012; 255: 302-310
- Function of mechanically lengthened jejunum after restoration into continuity.J Pediatr Surg. 2014; 49: 971-974
- Distraction induced enterogenesis: a unique mouse model using polyethylene glycol.J Surg Res. 2011; 170: 41-47
- Mesenteric neovascularization with distraction-induced intestinal growth: enterogenesis.Pediatr Surg Int. 2013; 29: 33-39
- Development of a novel approach to safely couple the intestine to a distraction-induced device for intestinal growth: use of reconstructive tissue matrix.Pediatr Surg Int. 2013; 29: 151-156
- Restoration of mechanically lengthened jejunum into intestinal continuity in rats.J Pediatr Surg. 2011; 46: 2321-2326
- Profound systemic inflammatory response syndrome following non-emergent intestinal surgery in children.J Pediatr Surg. 2013; 48: 1936-1940
- A novel double-balloon catheter device for fully endoluminal intestinal lengthening.Pediatr Surg Int. 2014; 30: 1223-1229
- Mechanics of materials.8th ed. Cengage Learning, Stamford, CT2012
- Noncontact laser Doppler imaging in burn depth analysis of the extremities.J Burn Care Rehabil. 2003; 24: 177-186
- Intestinal perforations secondary to nasojejunal feeding tubes.AJR Am J Roentgenol. 1976; 126: 1229-1232
- Effect of gastrojejunal feedings on visits and costs in children with neurologic impairment.J Pediatr Gastroenterol Nutr. 2014; 58: 518-524
- Delayed primary serial transverse enteroplasty as a novel management strategy for infants with congenital ultra-short bowel syndrome.J Pediatr Surg. 2013; 48: 993-999
- Improved tolerance for enteral nutrition after serial transverse enteroplasty (STEP) in infants and children with short bowel syndrome—A seven-year single-center experience.J Pediatr Surg. 2014; 49: 1589-1592
- Intestinal lengthening and nutritional outcomes in children with short bowel syndrome.Am J Surg. 2013; 205: 576-580
- Long-term controlled outcomes after autologous intestinal reconstruction surgery in treatment of severe short bowel syndrome.J Pediatr Surg. 2013; 48: 339-344
- Glucagon-like peptide 2 increases efficacy of distraction enterogenesis.J Surg Res. 2013; 184: 365-373
- Gastrointestinal microcirculation and cardiopulmonary function during experimentally increased intra-abdominal pressure.Crit Care Med. 2009; 37: 230-239
Published online: May 22, 2015
Accepted: March 31, 2015
This research was supported by NIH 2R44DK085765-02, FDA P50 Pediatric Device Consortia Grant 2-P50-FD-003787-03, Michigan Institute for Clinical & Health Research (MICHR) Grant UL1TR000433, and a Hartwell Biomedical Research Award.
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.