Background
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.
Methods
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.
Results
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.
Conclusion
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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Article info
Publication history
Published online: May 22, 2015
Accepted:
March 31,
2015
Footnotes
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.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
