Development of an endoluminal intestinal attachment for a clinically applicable distraction enterogenesis device.

Purpose: Previous methods of distraction enterogenesis have relied upon blind-ending intestinal segments or transmural device fixation, requiring multiple operations and potential bowel injury. We hypothesized that using a novel attachment would allow reversible device coupling to the luminal bowel surface, achieving effective endoluminal distraction.

Methods: A telescopic hydraulic device was designed with latex balloon attachments covered with high-friction mesh and a dilating fenestrated elastic mask (DFM attachment), allowing mesh-to-mucosa contact only with inflation.

Mesenteric neovascularization with distraction-induced intestinal growth: enterogenesis.

Background: Distraction-induced enterogenesis, whereby the intestine lengthens with application of linear forces, is an emerging area which may provide a unique treatment for short bowel syndrome. With an increase in overall tissue mass, there is an increase in oxygen and nutrient demand. We hypothesized that a neovascularization within the mesentery is necessary to support the growing small bowel.

Development of a novel approach to safely couple the intestine to a distraction-induced device for intestinal growth: use of reconstructive tissue matrix.

Background: Distraction-induced intestinal growth may be a novel treatment for short bowel syndrome. Longitudinal, distractive tension created by the application of force creates a significant challenge: to produce adequate force, yet not cause perforation at the fixation points. This paper describes our development of a coupling strategy to allow for successful bowel lengthening.

Flow through a mechanical distraction enterogenesis device: a pilot test.

Background: We tested the coupling portion of a prototype intraluminal distraction enterogenesis device to allow flow-through of simulated enteric contents (SEC) in both pig and human jejunum.

Materials And Methods: SEC was made using 80% corn syrup. Ten-cm pig and human intestinal segments had a spoke-shaped 2.

Application of distractive forces to the small intestine: defining safe limits.

Background: Distraction enterogenesis is a novel method for increasing small bowel length by the application of linearly directed forces. However, the magnitude of distractive forces that human and animal small bowel can safely withstand is unknown.

Methods: Acute ex vivo force-displacement curves for human (n = 5) and pig (n = 6) small intestine (with and without mesentery) were made by applying increasing amounts of distractive forces to bowel immersed in normal saline (39°C).

Mechanical Extension Implants for Short-Bowel Syndrome.

Short-bowel syndrome (SBS) is a rare, potentially lethal medical condition where the small intestine is far shorter than required for proper nutrient absorption. Current treatment, including nutritional, hormone-based, and surgical modification, have limited success resulting in 30% to 50% mortality rates. Recent advances in mechanotransduction, stressing the bowel to induce growth, show great promise; but for successful clinical use, more sophisticated devices that can be implanted are required.

Enterogenesis in a clinically feasible model of mechanical small-bowel lengthening.

Background: Recent work indicates that mechanical force induces small-bowel growth, although methods reported do not have direct clinical application. We report a clinically feasible technique of enterogenesis and describe intestinal function in this model.

Methods: Using a pig model (n = 11), we stretched isolated small intestinal segments mechanically for 7 days in vivo with an intraluminal device.