A novel double-balloon catheter device for fully endoluminal intestinal lengthening

Demehri, Farokh R.; Wong, Philip M.; Freeman, James J.; Fukatsu, Yumi; Teitelbaum, Daniel H.

doi:10.1007/s00383-014-3612-9

Cited by 21 publications

(21 citation statements)

References 22 publications

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“…This bending may create a focal point of radial force on the bowel, potentially inducing focal bowel ischemia and perforation. This phenomenon has been noted in a prior, catheter-based endoluminal distraction enterogenesis device (23), and it may explain reports of delayed perforation from the ends of enteric feeding tubes (26, 27). The gradual taper in stiffness of this device allowed for the catheter to exert progressively less radial force on the antimesenteric bowel wall as it approached the end of the device, preventing a sharp bend in the bowel over the end of the device, thereby decreasing the risk of perforation.…”

Section: Discussionmentioning

confidence: 66%

“…The cumulative distance from the stoma to each bowel marker along the distracted segment was measured and compared to a group of control segment marker intervals at explant, extrapolated over the same number of markers(23) (Fig 4B). The gain in length of the entire distracted segment relative to the fed control segment was 10.6 ± 1.7 cm after 7 days, corresponding to an average lengthening rate of 1.5 ± 0.2 cm/day.…”

Section: Resultsmentioning

confidence: 99%

“…Future work may establish the efficacy of this approach via delayed placement of the device into a fed intestinal segment. In prior studies using the current model, a segment of unfed intestine without distraction was used as a secondary control (20, 23). This approach was not performed in this study, because the device occupied the length of the Roux limb.…”

Section: Discussionmentioning

confidence: 99%

“…First, this device requires direct enteral access to the segment of intestine to be distracted. In contrast to a more flexible device with focal intestinal attachments, the current approach would not be applicable via trans-gastric or trans-oral placement (23). Also, this method of intestinal coupling relies on the mesenteric curvature of the small bowel.…”

Section: Discussionmentioning

confidence: 99%

“…This ‘tip-effect’ resulted in a disproportionate amount of longitudinal distractive force being applied in a concentrated area of the bowel wall at that point of transition. In previous devices where such a tapered tip was not used, perforation occurred at the end of the device (23). …”

Section: Methodsmentioning

confidence: 99%

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Development of an endoluminal intestinal lengthening device using a geometric intestinal attachment approach

Demehri

Freeman

Fukatsu

et al. 2015

Surgery

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Background Distraction enterogenesis may provide a novel therapy for short bowel syndrome. Previously described methods have relied on isolated intestinal segments or transmural fixation due to ineffective endoluminal attachment. We hypothesized that a novel approach using geometric coupling between a tapering device and the mesenteric curvature would allow transstomal 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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Section: Discussionmentioning

confidence: 66%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Development of an endoluminal intestinal lengthening device using a geometric intestinal attachment approach

Demehri

Freeman

Fukatsu

et al. 2015

Surgery

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Biomimetic Tendrils by Four Dimensional Printing Bimorph Springs with Torsion and Contraction Properties Based on Bio‐Compatible Graphene/Silk Fibroin and Poly(3‐Hydroxybutyrate‐co‐3‐Hydroxyvalerate)

Maria

Chiesa

Morselli

et al. 2021

Adv Funct Materials

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Taking inspiration from plant tendril geometry, in this study, 4D bimorph coiled structures with an internal core of graphene nanoplatelets-modified regenerated silk and an external shell of poly(3-hydroxybutyrate-co-3hydroxyvalerate) are fabricated by 4D printing. Finite element simulations and experimental tests demonstrate that integrating these biomaterials with different coefficients of thermal expansion results in the temperature induced self-compression and torsion of the structure. The bimorph spring also exhibits reversible contractive actuation after exposure to water environment that paves its exploitation in regenerative medicine, since core materials also have been proven to be biocompatible. Finally, the authors validate their findings with experimental measurements using such springs for temperaturemediated lengthening of an artificial intestine.

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Detecting emergence of ruptures in individual layers of the stretched intestinal wall using optical coherence elastography: A pilot study

Kiseleva,

Sovetsky,

Ryabkov

et al. 2024

Journal of Biophotonics

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We report a new application of compression optical coherence elastography (C‐OCE) to monitor the emergence of ruptures in individual layers of longitudinally stretched small‐intestine walls using tissue samples (n = 36) from nine minipigs. Before stretching, C‐OCE successfully estimated stiffness for each intestine‐wall layer: longitudinal muscular layer with serosa, circumferential muscular layer, submucosa and mucosa. In stretched samples, C‐OCE clearly visualized initial stiffening in both muscular layers. By 25% elongation, a sharp stiffness decrease for the longitudinal muscular layer, indicated emergence of tears in all samples. With further stretching, for most samples, ruptures emerged in the circumferential muscular layer and submucosa, while mucosa remained undamaged. Histology confirmed the OCE‐revealed damaging and absence of tissue damage for ~15% elongation. Thus, C‐OCE has demonstrated a high potential for determining the safety tissue‐stretching threshold which afterward may be used intraoperatively to prevent rupture risk in intestinal tissues stretched during various diagnostic/therapeutic procedures.

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A novel double-balloon catheter device for fully endoluminal intestinal lengthening

Abstract: A novel double-balloon catheter device allows for fully endoluminal distraction enterogenesis. This approach may allow development of clinically applicable technology for the treatment of patients with SBS.

Cited by 21 publications

References 22 publications

Development of an endoluminal intestinal lengthening device using a geometric intestinal attachment approach

Development of an endoluminal intestinal lengthening device using a geometric intestinal attachment approach

Biomimetic Tendrils by Four Dimensional Printing Bimorph Springs with Torsion and Contraction Properties Based on Bio‐Compatible Graphene/Silk Fibroin and Poly(3‐Hydroxybutyrate‐co‐3‐Hydroxyvalerate)

Detecting emergence of ruptures in individual layers of the stretched intestinal wall using optical coherence elastography: A pilot study

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