Mesenteric neovascularization with distraction-induced intestinal growth: enterogenesis

Abstract

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 (SBS). 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. Methods A curvilinear hydraulic device was used to induce growth within the small bowel of Yorkshire pigs, and the intestine was harvested after 14 days. High-resolution, gross pictures were recorded of the mesentery at implantation and at harvest, and CT imaging of the bowel and mesentery was performed at harvest after dye injection. Results After 2 weeks of distraction, an average of 72.5% (8.7cm) bowel lengthening was achieved. Gross images of the mesentery between major vessels showed a blossoming of the microvasculature and this was confirmed by CT imaging with 3D reconstruction. Mesenteric sample taken from the distracted segment had a 4-fold increase in the volume of microvasculature versus controls. Conclusion Enterogenesis results not only in increased bowel length, but significant increase in the mesenteric microvascularity. Presumably, this sustains the lengthened segment after application of longitudinal forces.

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

“…As we and others have previously shown, distraction enterogenesis produces significant, sustained intestinal lengthening with preservation of intestinal function [11][12][13]. This is characterized by mesenteric neovascularization, increased villus height and crypt depth, muscular hypertrophy, and increased epithelial cell proliferation [9,14,15].…”

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

“…While measurement of perfusion at implant was used to set the initial tension of the device, we could not verify that this tension was maintained after closure of the abdomen. Therefore, we used a distance-based distraction regimen of 1 cm advancement of the device per day, which was chosen based on success with prior end-abutment devices (15, 19, 20). A more robust parameter of distraction would be direct measurement of applied bowel tension, which could be used to guide safe clinical use.…”

“…Distraction enterogenesis is the use of mechanical force to induce small bowel lengthening, and has been shown in animal models to produce durable increases in length with preservation of intestinal function (15–17). Increased intestinal length is accompanied by mesenteric neovascularization, muscular hypertrophy, increased mucosal surface area, and increased epithelial cell proliferation (13, 18, 19). …”

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

“…A hydraulic-driven concentric piston device (Fig 1) was designed as previously described (21) and adapted for linear actuation and inclusion of novel attachments. Briefly, this device consisted of a 10 cm long reciprocating single-stage stainless steel linear pump that allowed 1.1 cm of linear extension with infusion of 1 ml of water.…”