Optimization of In-Continuity Spring-Mediated Intestinal Lengthening

Dubrovsky, Genia; Taylor, Jordan S.; Thomas, Anne-Laure; Shekherdimian, Shant; Dunn, James C.Y.

doi:10.1016/j.jpedsurg.2019.09.072

Cited by 6 publications

(4 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Springs initially used in this model were based on previously optimized methods used in healthy porcine models ( 22 , 23 , 26 ). However, following massive intestinal resection, the small intestine was more dilated and thickened than the historical controls.…”

Section: Resultsmentioning

confidence: 99%

“…Approximately 75% of the small intestine (~550-650cm) was removed with a jejunoileostomy to create the SBS model (T0), consistent with previously established models ( 25 ) ( Figure 1 ). 30-days following resection (T1), pigs underwent a second laparotomy to place an encapsulated compressed spring in the jejunal segment via plication with sutures as previously described ( 26 ). At T2 (30 days following spring placement and 60 days post-resection), pigs were sacrificed, and tissue was obtained from the site of spring placement and tissue proximal to the spring to serve as an internal control.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Spring-mediated distraction enterogenesis may alter the course of adaptation in porcine short bowel syndrome

Bautista,

Dubrovsky,

Sweeney

et al. 2024

Front. Gastroenterol.

Self Cite

View full text Add to dashboard Cite

IntroductionSevere forms of short bowel syndrome (SBS) resulting in chronic intestinal failure (IF) have limited therapeutic options, all of which are associated with significant morbidities. Spring-mediated distraction enterogenesis (SMDE) uses an intraluminal self-expanding spring to generate mechanical force to induce intestinal stretching and sustained axial growth, providing a promising novel approach for patients with SBS. Previous studies have established this method to be safe and effective in small and large animal models. However, SMDE has previously not been implemented in a large, clinically relevant animal model.MethodsJuvenile mini-Yucatan pigs with 75% of their small intestine resected had intraluminal springs placed after an initial adaptive period. Morphological and histological assessments were performed on SMDE segments compared to the control region of the intestine undergoing normal adaptive responses to resection.ResultsWhile the initial histologic adaptive response observed following resection was attenuated after a month, the SMDE segments instead augmented these adaptive changes. Specifically, intestinal length increased 2-fold in SMDE segments, and the widths of the epithelial, muscularis, and serosal layers were enhanced in SMDE compared with control segments of the same animal. This data suggests that morphologic intestinal adaptation may be enhanced with SMDE in the setting of SBS.DiscussionHere we demonstrate the successful and reproducible implementation of SMDE in a large animal model in the setting of prior intestinal resection, making SMDE a viable and novel approach for SBS to be explored further.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Spring-mediated distraction enterogenesis may alter the course of adaptation in porcine short bowel syndrome

Bautista,

Dubrovsky,

Sweeney

et al. 2024

Front. Gastroenterol.

Self Cite

View full text Add to dashboard Cite

show abstract

“…Springs that remained within the plications demonstrated the same two-fold lengthening effect that we have seen in previous experiments with external plication. Further experimentation is needed to perfect the internal plication technique to achieve consistent intestinal lengthening, particularly as the end goal is to be able to place these devices via an endoscopic approach [ 5 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…The spring was affixed with externally plicating sutures placed in the bowel wall immediately proximal and distal to the compressed spring. By the time the animals were euthanized, spring-containing intestinal segments had lengthened up to 3-fold [ 5 , 11 ]. We have also shown that multiple springs can be placed in continuity with minimal adverse effects, thus resulting in an overall more substantial intestinal lengthening relative to individual segments [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Internal plication for spring confinement to lengthen intestine in a porcine model

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background Short bowel syndrome and its resultant nutritional deficiencies are the most common cause of intestinal failure. Significant intestinal lengthening using intraluminal springs is feasible in porcine models using an external plication technique. We hypothesize that an internal plication technique will yield significant intestinal lengthening, which may lead to future endoscopic spring placement. Methods Uncompressed springs measuring 7.5 cm with a diameter of 1.0 cm were compressed to 2.0 cm. A gelatin-encapsulated compressed nitinol spring was inserted into the jejunal lumen of juvenile pigs and held in place with endoluminal sutures just proximal and distal to the spring-containing segment. A control segment distal to the spring was marked. Pigs were euthanized on postoperative day 7. Spring and control segments were collected for analyses. Results There was an average lengthening by 72% of the spring segment compared to the control segment. Two out of 7 springs stayed within both sets of plications and doubled in length. Histology showed normal mucosal integrity of the spring segment and plicated areas with similar muscular thickness but increased crypt depth and villus length compared to the control segment. Conclusion Internal plication resulted in significant bowel lengthening. Five springs had slipped through proximal, distal or both sets of plications, resulting in less lengthening than those that remained fixed. A more consistent methodology for endoluminal suturing is needed to produce more lengthening.

show abstract