Update on surgical therapies for intestinal failure

Sudan, Debra; Rege, Aparna

doi:10.1097/mot.0000000000000076

Cited by 16 publications

(17 citation statements)

References 75 publications

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“…In extreme cases, an extensive length of tissue must be removed, thereby impacting the patient's ability to digest food and absorb nutrients properly. 7,[13][14][15][16][17][18][19][20] To date, there is no ideal curative treatment for Short Bowel Syndrome. 7,[13][14][15][16][17][18][19][20] To date, there is no ideal curative treatment for Short Bowel Syndrome.…”

Section: Introductionmentioning

confidence: 99%

“…[13][14][15][16][17] Short Bowel Syndrome (SBS) is a life-threatening condition that leaves patients dependent upon intravenously administered nutrition until either lengthening procedures can be used to restore a functional intestinal length or the patient receives an intestinal transplant. 7,[18][19][20] In addition to common concerns for organ transplants, such as host rejection and lifetime dependency on immunosuppressives, intestinal transplants suffer from markedly lower success rates than other whole organ procedures, likely due to the high degree of immune activity that occurs within this organ system. Bowel lengthening procedures require sufficient healthy tissue and are technically challenging, time and resource intensive, and are often reversed by the body's natural adaptation and recovery processes.…”

Section: Introductionmentioning

confidence: 99%

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Protein-engineered scaffolds for in vitro 3D culture of primary adult intestinal organoids

et al. 2015

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Though in vitro culture of primary intestinal organoids has gained significant momentum in recent years, little has been done to investigate the impact of microenvironmental cues provided by the encapsulating matrix on the growth and development of these fragile cultures. In this work, the impact of various in vitro culture parameters on primary adult murine organoid formation and growth are analyzed with a focus on matrix properties and geometric culture configuration. The air-liquid interface culture configuration was found to result in enhanced organoid formation relative to a traditional submerged configuration. Additionally, through use of a recombinantly engineered extracellular matrix (eECM), the effects of biochemical and biomechanical cues were independently studied. Decreasing mechanical stiffness and increasing cell adhesivity were found to increase organoid yield. Tuning of eECM properties was used to obtain organoid formation efficiency values identical to those observed in naturally harvested collagen I matrices but within a stiffer construct with improved ease of physical manipulation. Increased ability to remodel the surrounding matrix through mechanical or enzymatic means was also shown to enhance organoid formation. As the engineering and tunability of recombinant matrices is essentially limitless, continued property optimization may result in further improved matrix performance and may help to identify additional microenvironmental cues that directly impact organoid formation, development, differentiation, and functional behavior. Continued culture of primary organoids in recombinant matrices could therefore prove to be largely advantageous in the field of intestinal tissue engineering for applications in regenerative medicine and in vitro tissue mimics.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Protein-engineered scaffolds for in vitro 3D culture of primary adult intestinal organoids

et al. 2015

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“…Aşağıdaki tanımla-malar ipuçları veriyor ancak yine de zor karar. Başa-rının kendisi bu sorulara uygun yanıt verilebildiğinde kolayca gelir (28,55) .…”

Section: Ortalama Girişim Yaşı Ne Olmuştur?unclassified

“…Benzer algoritmalar Manchester ve Duke (28,55) gruplarınca da tanımlanmıştır: Buna göre daha önce de belirtildiği üzere cerrahi seçiminde temel belirleyiciler a. kalan bağırsak uzunluğu b. bağırsak dilatasyonunun derecesi c. ve motilitedir. -eğer normale yakın bağırsak uzunluğu var ama diyare devam ediyorsa hastaya revers segment tedavileri (çok ender olarak) önerilirken -kısa bağırsak ve dilatasyon varsa uzatma girişimleri seçilmektedir.…”

Section: Ortalama Girişim Yaşı Ne Olmuştur?unclassified

“…Ancak girişim zamanlaması tartışmalı olup, daha önce de belirttiğim gibi Manchester grubu cerrahinin erken yapılmasını "girişimin kendisi adaptasyon için yapılır" mantığıyla daha erken önermekte iken (bu gruba göre, TPN komplikasyonlarından kaçınmak için yapılmalıdır), Duke grubu (Rege ve Sudan) (28,55) ise "adaptasyon olayı bir plato çizme-ye başlayınca girişim yapılmalı" şeklinde tersini savunuyor. Bu düşüncenin erişkin için doğru ama çocuklar için komplikasyon olasılıklarının ve mortalitenin yüksekliği nedeniyle riskli olduğunu dü-şünenler vardır (56) .…”

Section: Ortalama Girişim Yaşı Ne Olmuştur?unclassified

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Intestinal Failure/Nontransplant surgical interventions for short bowel syndrome

Çelik¹

2017

tcdd

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Öz GirişBağırsak sisteminin bireyin besin alımı ve sıvı dengesini sağlamada yetersiz kaldığı durumlara bağırsak yetmezliği adı verilmektedir. Bağırsak uzunluğunun azaldığı, ileoçekal valvin olmadığı, kolonun kaybedildiği gibi uzunluk kayıpları veya mukozal yetmezlik, dismotilite veya aktif enterit gibi besin emiliminin mümkün olmadığı durumlarda birey kalıcı veya uzun süreli total parenteral beslenmeye mecbur kalabilmektedir (1) . "Büyüme için gerekli sıvı ve besinlerin sindirimi ve emilimi için yeterli miktarda fonksiyonel bağırsak kalmaması" pediatrik bağırsak yetmezliğinin modern tanımlamasıdır. Bir başka tanımda ise, büyüme, hidrasyon ve elektrolit homeostazının bozulmasına neden olan bağırsak hastalığı olarak genellenebilmektedir.

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Results of Surgical and Medical Rehabilitation for Adult Patients With Type III Intestinal Failure in a Comprehensive Unit Today: Building a New Model to Predict Parenteral Nutrition Independency

Gondolesi

Doeyo

Lic

et al. 2019

J Parenter Enteral Nutr

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Background: Short-bowel syndrome remains the primary cause of intestinal failure (IF) in adult patients. We aim to report the long-term results of medical and surgical rehabilitation in a cohort of patients with type III IF (III-IF) and develop a formula to predict parenteral nutrition (PN) independency. Methods: We used a retrospective analysis of a prospective database for III-IF patients undergoing autologous gastrointestinal reconstruction surgery (AGIRS) from March 2006 to August 2018. Analyzed variables included demographic data, postsurgical intestinal length (PSIL), postsurgical anatomy, teduglutide (TED) treatment, and PN volume reduction. Univariate analysis, Cox regression, logistic regression forward stepwise models, and receiver operating characteristic (ROC) curve were done using SPSS v20. Results: AGIRS was performed in 88 patients. The most frequent anatomy at first visit was type 1. Prevailing anatomy after surgery was type 3. Eight patients started TED; 6 achieved freedom from PN. At a mean follow-up time of 1606.1 ± 1190.25 days, freedom from PN survival was achieved in 83%. Variables identified at the logistic regression analysis led to a novel formula to predict intestinal rehabilitation, including PSIL, presence of ileocecal valve, and use of TED as part of postsurgical treatment. Conclusions: AGIRS in this group of patients enabled intestinal length increase and also intestinal anatomy conversion into a more favorable type for intestinal rehabilitation. TED treatment was useful to discontinue PN in patients with classical negative anatomical predictors. The novel predicting formula has an ROC area under the curve = 0.82. Further studies are necessary to validate this formula.

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Update on surgical therapies for intestinal failure

Cited by 16 publications

References 75 publications

Protein-engineered scaffolds for in vitro 3D culture of primary adult intestinal organoids

Protein-engineered scaffolds for in vitro 3D culture of primary adult intestinal organoids

Intestinal Failure/Nontransplant surgical interventions for short bowel syndrome

Results of Surgical and Medical Rehabilitation for Adult Patients With Type III Intestinal Failure in a Comprehensive Unit Today: Building a New Model to Predict Parenteral Nutrition Independency

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