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Distraction Enterogenesis in Rats: A Novel Approach for the Treatment of Short Bowel Syndrome - PubMed

  • ️Mon Jan 01 2024

Distraction Enterogenesis in Rats: A Novel Approach for the Treatment of Short Bowel Syndrome

Collyn O'Quin et al. Pathophysiology. 2024.

Abstract

Background: Surgeons often encounter patients with intestinal failure due to inadequate intestinal length ("short bowel syndrome"/SBS). Treatment in these patients remains challenging and the process of physiologic adaptation may take years to complete, which frequently requires parenteral nutrition. We propose a proof-of-concept mechanical bowel elongation approach using a self-expanding prototype of an intestinal expansion sleeve (IES) for use in SBS to accelerate the adaptation process.

Methods: IESs were deployed in the small intestines of Sprague Dawley rats. Mechanical characterization of these prototypes was performed. IES length-tension relationships and post-implant bowel expansion were measured ex vivo. Bowel histology before and after implantation was evaluated.

Results: IES mechanical studies demonstrated decreasing expansive force with elongation. The deployment of IES devices produced an immediate 21 ± 8% increase in bowel length (p < 0.001, n = 11). Mechanical load testing data showed that the IESs expressed maximum expansive forces at 50% compression of the initial pre-contracted length. The small-intestine failure load in the rats was 1.88 ± 21 N. Intestinal histology post deployment of the IES showed significant expansive changes compared to unstretched bowel tissue.

Conclusions: IES devices were scalable to the rat intestinal model in our study. The failure load of the rat small intestine was many times higher than the force exerted by the contraction of the IES. Histology demonstrated preservation of intestinal structure with some mucosal erosion. Future in vivo rat studies on distraction enterogenesis with this IES should help to define this organogenesis phenomenon.

Keywords: distraction enterogenesis; intestinal elongation; intestinal expansion sleeve; necrotizing enterocolitis; short bowel syndrome.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of this study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1

IES device with angled (left) and sealed (right) ends measured to a 30 mm nominal length.

Figure 2
Figure 2

Mechanical characterization of IES device at i.l. (left) and 50% compressed (right).

Figure 3
Figure 3

Mechanical characterization of native small intestine, measuring the expansive force required to produce intestinal failure.

Figure 4
Figure 4

IESs inserted and sutured in the pre-deployment contracted state (a) and the post-deployment state (b).

Figure 5
Figure 5

Histological analysis of rat intestinal tissue. (A) Control tissue; (B,C) stretched tissue after IES deployment, demonstrating significant thinning of the muscularis and residual mucosa.

Figure 6
Figure 6

Potential deployment strategy for future in vivo IES implantation.

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