Distraction enterogenesis

Abstract

Distraction enterogenesis is a novel approach for treating short bowel syndrome by addressing the fundamental anatomic defect in this disease - the lack of functional intestinal surface area. It employs mechanotransduction, wherein mechanical force activates cellular mechanisms regulating growth. Several approaches have been demonstrated in animal models: devices with mucosal versus serosal force application, blind-end versus in-continuity intestinal attachments, and single payout versus multiple payout devices. While no approach has achieved clinical utility to date, they all achieve durable increases in functional intestinal length via the application of longitudinal distractive force. An endoluminal, in-continuity- multiple payout approach may prove clinically practical by providing a balance of minimal morbidity while achieving effective enterogenesis, with gains of over 40 % after 7 days of distraction in a large animal model. With further refinements and clinical testing, distraction enterogenesis may provide a device-based therapy for select patients with short bowel syndrome.