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Distraction Enterogenesis

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Current Concepts of Intestinal Failure

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.

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Abbreviations

DFM:

Dilating fenestrated elastic mask

ERK:

Extracellular signal-related kinase

FAK:

Focal adhesion kinase

GLP-2:

Glucagon-like peptide 2

IGF:

Insulin-like growth factor

MAPK:

Mitogen-activated protein kinase

PN:

Parenteral nutrition

PU:

Perfusion unit

SBS:

Short bowel syndrome

SEMS:

Self-expanding metal stents

STEP:

Serial transverse enteroplasty

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Conflicts of Interest

The authors declare no conflicts of interest.

Author information

Authors and Affiliations

  1. Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    Farokh R. Demehri MD & Daniel H. Teitelbaum MD

  2. Section of Pediatric Surgery, Mott Children’s Hospital, University of Michigan, 1540 E. Hospital Dr., SPC 4211, Ann Arbor, MI, 48109-4211, USA

    Daniel H. Teitelbaum MD

Authors
  1. Farokh R. Demehri MD
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  2. Daniel H. Teitelbaum MD
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Correspondence to Daniel H. Teitelbaum MD .

Editor information

Editors and Affiliations

  1. Children's Hospital, Helsinki University Central Hospital, HUS Helsinki, Finland

    Risto J. Rintala

  2. Children's Hospital, Helsinki University Central Hospital, HUS Helsinki, Finland

    Mikko Pakarinen

  3. Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden

    Tomas Wester

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Demehri, F.R., Teitelbaum, D.H. (2016). Distraction Enterogenesis. In: Rintala, R., Pakarinen, M., Wester, T. (eds) Current Concepts of Intestinal Failure. Springer, Cham. https://doi.org/10.1007/978-3-319-42551-1_13

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  • DOI: https://doi.org/10.1007/978-3-319-42551-1_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42549-8

  • Online ISBN: 978-3-319-42551-1

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