Biomechanical properties of the stomach: A comprehensive comparative analysis of human and porcine gastric tissue

Experimental and numerical study of solid needle insertions into human stomach tissue

PURPOSE

Oral drug delivery is the Holy Grail in the field of drug delivery. However, poor bioavailability limits the oral intake of macromolecular drugs. Oral devices may overcome this limitation, but a knowledge gap exists on the device-tissue interaction. This study focuses on needle insertion into the human stomach experimentally and numerically. This will guide early stages of device development.

METHODS

Needle insertions were done into excised human gastric tissue with sharp and blunt needles at velocities of 0.0001 and 0.1 m/s. Parameters for constitutive models were determined from tensile visco-hyperelastic biomechanical tests. The computational setup modeled four different needle shape indentations at five velocities from 0.0001 to 5 m/s.

RESULTS

From experiments, peak forces at 0.1 and 0.0001 m/s were 0.995 ± 0.296 N and 1.281 ± 0.670 N (blunt needle) and 0.325 ± 0.235 N and 0.362 ± 0.119 N (sharp needle). The needle geometry significantly influenced peak forces (p < 0.05). A Yeoh-Prony series combination was fitted to the tensile visco-hyperelastic biomechanical data and used for the numerical model with excellent fit (R2 = 0.973). Both needle geometry and insertion velocity influenced the stress contour and displacement magnitudes as well as energy curves.

CONCLUSION

This study contributes to a better understanding of needle insertion into the stomach wall. The numerical model demonstrated agreement with experimental data providing a good approach to early device iterations. Findings in this study showed that insertion velocity and needle shape affect tissue mechanical outcomes.

Implications of compressive loading of the stomach wall: Interplay between mechanical deformation and microstructure

During gastric surgery, the stomach wall is compressed with clamps and sutures or staple lines. These short- and long-term deformations can severely compromise the integrity of the tissue and make it difficult for the stomach wall to respond and remodel to the new loading conditions. Consequently, serious intra- and postoperative complications such as the formation of leaks during bariatric surgeries, can be associated with these immense tissue deformations. Hence, the study aimed to investigate the effects of compressive loading of the stomach wall in the radial direction. This was done by macroscopic mechanical loading of the stomach wall in each region of the stomach and evaluating the microstructural changes inflicted in the tissue. For this purpose, several imaging techniques were used, i.e., a histological analysis, second-harmonic generation microscopy, and X-ray micro-computed tomography. The combination of these three methods allowed us to investigate the gradual compression of the different stomach layers as well as the local reorientation and deformation of the main microstructural components, e.g., collagen fibers and muscle bundles. Importantly, this study found that the collagen bundles in the stomach wall straighten and reorient toward the circumferential-longitudinal plane and partially fan out with increased radial compressive deformation. The 3D scans of the stomach wall indicated a deterioration of the blood vessels and buckling of the mucosal glands due to compression. Statement of significance Unfortunately, little is known about the load transfer in the stomach wall during gastric surgery and the associated deformations on the macro- and microscale. The present study investigates the structural changes of the stomach wall, its layers and the inherent biological building blocks using histology, multi-photon microscopy, and micro-computed tomography. For the first time, the layer-specific response to stepwise radial compression of the stomach wall was studied, the related collagen fiber parameters were estimated, and a 3D sample structure was visualized. This clinically-oriented study links the structural changes within the wall to the postoperative remodel- ing process and the irreversibly altered gastric motility, thereby underscoring its relevance to the field of biomedical engineering, e.g., the development and improvement of surgical instruments.

Biomechanics of soft biological tissues and organs, mechanobiology, homeostasis and modelling

The human body consists of many different soft biological tissues that exhibit diverse microstructures and functions and experience diverse loading conditions. Yet, under many conditions, the mechanical behaviour of these tissues can be described well with similar nonlinearly elastic or inelastic constitutive relations, both in health and some diseases. Such constitutive relations are essential for performing nonlinear stress analyses, which in turn are critical for understanding physiology, pathophysiology and even clinical interventions, including surgery. Indeed, most cells within load-bearing soft tissues are highly sensitive to their local mechanical environment, which can typically be quantified using methods of continuum mechanics only after the constitutive relations are determined from appropriate data, often multi-axial. In this review, we discuss some of the many experimental findings of the structure and the mechanical response, as well as constitutive formulations for 10 representative soft tissues or organs, and present basic concepts of mechanobiology to support continuum biomechanical studies. We conclude by encouraging similar research along these lines, but also the need for models that can describe and predict evolving tissue properties under many conditions, ranging from normal development to disease progression and wound healing. An important foundation for biomechanics and mechanobiology now exists and methods for collecting detailed multi-scale data continue to progress. There is, thus, considerable opportunity for continued advancement of mechanobiology and biomechanics.

Unravelling the mechanics of gastric tissue: A comparison of constitutive models, damage probability and microstructural insights

With the increasing prevalence of obesity worldwide, bariatric surgery is becoming increasingly common. However, the mechanic of the gastric wall related to bariatric surgery complications remains to be investigated. This study aims to understand mechanical behaviour of stomach by developing advanced material laws for gastric tissue incorporating microstructure. A multi-scale characterisation of the porcine stomach wall was performed in the fundus and corpus anatomical regions and in circumferential and longitudinal orientations The protocol included uniaxial tensile testing until damage, survival analysis to provide damage probability, comparison of phenomenological (Fung and Ogden order 1, 2 and 3) and structural (Holzapfel fibre-reinforced) computational models fitted to the experimental data, and quantitative analysis of elastin and collagen fibre structure from histological slides. All constitutive models fitted the experimental data well (r2 > 0.988 and RSME<3.8 kPa). Longitudinal and circumferential elastic modulus in quasi linear phase were respectively 1.75 ± 1.2 MPa, 0.76 ± 0.35 MPa for fundus, and 2.30 ± 0.66 MPa, 1.36 ± 0.89 MPa for corpus, highlighting significant differences between orientations in fundus and corpus, with an overall softer fundus in the circumferential direction. Microstructure analysis illustrated collagen and elastin fibre orientation, dispersion and density. As microstructure appears to play an important role in stomach biomechanics, model incorporating fibre structure such as Holzapfel fibre-reinforced model, seem best suited to describe the material behaviour of the stomach wall. Future research should complement these findings with an expanded sample set in human models.

Post-correctional improvement of T2-weighted fast spin echo magnetic resonance imaging pulse sequence for detecting high intensity focused ultrasound thermal lesions

High intensity focused ultrasound (HIFU) is a non-invasive therapy that induces heat in a small, localized volume of cancerous tissue without damaging neighbouring vital structures and cells. Precise targeting and treatment monitoring is typically achieved by pairing HIFU with an imaging modality such as magnetic resonance imaging (MRI). The most commonly used MRI pulse sequence for detecting HIFU thermal lesions is the T2-weighted fast spin echo (T2W-FSE) pulse sequence as it provides good contrast between normal and coagulated tissue. The drawbacks of the T2W-FSE pulse sequence are the manifestation of ringing artifacts and the loss of spatial resolution due to the signal modulation in k-space caused by the T2 decay. The inverse Fourier transform (IFT) multiplication scheme aims to remove the signal modulation by incorporating an inverse filter, which is an inverse of the signal modulation trend present in the k-space, to reduce the effects of T2 decay and improve image quality. In this study, four inverse filters (named as regular, narrow, wide, and compound) were developed and implemented on T2W-FSE MR images of ex vivo porcine muscle tissue with HIFU induced thermal lesion using a 0.55 T benchtop MRI research system (Pure Devices, Rimpar, Germany). Offline processing and enhancement of MR images of ex vivo porcine muscle tissue with HIFU induced thermal lesion using the narrow filter yielded the largest improvements of 13.8 ± 2.5 %, 17.0 ± 2.3 %, and 14.4 ± 1.1 % in lateral and axial spatial resolutions, and lesion signal-to-noise ratio (SNR), respectively, compared to the original images. Our results indicate an amplification of the signals in k-space and a reduction in the exponential signal modulation caused by T2 decay. These results also indicate the potential of the IFT multiplication scheme as an image processing method to improve thermal lesion detectability in MR-guided HIFU procedures.

Towards the biomechanical modelling of the behaviour of ex-vivo porcine perineal tissues

The perineum is a layered soft tissue structure with mechanical properties that maintain the integrity of the pelvic floor. During childbirth, the perineum undergoes significant deformation that often results in tears of various degrees of severity. To better understand the mechanisms underlying perineal tears, it is crucial to consider the mechanical properties of the different tissues that make up the perineum. Unfortunately, there is a lack of data on the mechanical properties of the perineum in the literature. The objective of this study is to partly fill these gaps. Hence sow perineums were dissected and the five perineal tissues involved in tears were characterized by uniaxial tension tests: Skin, Vagina, External Anal Sphincter, Internal Anal Sphincter and Anal Mucosa. From our knowledge, this study is the first to investigate all these tissues and to design a testing protocol to characterize their material properties. Six material models were used to fit the experimental data and the correlation between experimental and predicted data was evaluated for comparison. As a result, even if the tissues are of different nature, the best correlation was obtained with the Yeoh and Martins material models for all tissues. Moreover, these preliminary results show the difference in stiffness between the tissues which indicates that they might have different roles in the structure. These obtained results will serve as a basis to design an improved experimental protocol for a more robust structural model of the porcine perineum that can be used for the human perineum to predict perineal tears.

Regional differences in stomach stretch during organ filling and their implications on the mechanical stress response

As part of the digestive system, the stomach plays a crucial role in the health and well-being of an organism. It produces acids and performs contractions that initiate the digestive process and begin the break-up of ingested food. Therefore, its mechanical properties are of interest. This study includes a detailed investigation of strains in the porcine stomach wall during passive organ filling. In addition, the observed strains were applied to tissue samples subjected to biaxial tensile tests. The results show inhomogeneous strains during filling, which tend to be higher in the circumferential direction (antrum: 13.2%, corpus: 22.0%, fundus: 67.8%), compared to the longitudinal direction (antrum: 4.8%, corpus: 24.7%, fundus: 50.0%) at a maximum filling of 3500 ml. Consequently, the fundus region experienced the greatest strain. In the biaxial tensile experiments, the corpus region appeared to be the stiffest, reaching nominal stress values above 400 kPa in the circumferential direction, whereas the other regions only reached stress levels of below 50 kPa in both directions for the investigated stretch range. Our findings gain new insight into stomach mechanics and provide valuable data for the development and validation of computational stomach models.

Comparison of the Biomechanical Properties between Healthy and Whole Human and Porcine Stomachs

Gastric cancer poses a societal and economic burden, prompting an exploration into the development of materials suitable for gastric reconstruction. However, there is a dearth of studies on the mechanical properties of porcine and human stomachs. Therefore, this study was conducted to elucidate their mechanical properties, focusing on interspecies correlations. Stress relaxation and tensile tests assessed the hyperelastic and viscoelastic characteristics of porcine and human stomachs. The thickness, stress-strain curve, elastic modulus, and stress relaxation were assessed. Porcine stomachs were significantly thicker than human stomachs. The stiffness contrast between porcine and human stomachs was evident. Porcine stomachs demonstrated varying elastic modulus values, with the highest in the longitudinal mucosa layer of the corpus and the lowest in the longitudinal intact layer of the fundus. In human stomachs, the elastic modulus of the longitudinal muscular layer of the antrum was the highest, whereas that of the circumferential muscularis layer of the corpus was the lowest. The degree of stress relaxation was higher in human stomachs than in porcine stomachs. This study comprehensively elucidated the differences between porcine and human stomachs attributable to variations across different regions and tissue layers, providing essential biomechanical support for subsequent studies in this field.

Biomechanical characterization of the passive porcine stomach

The complex mechanics of the gastric wall facilitates the main digestive tasks of the stomach. However, the interplay between the mechanical properties of the stomach, its microstructure, and its vital functions is not yet fully understood. Importantly, the pig animal model is widely used in biomedical research for preliminary or ethically prohibited studies of the human digestion system. Therefore, this study aims to thoroughly characterize the mechanical behavior and microstructure of the porcine stomach. For this purpose, multiple quasi-static mechanical tests were carried out with three different loading modes, i.e., planar biaxial extension, radial compression, and simple shear. Stress-relaxation tests complemented the quasi-static experiments to evaluate the deformation and strain-dependent viscoelastic properties. Each experiment was conducted on specimens of the complete stomach wall and two separate layers, mucosa and muscularis, from each of the three gastric regions, i.e., fundus, body, and antrum. The significant preconditioning effects and the considerable regional and layer-specific differences in the tissue response were analyzed. Furthermore, the mechanical experiments were complemented with histology to examine the influence of the microstructural composition on the macrostructural mechanical response and vice versa. Importantly, the shear tests showed lower stresses in the complete wall compared to the single layers which the loose network of submucosal collagen might explain. Also, the stratum arrangement of the muscularis might explain mechanical anisotropy during tensile tests. This study shows that gastric tissue is characterized by a highly heterogeneous microstructure with regional variations in layer composition reflecting not only functional differences but also diverse mechanical behavior. STATEMENT OF SIGNIFICANCE: Unfortunately, only few experimental data on gastric tissue are available for an adequate material parameter and model estimation. The present study therefore combines layer- and region-specific stomach wall mechanics obtained under multiple loading conditions with histological insights into the heterogeneous microstructure. On the one hand, the extensive data sets of this study expand our understanding of the interplay between gastric mechanics, motility and functionality, which could help to identify and treat associated pathologies. On the other hand, such data sets are of high relevance for the constitutive modeling of stomach tissue, and its application in the field of medical engineering, e.g., in the development of surgical staplers and the improvement of bariatric surgical interventions.