Intestinal retentive systems - recent advances and emerging approaches

Intestinal retentive devices (IRDs) are devices designed to anchor within the lumen of the intestines for long-term residence in the gastrointestinal tract. IRDs can enable impactful medical device technologies including sustained oral drug delivery systems, indwelling sensors, or real-time diagnostics. The design and testing of IRDs present a myriad of challenges, including precise deployment of the device at desired intestinal locations, secure anchoring within the gastrointestinal tract to allow for natural function, and safe removal of the IRD at user-defined times. Advancing the state-of-the-art of IRD is an interdisciplinary effort that requires innovations such as new materials, novel anchoring mechanisms, and medical device design with consistent input from clinical practitioners and end-users. This perspective briefly reviews the current state-of-the-art for IRDs and charts a path forward to inform the design of future concepts. Specifically, this article will highlight materials, retention mechanisms, and test beds to measure the efficacy of IRDs and their mechanisms. Finally, potential synergies between IRD and other medical device technologies are presented to identify future opportunities.

Intravascular placement and migration of a colonic stent into the inferior mesenteric vein

Colonic self-expanding metal stents (SEMSs) are commonly used to treat large bowel obstruction due to gastrointestinal malignancy with great success. While mortality is negligible, morbidity from both early and late complications can be significant. Stent perforation, erosion and migration are the most feared complications. We present the first reported case of wire-associated colon perforation with placement and migration of an SEMS into the inferior mesenteric vein (IMV). A man in his early 60s presented with a large bowel obstruction due to a colorectal mass. He underwent endoscopic colonic SEMS placement for colonic decompression. The stent was later found to be within the IMV, requiring a colon resection and retrieval of the stent.

Case Report of Surgical Management of Duodenal Perforation Secondary to Stent in a Patient With Gastric Outlet Obstruction Due to a Rare Neuroendocrine Adenocarcinoma of Duodenum

Neuroendocrine adenocarcinomas of the duodenum comprise a rare subset of neuroendocrine tumors and commonly present with symptoms of gastric outlet obstruction (GOO). Most of the time, patients are recommended a GI bypass in the setting of metastatic disease. In a small subset of patients who prefer a non-operative approach or are poor surgical candidates, duodenal stenting can often accomplish similar results as surgery. However, duodenal stenting is associated with numerous complications, including duodenal stent migration and, less commonly, duodenal perforation. We present a case where duodenal stenting resulted in a perforation of the second portion of the duodenum that ultimately required a definitive pancreaticoduodenectomy.