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Liu S, Luan Z, Wang T, Xu K, Luo Q, Ye S, Wang W, Dan R, Shu Z, Huang Y, Mequanint K, Fan C, Xing M, Yang S. Endoscopy Deliverable and Mushroom-Cap-Inspired Hyperboloid-Shaped Drug-Laden Bioadhesive Hydrogel for Stomach Perforation Repair. ACS NANO 2023; 17:111-126. [PMID: 36343209 DOI: 10.1021/acsnano.2c05247] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Gastrointestinal tract perforation is a full-thickness injury that causes bleeding and fatal infection of the peritoneum. This condition worsens in an acidic gastric environment which interferes with the normal coagulation cascade. Current endoscopic clips to repair gastric perforations are ineffective, and metal or plastic occluders need secondary surgery to remove them. Herein, we report a self-expandable, endoscopy deliverable, adhesive hydrogel to block gastric perforation. We found the nanosilica coating significantly enhanced the adhesive strength even under a simulated strong acidic stomach environment. The developed device was disulfide cross-linked for the reducible degraded gel. By loading with vonoprazan fumarate (VF) and acidic fibroblast growth factor (AFGF), the hyperboloid-shaped device can have a sustained drug release to regulate intragastric pH and promote wound healing. The gel device can be compressed and then expanded like a mushroom when applied in an acute gastric perforation model in both rabbits and minipigs. By utilizing a stomach capsule robot for remotely monitoring the pH and by immunohistochemical analysis, we demonstrated that the compressible hyperboloid-shaped gel could stably block the perforation and promoted wound healing during the 28 days of observation. The real-time pH meter demonstrated that the gel could control intragastric pH above 4 for nearly 60 h to prevent bleeding.
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Affiliation(s)
- Shuang Liu
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
| | - Zhaohui Luan
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
| | - Tongchuan Wang
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
| | - Kaige Xu
- Departments of Mechanical Engineering, University of Manitoba, Winnipeg, ManitobaR3T 2N2, Canada
| | - Qiang Luo
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
| | - Shaosong Ye
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
| | - Wei Wang
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
| | - Ruijue Dan
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
| | - Zhenzhen Shu
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
| | - Yu Huang
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
| | - Kibret Mequanint
- Department of Chemical and Biochemical Engineering, and School of Biomedical Engineering, The University of Western Ontario, London, OntarioN6A 5B9, Canada
| | - Chaoqiang Fan
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
- Chongqing Municipality Clinical Research Center for Gastroenterology, Chongqing400037, China
| | - Malcolm Xing
- Departments of Mechanical Engineering, University of Manitoba, Winnipeg, ManitobaR3T 2N2, Canada
| | - Shiming Yang
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing400037, China
- Chongqing Municipality Clinical Research Center for Gastroenterology, Chongqing400037, China
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Yurttas C, Thiel C, Wichmann D, Horvath P, Strohäker J, Bongers MN, Schenk M, Stüker D, Königsrainer A, Thiel K. Retrospective analysis of different therapeutic approaches for retroperitoneal duodenal perforations. Sci Rep 2022; 12:10243. [PMID: 35715523 PMCID: PMC9205956 DOI: 10.1038/s41598-022-14278-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 05/17/2022] [Indexed: 11/24/2022] Open
Abstract
Surgical therapy of duodenal perforation into the retroperitoneum entails high morbidity. Conservative treatment and endoscopic negative pressure therapy have been suggested as promising therapeutic alternatives. We aimed to retrospectively assess outcomes of patients treated for duodenal perforation to the retroperitoneum at our department. A retrospective analysis of all patients that were treated for duodenal perforation to the retroperitoneum at our institution between 2010 and 2021 was conducted. Different therapeutic approaches with associated complications within 30 days, length of in-hospital stay, number of readmissions and necessity of parenteral nutrition were assessed. We included thirteen patients in our final analysis. Six patients underwent surgery, five patients were treated conservatively and two patients received interventional treatment by endoscopic negative pressure therapy. Length of stay was shorter in patients treated conservatively. One patient following conservative and surgical treatment each was readmitted to hospital within 30 days after initial therapy whereas no readmissions after interventional treatment occurred. There was no failure of therapy in patients treated without surgery whereas four (66.7%) of six patients required revision surgery following primary surgical therapy. Conservative and interventional treatment were associated with fewer complications than surgical therapy which involves high morbidity. Conservative and interventional treatment using endoscopic negative pressure therapy in selected patients might constitute appropriate therapeutic alternatives for duodenal perforations to the retroperitoneum.
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Affiliation(s)
- Can Yurttas
- Department of General, Visceral and Transplant Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Christian Thiel
- Department of General, Visceral and Transplant Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Dörte Wichmann
- Department of General, Visceral and Transplant Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Philipp Horvath
- Department of General, Visceral and Transplant Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Jens Strohäker
- Department of General, Visceral and Transplant Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Malte Niklas Bongers
- Department for Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Martin Schenk
- Department of General, Visceral and Transplant Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Dietmar Stüker
- Department of General, Visceral and Transplant Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Karolin Thiel
- Department of General, Visceral and Transplant Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
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Abbitt D, Barnes AL, Hammad HT, Reveille RM, Jones EL. Endoluminal vacuum closure of a duodenal perforation. J Surg Case Rep 2021; 2021:rjab479. [PMID: 34754414 DOI: 10.1093/jscr/rjab479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Perforation is a known complication of endoscopic resection and has been managed with endoscopic defect closure, antibiotics and close observation. Closure of duodenal perforations are more challenging due to the presence of gastric and pancreaticobiliary secretions. The use of endoluminal vacuum therapy (EVT) to divert flow and aid closure is increasingly prevalent and may avoid high-risk surgery. We describe the use of endoluminal vacuum closure to salvage an iatrogenic duodenal perforation in a 57-year-old male who underwent an endoscopic mucosal resection of a 35-mm polypoid lesion on the posterior wall of the second portion of the duodenum. The endoluminal wound vac successfully controlled leakage and allowed defect closure. EVT is an emerging technique that can effectively manage complicated injuries throughout the GI tract and may allow enhanced recovery by avoiding surgical salvage and its associated morbidity and mortality.
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Affiliation(s)
- Danielle Abbitt
- Department of GI, Trauma and Endocrine Surgery, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Hazem T Hammad
- Division of Gastroenterology, Department of Medicine, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - R Matthew Reveille
- Division of Gastroenterology, Department of Medicine, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Edward L Jones
- Department of GI, Trauma and Endocrine Surgery, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Jung AL, Park SW, Hong GY, Moon HC, Eun SJ. Endoscopic Full-Thickness Resection for Gastric Subepithelial Lesions Arising from the Muscularis Propria. Clin Endosc 2020; 54:131-135. [PMID: 32819051 PMCID: PMC7939773 DOI: 10.5946/ce.2020.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/21/2020] [Indexed: 12/17/2022] Open
Abstract
Most cases of gastric subepithelial lesions follow a good clinical course; however, some lesions progress to malignant tumors, and treatment of tumors with a high risk of malignancy is essential. Surgical excision has been the primary treatment for tumors originating from the propria muscle layer, but it has the disadvantages of being invasive and causing postoperative functional abnormalities. With the development of endoscopic techniques and instruments, the role of endoscopic resection, which is a less invasive method for the removal of gastric subepithelial lesions, has been attracting attention. We performed an endoscopic full-thickness resection for 8 patients with gastric subepithelial lesions originating from the muscularis propria. No fatal complications occurred. Our findings suggest the need to develop various devices for resection and closure and to accumulate further experience through additional studies to prevent complications and specimen loss.
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Affiliation(s)
- Ah Lon Jung
- Division of Gastroenterology, Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Sang Wook Park
- Division of Gastroenterology, Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Gun Young Hong
- Division of Gastroenterology, Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Hyeong Chul Moon
- Division of Gastroenterology, Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Seo Joon Eun
- Division of Gastroenterology, Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
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5
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Wu PH, Chen JH, Chu KE. Successful Endoscopic Management of Double Iatrogenic Perforations Induced by Endoscopic Retrograde Cholangiopancreatography and Computed Tomography-Guided Colon Drainage. Case Rep Gastroenterol 2019; 13:1-5. [PMID: 30792616 PMCID: PMC6381880 DOI: 10.1159/000495245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/08/2018] [Indexed: 02/02/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is a high-risk procedure with a significantly high rate of complications, such as pancreatitis, bleeding, perforation, and infection. Pancreatitis is the most common post-ERCP complication with an incidence of approximately 3.5%. Although perforation is a rare complication with an incidence of 0.1–0.6%, it may be associated with a high rate of mortality of 1.0–1.5%. Here, we report a rare case of ERCP-induced double iatrogenic perforations in the duodenum and colon complicated by an intra-abdominal abscess. The post-ERCP perforation was successfully sealed using fibrin glue (Tisseel). The intra-abdominal abscess was treated with a computed tomography-guided pigtail drainage; however, the pigtail spontaneously migrated and perforated the ascending colon. The pigtail was removed, and closure of the colon perforation was successfully achieved with endoscopic clipping. Tisseel spray can be a treatment option for post-ERCP perforations. Careful consideration of procedural complications, early detection of perforations, and prompt treatment can be life-saving.
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Affiliation(s)
- Ping-Hsiu Wu
- Division of Hepatology and Gastroenterology, Departments of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Jui-Hao Chen
- Division of Hepatology and Gastroenterology, Departments of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Kuang-En Chu
- Division of Hepatology and Gastroenterology, Departments of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Fockens P. Endoscopic Management of Perforations in the Gastrointestinal Tract. Gastroenterol Hepatol (N Y) 2016; 12:641-643. [PMID: 27917080 PMCID: PMC5114508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Paul Fockens
- Professor and Chairman Department of Gastroenterology and Hepatology Academic Medical Center University of Amsterdam Amsterdam, The Netherlands
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7
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Loske G, Schorsch T, Müller CT. Endoscopic Vacuum Therapy Was Omitted. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:539. [PMID: 27581507 DOI: 10.3238/arztebl.2016.0539a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Schmidt A, Caca K. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:539-540. [PMID: 27581508 PMCID: PMC5012165 DOI: 10.3238/arztebl.2016.0539b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Arthur Schmidt
- *Klinik für Innere Medizin, Gastroenterologie, Hämato-Onkologie, Diabetologie und Infektiologie, Klinikum Ludwigsburg,
| | - Karel Caca
- *Klinik für Innere Medizin, Gastroenterologie, Hämato-Onkologie, Diabetologie und Infektiologie, Klinikum Ludwigsburg,
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Mayerle J, Greinacher A. Interventional Endoscopy--Opportunities and Limitations. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:119-20. [PMID: 26976711 DOI: 10.3238/arztebl.2016.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Julia Mayerle
- Department of Internal Medicine A, University Medicine Greifswald, Ernst-Moritz-Arndt University of Greifswald, Department of Transfusion Medicine, Institute for Immunology and Transfusion Medicine, University Medicine Greifswald, Ernst-Moritz-Arndt University of Greifswald
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