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Updated: Feb 8, 2026
Ex Vivo Intestinal Sacs to Assess Mucosal Permeability in Models of Gastrointestinal Disease
Published on: February 9, 2016
Initial Assessment of Mucosal Capture and Leak Pressure After Gastrointestinal Stapling in a Porcine Model
Suzanne E Thompson1, Maggie T Young1, Michelle T Lewis1
1Ethicon, Inc., 4545 Creek Rd, Cincinnati, OH, 45242, USA.
Background:
Anastomotic leak is a leading cause of morbidity and mortality in gastrointestinal surgery. The serosal aspect of staple lines is commonly observed for integrity, but the mucosal surface and state of mucosa after firing is less often inspected. We sought to assess the degree of mucosal capture when using stapling devices and determine whether incomplete capture influences staple line integrity.
Methods:
Porcine ileum was transected in vivo and staple lines were collected and rated for degree of mucosal capture on a 5-point scale from 1 (mucosa mainly captured on both sides) to 5 (majority of mucosa not captured). Mucosal capture was also assessed in ex vivo staple lines, and fluid leakage pressure and location of first leak was assessed. Stapling devices studied were Echelon Flex GST with 60-mm blue (GST60B) and green (GST60G) cartridges, and Medtronic EndoGIA Universal with Tri-Staple Technology™ with 60 mm medium (EGIA60AMT) reloads (purple).
Results:
GST60B and GST60G staple lines produced significantly better mucosal capture scores than the EGIA60AMT staple lines (p < 0.001, in all tests). Compared to EGIA60AMT, leak pressures were 39% higher for GST60B (p < 0.001) and 23% higher for GST60G (p = 0.022). Initial staple line leak site was associated with incomplete mucosal capture 78% of the time.
Conclusions:
There are differences in degree of mucosal capture between commercial staplers, and the devices that produce better mucosal capture had significantly higher leak pressures. Further research is needed to determine the significance of these findings on staple line healing throughout the postoperative period.
Insights
Gastrointestinal stapling devices differ in how well they capture tissue. Devices with better tissue capture showed higher leak pressures, suggesting improved staple line integrity for reducing anastomotic leaks.
Area of Science:
- Gastrointestinal surgery
- Surgical device technology
- Wound healing
Background:
- Anastomotic leak is a major complication in gastrointestinal surgery.
- Assessing staple line integrity typically focuses on the serosal aspect, neglecting mucosal capture.
- Incomplete mucosal capture may compromise staple line integrity.
Purpose of the Study:
- To evaluate the degree of mucosal capture by different surgical stapling devices.
- To determine if incomplete mucosal capture impacts staple line integrity and leak pressure.
Main Methods:
- Porcine ileum was used for in vivo and ex vivo analysis of staple lines.
- Mucosal capture was rated on a 5-point scale.
- Leak pressure and leak site were assessed for Echelon Flex GST (GST60B, GST60G) and Medtronic EndoGIA Universal (EGIA60AMT) devices.
Main Results:
- Echelon Flex GST devices demonstrated significantly better mucosal capture than the Medtronic EndoGIA Universal device (p < 0.001).
- Staple lines from GST devices exhibited higher leak pressures (39% for GST60B, 23% for GST60G) compared to EGIA60AMT.
- Incomplete mucosal capture was associated with the initial staple line leak site in 78% of cases.
Conclusions:
- Significant differences exist in mucosal capture among commercial surgical staplers.
- Enhanced mucosal capture correlates with increased staple line leak pressures.
- Further investigation is required to understand the long-term impact on staple line healing.
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