Enhanced Endoscopic Internal Drainage of Gastric Abscess Through Additively Manufactured Stents.

Abstract

Postoperative gastric leaks (GL), a serious complication of bariatric surgery, are often managed by endoscopic internal drainage using biliary double-pigtail stents (DPS). However, conventional extruded thermoplastic (e.g., polyethylene, polyurethane, and polytetrafluoroethylene) stents often provide inadequate drainage, suboptimal anatomical conformity, and are prone to migration, collectively hindering patient recovery and contributing to an adverse event rate of 13.8%. To address these limitations, we developed PETALS (Personalized Endoscopic Transmural Abscess Leak Solution), an analytical framework for the optimization of stent designs dedicated to transmural fluid drainage. We identified stent length and diameter as critical geometric parameters influencing fluid dynamics. Using PETALS, we designed a family of stents with longitudinal fins fabricated by stereolithography (SLA) using Formlabs Flexible 80A resin. The Lily design, a six-segment PETALS construct, achieved a 32% reduction in hydraulic resistance and a 30% increase in flow rate compared with a commercial DPS in a benchtop GL model, while also exhibiting superior flexibility. PETALS thus enables the fabrication of patient-specific, additively manufactured stents with increased flow rate, potentially reducing complications and shortening hospitalization.