Extracellular matrices for gastrointestinal surgery: Ex vivo testing and current applications

Table 1 Extracellular matrix degradation ultrastructural grading system

Characteristic	Resistance→Degradation
	Score 0	Score 1	Score 2	Score 3
Porosity	No change	Light increase	Distinct increase	Strong increase
Surface fibrillar arrangement	No change	Light alteration	Distinct alteration	Native arrangement not recognizable
Erosion of matrix surface	No change	Light surface erosion	Distinct surface erosion	Native surface structure not recognizable

Original materials incubated for 60 min in phosphate buffered saline were used as reference.

Table 2 Degradation time with phosphate buffered saline, bile and pancreatic juice

	PBS	Bile	Pancreatic juice1
SIS 4-layer	> 60	> 60	> 60
SIS 1-layer	> 60	> 60	> 60
PDM	40	2	4
PPM	> 60	> 60	> 60
BPM	> 60	> 60	> 60

Degradation time is given in days. Incubation was performed at 37°C for 60 d.

¹Enzyme concentration: amylase 86 040 U/L; lipase 210 630 U/L. PBS: Phosphate buffered saline; SIS: Small-intestinal submucosa; PDM: Porcine dermal matrix; PPM: Porcine pericardial matrix; BPM: Bovine pericardial matrix.

Table 3 Mechanical resistance of the biomaterials after incubation in phosphate buffered saline, bile or pancreatic juice (mean ± SE)

	PBS		Bile		Pancreatic juice
	24 h	14 d	24 h	14 d	24 h	14 d
SIS 4-layer	31.40 ± 4.3	26.03 ± 3.2	13.70 ± 0.9	4.01 ± 0.3	30.20 ± 1.0	14.27 ± 0.6
SIS 1-layer	4.56 ± 1.2	3.42 ± 0.4	3.60 ± 1.6	1.96 ± 0.2	2.56 ± 0.4	2.59 ± 0.4
PDM	1.05 ± 0.2	0.74 ± 0.1	0.81 ± 0.1	Dissolved	0.97 ± 0.1	Dissolved
PPM	19.03 ± 2.9	13.8 ± 4.9	10.45 ± 1.4	2.08 ± 0.6	21.95 ± 7.2	5.23 ± 1.3
BPM	27.13 ± 7.3	31.07 ± 5.2	10.34 ± 1.3	1.48 ± 0.3	30.07 ± 2.2	7.89 ± 1.8

Experiments were carried out in triplicate. PBS: Phosphate buffered saline; SIS: Small-intestinal submucosa; PDM: Porcine dermal matrix; PPM: Porcine pericardial matrix; BPM: Bovine pericardial matrix.

Table 4 Ultrastructural alteration of extracellular matrices incubated in human bile and human pancreatic juice

	Bile				Pancreatic juice1
	Porosity	Surface fibrillar arrangement	Erosion of matrix surface	Σ	Porosity	Surface fibrillar arrangement	Erosion of matrix surface	Σ
SIS 4-layer	3	2	3	8	2	1	1	4
SIS 1-layer	3	2	3	8	2	1	1	4
PPM	1	3	1	5	1	3	3	7
BPM	0	2	2	4	1	2	1	4

Incubation was performed at 37°C for 7 d.

¹Enzyme concentration: amylase 86 040 U/L; lipase 210 630 U/L. SIS: Small-intestinal submucosa; PPM: Porcine pericardial matrix; BPM: Bovine pericardial matrix.

Table 5 Structural regeneration in experimental application of small-intestinal submucosa in the alimentary tract

Autor	Location	Model	Structural regeneration
			Mucosa	Muscularis	Nerve
Badylak et al[4]	Esophagus	Dog	+	+	NR
Lopes et al[11]	Esophagus	Rat	+	+	+
de la Fuente et al[3]	Stomach	Rat	(+)	-	-
Ueno et al[6]	Stomach	Rat	+	+	+
Rosen et al[1]	Bile duct	Dog	+	-	NR
De Ugarte et al[9]	Duodenum	Rat	(+)	-	NR
Souza Filho et al[8]	Duodenum	Dog	(+)	-	NR
Demirbilek et al[12]	Jejunum	Rabbit	+	-	NR
Chen et al[2]	Small bowel	Dog	+	+	NR
Ansaloni et al[10]	Ileum (isolated loop)	Rat	+	+	+
Wang et al[13]	Ileum	Rat	+	(+)	NR
Ueno et al[5]	Ceacum	Rat	+	+	+
Hoeppner et al[7]	Colon	Pig	(+)	(+)	-

+: Complete regeneration; (+): Partial/marginal regeneration; -: Missing regeneration; NR: Not reported.