For most patients, weight-loss surgery marks the beginning of recovery.
For a small few, however, a leak can develop where the stomach has been cut or joined, allowing fluid to escape into the abdomen and form a life-threatening abscess.
Doctors typically drain these abscesses using small plastic stents threaded through the stomach. Yet the devices they rely on were originally developed to drain the bile ducts, leaving clinicians to adapt them to an anatomy and medical problem they were never designed to treat.
At NYU Abu Dhabi, Research Assistant Parima Phowarasoontorn is working on an alternative. In the Ramadi Lab, she has helped develop new gastric stents specifically for these leaks, including a 3D-printed biodegradable device that could improve drainage and eliminate the need for patients to return for removal.
For Phowarasoontorn, the stakes behind the engineering are clear.
“If you don’t drain it, it will just keep getting infected,” she says. “Then you can face a systemic infection or even sepsis, which can be deadly.”
The move into medical engineering
Phowarasoontorn grew up in Bangkok, Thailand, and came to NYUAD as an undergraduate, studying mechanical engineering while developing an increasing interest in medical devices.
That interest became more concrete during her senior Capstone project, when she explored an alternative method for reconnecting sections of the intestine after colorectal surgery. The project brought her to the Ramadi Lab and introduced her to medical device research in a laboratory setting.
“I spent a year looking into medical devices in a deeper, more analytical, and experimental way,” she says. “I really enjoyed the work.”
After graduating in 2023, she stayed at NYUAD as a research assistant, drawn particularly to translational research and the possibility that something developed at the lab bench could ultimately reach clinical care.
Building a better gastric stent using real life examples
Her current research began with clinicians at Cleveland Clinic Abu Dhabi, who highlighted the limitations of the current stents used to treat gastric leaks after bariatric surgery.
Known as double-pigtail stents, the devices were originally developed to drain the biliary system, which carries bile from the liver and gallbladder. When used for gastric leaks, they can move out of position or drain inefficiently, and patients must undergo another procedure to have them removed.
It was exactly the kind of practical medical problem that interested Phowarasoontorn.
“They come to us with problems they are seeing firsthand with the devices they use every day,” she says. “That means we’re not solving a hypothetical problem. We’re working on something that could make a real difference.”
Designing the stent
The team’s first approach used PETALS, or Personalized Endoscopic Transmural Abscess Leak Solution, a design framework that led to the development of the Lily stent. Its six-part, flower-like cross-section creates more space between the device and surrounding tissue, allowing fluid to move around it more efficiently.
The team then developed BRIDGE, or Biodegradable aRchitected Internal DrainaGE. Made using advanced 3D printing, its intricate internal lattice improves fluid flow while allowing the stent to bend through complex anatomy without kinking.
Laboratory testing found that BRIDGE could more than double drainage performance compared with conventional stents. The team is now working with biodegradable materials so that after the leak has healed, the device could gradually break down inside the body.
For patients, that could mean a less burdensome course of treatment, with faster drainage potentially reducing the need for repeat procedures. Once healing is complete, the biodegradable stent could also remove the need for a final procedure to retrieve it.
Further testing is required before BRIDGE can move toward clinical use, but the same engineering approach could eventually be applied to drainage devices elsewhere in the body.
Patient first approach
That wider possibility is where Phowarasoontorn sees her research heading. She wants to continue working closely with clinicians to identify shortcomings in existing medical devices and develop solutions around the anatomy and needs of the people who depend on them.
Translating a promising device from the laboratory into clinical care can take years, but Phowarasoontorn is motivated by the possibility of seeing that work eventually reach patients.
“There are a lot of problems like these,” she says. “Different parts of the body require so many vastly different things.”
Each presents another opportunity to make treatment more effective and reduce the number of procedures a patient must endure.
“A lot of medicine is very much, ‘We have this. We just use it the best way we can,” Phowarasoontorn says. “With the tools we have today, we can do better than that, and for patients, that really matters.”
