Patent Publication Number: US-11638594-B2

Title: Replaceable inner tube

Description:
RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 16/065,807 filed on Jun. 24, 2018, now U.S. Pat. No. 10,702,304, which is a National Phase of PCT Patent Application No. PCT/IL2016/051377 having International Filing Date of Dec. 23, 2016, which claims the benefit of priority under 35 USC § 119(e) of U.S. Provisional Patent Application No. 62/356,482 filed on Jun. 29, 2016. PCT Patent Application No. PCT/IL2016/051377 is also a Continuation-in-Part (CIP) of PCT Patent Application No. PCT/IL2015/051252 having International Filing Date of Dec. 23, 2015, which claims the benefit of priority under 35 USC § 119(e) of U.S. Provisional Patent Application No. 62/095,986 filed on Dec. 23, 2014. 
     The contents of the above applications are all incorporated by reference as if fully set forth herein in their entirety. 
    
    
     FIELD AND BACKGROUND OF THE INVENTION 
     The present invention, in some embodiments thereof, relates to port devices and procedures and, more particularly, but not exclusively, to devices and procedures for percutaneous endoscopic gastronomy (PEG). 
     U.S. Pat. No. 7,582,072 discloses “A device for creating a channel between the stomach lumen and the abdominal surface of a patient. The device includes a tube and a first bolster. The tube has a proximal end, a distal end, and a wall, the wall having an inner surface and an outer abdominal surface, and each end having an opening therein. The first bolster is attached to the distal end of the tube and the tube is adapted to slidably receive a feeding device having a shaft, wherein at least a portion of the outer diameter of the shaft of the feeding device is substantially the same size as that of the inner wall of the tube. The first bolster is adapted to sealingly engage with the patient so as to minimize or avoid fluid leakage about the tube. The present invention is also directed to a method of using an artificial stoma.” 
     U.S. Patent Application Publication No. US2003/0163119 discloses “A medical catheter assembly including a removable inner sleeve. In one embodiment, the assembly is a low profile percutaneous endoscopic gastrostomy (PEG) device and comprises a body, a clamp, a feeding tube, a cap and an inner sleeve assembly. The body includes a base portion and a sleeve portion, the base portion being dimensioned to engage the skin of a patient and having a transverse bore, the sleeve portion extending upwardly from the base portion and having a longitudinal slot aligned with the transverse bore and a transverse slot intersecting the longitudinal bore. The clamp, which is slidably mounted on the base portion and across the transverse slot of the sleeve, comprises a plate having a transverse opening. The transverse opening has a wide region and a narrow region, the two regions being alternately alignable with the longitudinal bore to open and to close, respectively, the feeding tube. The feeding tube has a distal end adapted to be anchored to the inside of a patient and a proximal end inserted up through the base portion and the sleeve portion, including the transverse opening of the clamp situated within the sleeve, and then inverted over the top edge of the sleeve. The cap is then mounted on top of the sleeve so as to secure the inverted end of the catheter to the exterior of the sleeve. The cap is provided with an opening through which access to the catheter may be gained. An inner sleeve, sized to engage the inside surface of the feeding tube, is removably inserted through the cap and the feeding tube, the inner sleeve having a proximal end to which a tubular fitting is secured. Food and/or medications are dispensed to the patient through the fitting and the inner sleeve and, in this manner, prevent clogging of the feeding tube.” 
     SUMMARY OF THE INVENTION 
     According to an aspect of a first embodiments of the invention, there is provided a PEG feeding device for conducting fluid through a stoma to a stomach comprising: 
     a tube sized to bridge a channel between a stomach and an outer abdominal surface; an internal bolster, sized to resist movement out of the stomach through the stoma and connected to the tube; an external bolster, sized to resist movement into the stoma and connected to the tube; wherein the external bolster includes at least one element including an underside which extends from the tube in a radial direction and then towards the external bolster contacting the outer abdominal surface at a distance from an external opening of the stoma. 
     According to a second and optionally according to the first embodiments of the invention, the distance is at least 5 mm. 
     According to a third and optionally according to any of the first to the second embodiments of the invention, at least a portion of the external bolster is elastically deflectable in an axial direction. 
     In some embodiments, said reading comprises reading using an intrabody imager includes viewing said marker at said location. 
     According to a fourth and optionally according to any of the first to the third embodiments of the invention, the external bolster includes a plurality of portions which are individually elastically deflectable. 
     According to a fifth and optionally according to the fourth embodiments of the invention, the portions are at least partially circumferentially separated. 
     In some embodiments, said graduations comprise color-coded graduations. 
     According to a sixth and optionally according to any of the first to the fifth embodiments of the invention, at least a portion of the inner bolster is elastic with respect to a long axis of the tube. 
     In some embodiments, said marker comprises at least one separating section between adjacent graduations. 
     According to a seventh and optionally according to any of the first to the sixth embodiments of the invention, the internal bolster includes a plurality of parts connected by at least one connector. 
     There is provided in accordance with some embodiments, a method for inserting a PEG device into a stomach lumen, comprising: 
     determining a thickness of tissue between the stomach and skin to a precision of 4 mm or better; 
     selecting a permanent PEG tube having a bridging length corresponding to said determined thickness; 
     inserting said selected permanent PEG tube to bridge between said skin and said stomach; and 
     compensating for a mismatch between said bridging length and said thickness using at least one elastic bolster positioned against the skin and/or against the stomach wall. 
     According to an eighth and optionally according to any of the first to the seventh embodiments of the invention, the internal bolster includes circumferential separations. 
     In some embodiments of the invention, said compensating comprises attaching an elastic outer bolster to said tube. 
     According to a ninth and optionally according to any of the first to the eighth embodiments of the invention, the PEG feeding device comprises an inner tube sized to fit into the tube and to bridge a channel between a stomach and a patient outer abdominal surface. 
     In some embodiments of the invention, when said compensating, said at least one elastic bolster applies a pressure on said tissue lower than a tissue damaging pressure. 
     According to a tenth and optionally according to the ninth embodiments of the invention, the inner tube is permanently attached to a food reservoir. 
     In some embodiments of the invention, said determining comprises determining by visualizing markings of a measuring device that bridges said thickness, from within said stomach lumen. 
     According to an eleventh and optionally according to any of the ninth to tenth embodiments of the invention, the PEG feeding device comprises a rigid connector connecting the inner tube and the external bolster. 
     There is provided in accordance with some embodiments, a PEG feeding device comprising: 
     a tube; wherein said tube is shaped and sized to be positioned between a stomach lumen and the outer surface of the skin; 
     an internal bolster and an external bolster, at least one of which being elastic, connected to said tube, wherein said elasticity allows deformation of one or both of said bolster so as to vary the distance between the two bolsters by at least 4 mm, while not applying a tissue-damaging pressure to said lumen or said skin. 
     According to a twelfth and optionally according to any of the ninth to eleventh embodiments of the invention, the PEG feeding device according comprises a sealing element occluding a channel between the tube and the inner tube. 
     In some embodiments of the invention, said tube is connected to said external bolster by an interference mechanism configured to prevent both relative rotation and release of said external bolster from said tube. 
     According to a thirteenth and optionally according to any of the ninth to twelfth embodiments of the invention, the inner tube includes at least one cleaning portion sized to contact inner walls of the tube. 
     In some embodiments of the invention, said interference mechanism comprises matching geometries between said external bolster and said tube. 
     According to a fourteenth and optionally according to the thirteenth embodiments of the invention, the cleaning portion elastically applies radial pressure to the inner walls of the tube. 
     In some embodiments of the invention, said tube includes a geometric shape which guides a mounting of said bolster over said shape in an orientation matching an orientation of the interference mechanism. 
     According to a fifteenth and optionally according to any of the first to the fourteenth embodiments of the invention, the tube connects to one of the internal bolster and the external bolster by a rigid connector. 
     There is provided in accordance with some embodiments, a kit for measuring tissue thickness, comprising: 
     (a) a cannula having a proximal size adapted to remain outside the body and a distal side adapted to pierce tissue and enter the body; 
     (b) a marked shaft sized to fit in said cannula and fixedly abut against a portion of said cannula which remains outside the body, when the shaft is moved axially through the cannula,
         wherein said shaft includes a plurality of markings which extend past said distal end of said cannula when said shaft fixedly abuts said portion of said cannula.       

     According to a sixteenth and optionally according to any of the first to the fifteenth embodiments of the invention, a height of the device above a patient outer abdominal surface is less than 5 cm. 
     There is provided in accordance with some embodiments, a PEG feeding device for conducting fluid through a stoma to a stomach comprising:
         a tube sized to bridge a channel between the stomach and an outer abdominal surface;   an internal bolster, sized to resist movement out of the stomach through the stoma and connected to said tube; and   an external bolster, sized to resist movement into the stoma and connected to said tube;       

     wherein said external bolster includes at least one elastic element positioned between a connection to said tube and an interface contacting said outer abdominal surface and wherein a shortest path on said elastic element from said connection to said interface is at least 20% longer than a straight line joining said connection to said interface. 
     According to a seventeenth and optionally according to any of the first to the sixteenth embodiments of the invention, an axial height of the external bolster is less than 5 cm. 
     In some embodiments of the invention, said internal bolster further comprises a central shaft and at least 3 spaced apart petals connected to said central shaft via a connecting end of said petals. 
     According to a eighteenth and optionally according to any of the first to the seventeenth embodiments of the invention, the external bolster is connected to the outer tube by a rigid connector. 
     In some embodiments of the invention, said width of said connecting end is at least 5% larger than the cross-sectional geometry of an outer end of said petals. 
     According to an nineteenth and optionally according to any of the first to the eighteenth embodiments of the invention, the PEG further comprises: a variable angle joint joining the external bolster to the tube and allowing the external bolster to tilt with respect the tube. 
     In some embodiments of the invention, said central shaft has a hardness of at least 40 shore A. 
     According to an aspect of a twentieth embodiment of the invention, there is provided a PEG feeding device for conducting fluid through a stoma to a stomach comprising: a tube sized to bridge a channel between a stomach and an outer abdominal surface; a bolster sized to resist movement into the stoma; and a rigid connector comprising a lumen and connecting the tube to the bolster; wherein a portion of the rigid connector is disposed within a first end of the tube. 
     There is provided in accordance with some embodiments, a PEG feeding device for conducting fluid through a stoma to a stomach comprising:
         a tube sized to bridge a channel between the stomach and an outer abdominal surface;   an internal bolster, sized to resist movement out of the stomach through the stoma and connected to said tube; and   an external bolster, sized to resist movement into the stoma and connected to said tube;       

     wherein said external bolster includes at least one elastic element positioned between a connection to said tube and an interface contacting said outer abdominal surface and wherein said elastic element is shaped and sized to transmit a force between said interface and said connection by means of an axial stress on the elastic element. 
     According to a twenty first and optionally according to the twentieth embodiments of the invention, the portion of the rigid connector comprises a fitted friction fit with the tube. 
     In some embodiments of the invention, said interface contacts said outer abdominal surface at a radial distance from an external opening of said stoma. 
     According to a twenty second and optionally according to any of the first to the twenty first embodiments of the invention, the first end of the tube comprises thickened walls. 
     In some embodiments of the invention, said interface includes an underside of said elastic element. 
     According to a twenty third and optionally according to any of the first to the twenty second embodiments of the invention, the tube comprises an internal supporting structure and within a sheath. 
     In some embodiments of the invention, said distance is at least 5 mm. 
     According to a twenty forth and optionally according to the twenty third embodiments of the invention, the internal structure includes a mesh. 
     In some embodiments of the invention, at least a portion of said external bolster is elastically deflectable in an axial direction. 
     According to a twenty fifth and optionally according to any of the first to the twenty fourth embodiments of the invention, the internal structure includes elongated elements. 
     In some embodiments of the invention, at least a portion of said external bolster is elastically deflectable in an axial direction. 
     According to a twenty sixth and optionally according to any of the first to the twenty fifth embodiments of the invention, the PEG feeding device comprises a second bolster sized to resist movement into the stoma; wherein the second bolster is connected to a second end of the tube. 
     In some embodiments of the invention, said portions are at least partially circumferentially separated. 
     According to a twenty seventh and optionally according to any of the first to the twenty sixth embodiments of the invention, the rigid connector connects to a rigid part of the bolster. 
     In some embodiments of the invention, at least a portion of said inner bolster is elastic with respect to a long axis of said tube. 
     According to a twenty eighth and optionally according to any of the first to the twenty seventh embodiments of the invention, the rigid connector connects to the bolster by an interference connection. 
     In some embodiments of the invention, said internal bolster includes a plurality of parts connected by at least one connector. 
     According to an aspect of a twenty ninth and optionally according to any of the first to the twenty eighth embodiments of the invention, there is provided a PEG feeding device for conducting fluid through a stoma to a stomach comprising: a tube sized to bridge a channel between a stomach and an outer abdominal surface; an internal bolster, sized to resist movement out of the stomach through the stoma and connected to the tube comprising: a plurality of parts held together by one or more connector; and an external bolster, sized to resist movement into the stoma and connected to the tube; wherein the plurality of parts overlap axially by less than 20%. 
     In some embodiments of the invention, said internal bolster includes circumferential separations. 
     According to a thirtieth and optionally according to any of the first to the twenty ninth embodiments of the invention, the connector includes a torque connection. 
     In some embodiments of the invention, the PEG feeding device comprising an inner tube sized to fit into said tube and to bridge a channel between a stomach and a patient outer abdominal surface. 
     According to an aspect of a thirty first embodiment of the invention, there is provided a method of installing a PEG feeding device comprising: selecting an approximately sized tube; installing the tube in a stoma connecting a stomach and an outer abdominal surface of a patient where an installed tube is held by an inner bolster disposed within the stomach and an external bolster at an abdominal outer surface; compensating for a discrepancy between the tube length and a length of the stoma. 
     In some embodiments of the invention, the PEG feeding device comprising a rigid connector connecting said inner tube and said external bolster. 
     According to a thirty second and optionally according to the thirty first embodiments of the invention, the compensating comprises: adjusting a minimum separation between the inner bolster and the external bolster. 
     In some embodiments, said inner tube is part of an inner tube section which is connected to said external bolster by a snap fit locking mechanism. 
     According to a thirty third and optionally according to the thirty second embodiments of the invention, the adjusting comprises changing a position of attachment of the bolster with respect to the tube. 
     In some embodiments of the invention, said inner tube portion comprises an external tube connector, wherein said external tube connector is configured to connect said inner tube portion to an external feeding tube with a greater resistance to a pull-out force than said snap fit locking mechanism. 
     According to a thirty fourth and optionally according to any of the thirty second to the thirty third embodiments of the invention, the adjusting comprises: selecting an axial extent of a compressible element between an inner bolster and a lumen inner wall. 
     In some embodiments, said tube connects to one of said internal bolster and said external bolster by a rigid connector. 
     According to a thirty fifth and optionally according to any of the thirty second to the thirty fourth embodiments of the invention, the adjusting comprises: axially elastically deflecting a portion of the external bolster. 
     In some embodiments of the invention, said tube comprises a flared section positioned at least partially within said stomach. 
     According to a thirty sixth and optionally according to any of the thirty second to the thirty fifth embodiments of the invention, the adjusting comprises: axially elastically deflecting a portion of the inner bolster. 
     There is provided in accordance with some embodiments, a PEG feeding device for conducting fluid through a stoma to a stomach comprising:
         a tube sized to bridge a channel between the stomach and an outer abdominal surface;   a bolster sized to resist movement into the stoma; and   a rigid connector comprising a lumen and connecting said tube to said bolster;       

     wherein a portion of said rigid connector is disposed within a first end of said tube. 
     According to a thirty seventh and optionally according to any of the thirty second to the thirty sixth embodiments of the invention, the adjusting is self adjusting of the PEG device. 
     In some embodiments of the invention, said portion of said rigid connector comprises a fitted friction fit with said tube. 
     According to an aspect of a thirty eight and optionally according to any of the thirty first to the thirty seventh embodiments of the invention, there is provided a method of use of a PEG feeding device: installing a PEG feeding device comprising an inner and outer tube the outer tube forming a channel between a lumen and a patient outer abdominal surface, the inner tube forming a channel between a lumen and a patient outer abdominal surface and within the outer tube; and replacing the inner tube periodically. 
     In some embodiments of the invention, said tube comprises an internal supporting structure and within a sheath. 
     According to a thirty ninth and optionally according to any of the thirty first to the thirty eighth embodiments of the invention, the replacing comprises cleaning said outer tube. 
     In some embodiments of the invention, said internal structure includes a mesh. 
     According to a fortieth and optionally according to the thirty eighth embodiments of the invention, the method further comprises: pivoting an angle between at least one of the internal bolster and the external bolster with respect to the tube. 
     In some embodiments of the invention, said internal structure includes elongated elements. 
     According to a forty first and optionally according to the fortieth embodiments of the invention, pivoting compensates for a difference between an axis of the tube and a normal from at least one of an inner surface of a stomach and an outer surface of an abdomen at the location of a stoma. 
     In some embodiments of the invention, the PEG feeding device comprising a second bolster sized to resist movement into the stoma; 
     wherein said second bolster is connected to a second end of said tube. 
     According to an aspect of a forty second and optionally according to any of the first to the thirtieth embodiments of the invention, there is provided a PEG feeding device for conducting fluid through a stoma to a stomach comprising: a tube sized to bridge a channel between a stomach and an outer abdominal surface; an external bolster, sized to resist movement into the stoma and connected to the tube; a variable angle joint joining the external bolster to the tube and allowing the external bolster to tilt with respect the tube. 
     There is provided in accordance with some embodiments, A PEG feeding device for conducting fluid through a stoma to a stomach comprising:
         a tube sized to bridge a channel between the stomach and an outer abdominal surface;   an internal bolster, sized to resist movement out of the stomach through the stoma and connected to said tube comprising:
           a plurality of parts held together by one or more connector; and   
           an external bolster, sized to resist movement into the stoma and connected to said tube;       

     wherein said plurality of parts overlap axially by less than 20%. 
     According to a forty third and optionally according to the forty second embodiments of the invention, the PEG further comprises: an adjuster for setting a resistance of the external bolster to tilt with respect to an axis of the tube. 
     In some embodiments of the invention, said connector includes a torque connection. 
     According to a forty fourth and optionally according to any of the fortieth to the forty third embodiments of the invention, the PEG further comprises: at least one element including an underside which extends from the tube in a radial direction and then towards the external bolster contacting the outer abdominal surface at a distance from an external opening of the stoma. 
     There is provided in accordance with some embodiments, a method of installing a PEG feeding device comprising: 
     selecting an approximately sized tube; 
     installing said tube in a stoma connecting a stomach and an outer abdominal surface of a patient where an installed tube is held by an inner bolster disposed within said stomach and an external bolster at an abdominal outer surface; and 
     compensating for a discrepancy between said tube length and a length of said stoma. 
     According to a forty fifth and optionally according to any of the fortieth to the forty fourth embodiments of the invention, the PEG further comprises: an internal bolster, sized to resist movement out of the stomach through the stoma and connected to the tube. 
     In some embodiments of the invention, said compensating comprises:
         adjusting a minimum separation between said inner bolster and said external bolster.       

     According to a forty sixth and optionally according to any of the fortieth to the forty fifth embodiments of the invention, the PEG further comprises: an elastic biasing element biasing an angle of the tilting of the external bolster to a preferred angle. 
     In some embodiments, said adjusting comprises changing a position of attachment of said bolster with respect to said tube. 
     According to an aspect of a forty seventh and optionally according to any of the first to thirtieth and the fortieth to the forty sixth embodiments, there is provided a PEG device for conducting material through a stoma to or from a lumen comprising: a tube sized to bridge a channel between a lumen and an outer surface of a patient; an internal bolster, sized to resist movement out of the lumen through the stoma and connected to the tube; an external bolster, sized to resist movement into the stoma and connected to the tube; wherein the external bolster includes at least one element including an underside which extends from the tube in a radial direction and then towards the external bolster contacting the outer surface at a distance from an external opening of the stoma. 
     In some embodiments, said adjusting comprises:
         selecting an axial extent of a compressible element between an inner bolster and a lumen inner wall.       

     In some embodiments of the invention, said adjusting comprises:
         axially elastically deflecting a portion of said external bolster.       

     There is provided in accordance with some embodiments, a PEG feeding device for conducting fluid through a stoma to a stomach comprising:
         a tube sized to bridge a channel between a stomach and an outer abdominal surface;   an external bolster, sized to resist movement into the stoma and connected to said tube; and       

     a variable angle joint joining said external bolster to said tube and allowing said external bolster to tilt with respect said tube. 
     In some embodiments of the invention, the PEG further comprising: 
     an adjuster for setting a resistance of said external bolster to tilt with respect to an axis of said tube. 
     In some embodiments of the invention, the PEG further comprising:
         at least one element including an underside which extends from said tube in a radial direction and then towards said external bolster contacting said outer abdominal surface at a distance from an external opening of said stoma.       

     In some embodiments of the invention, the PEG of claim  49 , further comprising:
         an internal bolster, sized to resist movement out of the stomach through the stoma and connected to said tube.       

     In some embodiments of the invention, the PEG further comprising:
         an elastic biasing element biasing an angle of said tilting of said external bolster to a preferred angle.       

     There is provided in accordance with some embodiments, a PEG device for forming a channel through a stoma to a lumen comprising:
         a tube sized to bridge a channel between the lumen and an outer abdominal surface;   an internal bolster, sized to resist movement out of the stomach through the stoma and connected to said tube; and   an external bolster, sized to resist movement into the stoma and connected to said tube;       

     wherein said external bolster includes at least one element including an underside which extends from said tube in a radial direction and then towards said external bolster contacting said outer abdominal surface at a distance from an external opening of said stoma. 
     There is provided in accordance with some embodiments, a method for draining the content of a stomach through a tube fixed between a stomach lumen and an abdominal opening, comprising: 
     inserting a replaceable inner tube with an expandable filter into said tube; and 
     draining food from said stomach lumen through said inner tube and said abdominal opening. 
     In some embodiments of the invention, the method further comprising: 
     monitoring the amount of said drained food after said draining. 
     In some embodiments of the invention, the method of claim  55 , further comprising: 
     grinding the content of the stomach and/or the food within said replaceable inner tube during and/or before said draining. 
     There is provided in accordance with some embodiments, a device for draining the content of a stomach, comprising:
         a tube, sized to bridge a channel between a stomach lumen and an outer abdominal surface;   an inner replaceable tube, sized to be placed within said tube, further comprising an expandable filter at the portion of said inner tube placed within said stomach lumen;   an inner body bolster and/or an outer body bolster configured to fix the position of said tube.       

     In some embodiments of the invention, said inner tube further comprises a grinder placed within the lumen of said inner tube, wherein said grinder is configured to reduce food particle size within said inner tube and/or within said stomach lumen. 
     In some embodiments of the invention, said inner tube further comprises a motor connector for connecting an outside motor to said grinder. 
     Unless otherwise defined, all technical and/or scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which the invention pertains. Although methods and materials similar or equivalent to those described herein can be used in the practice or testing of embodiments of the invention, exemplary methods and/or materials are described below. In case of conflict, the patent specification, including definitions, will control. In addition, the materials, methods, and examples are illustrative only and are not intended to be necessarily limiting. 
     BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS 
     Some embodiments of the invention are herein described, by way of example only, with reference to the accompanying drawings. With specific reference now to the drawings in detail, it is stressed that the particulars shown are by way of example and for purposes of illustrative discussion of embodiments of the invention. In this regard, the description taken with the drawings makes apparent to those skilled in the art how embodiments of the invention may be practiced. 
     In the figures generally, like components are indicated with like numerals, however, it should be noted that in some figures similar elements to those indicated in previous figures are provided with a new leading figure number. 
    
    
     
       In the drawings: 
         FIG.  1 A  is a simplified schematic cross section of an ostomy device which provides a channel between an internal patient lumen and an outer abdominal surface of the patient, according to some embodiments of the invention; 
         FIG.  1 B  is a simplified schematic cross section of an ostomy device with a flexible tube, according to some embodiments of the invention; 
         FIG.  2 A  is a simplified schematic sectional view of ostomy device including an inner tube, according to some embodiments of the invention; 
         FIG.  2 B  is a simplified schematic side view of a ostomy device body and an inner tube portion, according to some embodiments of the invention; 
         FIG.  3    is a flow diagram of a method of feeding, according to some embodiments of the invention; 
         FIG.  4 A  is a simplified schematic of a patient with an installed ostomy device, and a feeding device, according to some embodiments of the invention; 
         FIG.  4 B  is a simplified schematic of a patient with an installed ostomy device, where a feeding device is connected to ostomy device, according to some embodiments of the invention; 
         FIG.  5 A  is a simplified schematic of a patient with an installed ostomy device, and a feeding device, according to some embodiments of the invention; 
         FIG.  5 B  is a simplified schematic of a patient with an installed ostomy device, where a connector forms an ostomy device inner tube, according to some embodiments of the invention; 
         FIG.  6    is a simplified schematic of a feeding device where a connector is directly attached to a food reservoir, according to some embodiments, of the invention; 
         FIG.  7    is a simplified schematic of a feeding device where a connector, which includes a tube, is directly attached to a food reservoir, according to some embodiments, of the invention; 
         FIG.  8    is a simplified schematic cross sectional view of a tip of a portion of an ostomy device including a sealing element between an inner tube and an outer tube, according to some embodiments of the invention; 
         FIG.  9 A  is a simplified schematic cross sectional view of a portion of an ostomy device during insertion of an inner tube which includes an expanding sealing element, according to some embodiments of the invention; 
         FIG.  9 B  is a simplified schematic cross sectional view of a portion of an ostomy device and an expanded sealing element, according to some embodiments of the invention; 
         FIG.  10    is a simplified schematic of a portion of an ostomy device including a sealing element, according to some embodiments of the invention; 
         FIG.  11    is a simplified schematic of a portion of an ostomy device including a sealing element and an angled outer tube edge in contact with the sealing element, according to some embodiments of the invention; 
         FIG.  12 A  is a simplified schematic cross sectional view of an inner tube before insertion into an outer tube which has accumulated residue, according to some embodiments of the invention; 
         FIG.  12 B  is a simplified schematic cross sectional view of an inner tube during insertion into an outer tube which has accumulated residue, according to some embodiments of the invention; 
         FIG.  13 A  is a simplified schematic cross sectional view of a portion of an ostomy device where an inner tube is disposed within an outer tube which has accumulated residue, according to some embodiments of the invention; 
         FIG.  13 B  is a simplified schematic cross sectional view of an inner tube during removal from an outer tube which has accumulated residue, according to some embodiments of the invention; 
         FIG.  14 A  is a simplified schematic cross sectional view of insertion of an inner tube including multiple cleaning elements into an outer tube, according to some embodiments of the invention; 
         FIG.  14 B  is a simplified schematic cross sectional view of an inner tube including multiple cleaning elements after exiting an outer tube, according to some embodiments of the invention; 
         FIG.  15 A  is a simplified schematic cross section of a bolster coupled to an inner tube by an elastic element, according to some embodiments of the invention; 
         FIG.  15 B  is a simplified schematic cross section of an inner tube released from an elastic element, according to some embodiments of the invention; 
         FIG.  16    is a simplified section view of an external bolster fitting over an inner tube portion, according to some embodiments of the invention; 
         FIG.  17    is a simplified schematic cross sectional view of a connection between an inner tube portion and an external bolster, according to some embodiments of the invention; 
         FIG.  18 A  is a simplified schematic isometric view of an ostomy device including a plug-socket connection between an inner tube portion and an rigid connector, according to some embodiments of the invention; 
         FIG.  18 B  is a simplified schematic section view of an ostomy device including a plug-socket connection between an inner tube portion and a rigid connector, according to some embodiments of the invention; 
         FIG.  18 C  is a simplified schematic section view of an ostomy device inner tube portion including a plug connector, according to some embodiments of the invention; 
         FIG.  19    is a simplified schematic of an outer tube including anti-rotation elements, according to some embodiments of the invention; 
         FIG.  20 A  is a simplified schematic of an external bolster including a hollow, according to some embodiments of the invention; 
         FIG.  20 B  is a simplified schematic of an inner tube portion head including a protrusion, according to some embodiments of the invention; 
         FIG.  21    is a simplified schematic side view of an inner tube portion head including more than one hollow, according to some embodiments of the invention; 
         FIG.  22    is a simplified schematic cross sectional view of a portion of an inner bolster connected to an outer tube (not illustrated) by interlocking connecting elements, according to some embodiments of the invention; 
         FIG.  23    is a simplified schematic cross sectional view of an ostomy device, according to some embodiments of the invention; 
         FIG.  24    is a simplified schematic of a tube including a mesh and connectors, according to some embodiments of the invention; 
         FIG.  25    is a simplified schematic of a wire-reinforced tube and connectors, according to some embodiments of the invention; 
         FIG.  26    is a simplified schematic cross sectional view of tube including thickened tube wall portions, and connectors, according to some embodiments of the invention; 
         FIG.  27    is a simplified schematic cross section of an ostomy device with an adjustable tube length within the patient body, according to some embodiments of the invention; 
         FIG.  28 A  is a simplified schematic section view of a portion of an ostomy device, according to some embodiments of the invention; 
         FIGS.  28 B- 28 D  are simplified schematic cross sectional views of exemplary interlocking connection between external bolster and connector, according to some embodiments of the invention; 
         FIG.  29 A  is a simplified schematic cross section of an ostomy device with adjustable axial length, according to some embodiments of the invention; 
         FIG.  29 B  is a simplified schematic cross section of an ostomy device with adjustable axial length within swollen tissue, according to some embodiments of the invention; 
         FIG.  30    is a simplified schematic section view of a portion of an ostomy device where a protrusion of the device above a patient outer abdominal surface is adjustable, according to some embodiments of the invention; 
         FIG.  31 A  is a simplified schematic section view of an external bolster bending to fit an abdominal outer surface, according to some embodiments of the invention; 
         FIG.  31 B  is a simplified schematic section view of a device where an external bolster is bending to fit the device to a patient anatomy, according to some embodiments of the invention; 
         FIG.  32 A  is a simplified schematic section view of a portion of an elastic internal bolster, according to some embodiments of the invention; 
         FIG.  32 B  is a simplified schematic cross sectional view of an inner bolster, a lumen inner wall and a compressible component therebetween, according to some embodiments of the invention; 
         FIG.  33    is a simplified schematic isometric view of an external bolster including a plurality of notches  3360 , according to some embodiments of the invention; 
         FIG.  34    is a flow chart of a method of ostomy device removal, according to some embodiments of the invention; 
         FIG.  35 A  is a simplified schematic side view of an internal bolster including a plurality of petals, according to some embodiments of the invention; 
         FIG.  35 B  is a simplified schematic side view of a dismantled internal bolster including a plurality of petals, according to some embodiments of the invention; 
         FIG.  36    is a simplified section view of a portion of an internal bolster including a tool channel for a dismantling tool, according to some embodiments of the invention; 
         FIG.  37 A  is a simplified schematic side view of an inner tube portion where inner tube is non-cylindrical, according to some embodiments of the invention; 
         FIG.  37 B  illustrates an inner tube portion including two channels, a feeding channel and a tool channel, according to some embodiments of the invention; 
         FIG.  38 A  is a simplified schematic section view of an internal bolster with a screw dismantling mechanism, according to some embodiments of the invention; 
         FIG.  38 B  is a simplified schematic side view of a screw dismantling mechanism tool  3868 , according to some embodiments of the invention; 
         FIG.  39    is a simplified schematic of a portion of a bolster and an expanding dismantling tool, according to some embodiments of the invention; 
         FIG.  40 A  is a simplified schematic side view of a disassembly tool, according to some embodiments of the invention; 
         FIG.  40 B  is a simplified schematic side view of a disassembly tool inserted into an inner bolster, according to some embodiments of the invention; 
         FIG.  41 A  is a simplified schematic side view of an inner bolster where each petal of the inner bolster is attached to an elongated element, according to some embodiments of the invention; 
         FIG.  41 B  illustrates removal of disassembled inner bolster portions through an outer tube by pulling, force P on an elongated element  4188 , according to some embodiments of the invention; 
         FIG.  42    is a flow chart of a method of ostomy device installation, according to some embodiments of the invention; 
         FIG.  43    is a simplified schematic cross sectional view of an outer tube being pulled into a stoma by a pushing device  4380 , according to some embodiments of the invention; 
         FIG.  44 A  is a simplified schematic side view of a pushing device, according to some embodiments of the invention; 
         FIG.  44 B  is a simplified schematic side view of a pushing device threaded with an elongated element, according to some embodiments of the invention; 
         FIG.  45 A  is a simplified schematic side view of a pushing device including a tapered end, according to some embodiments of the invention; 
         FIG.  45 B  is a simplified schematic side view of a pushing device within an outer tube attached to an inner bolster where a portion of the pushing device protrudes through the outer tube, according to some embodiments of the invention; 
         FIG.  46 A  is a simplified schematic side view of a pushing device, according to some embodiments of the invention; 
         FIG.  46 B  is a simplified schematic side view of a pushing device within an outer tube attached to an internal bolster where a portion of the pushing device protrudes through the outer tube, according to some embodiments of the invention; 
         FIG.  47    is a simplified schematic side view of an ostomy device where an external bolster is being attached to an outer tube, according to some embodiments of the invention; 
         FIG.  48    is a simplified schematic section view of device installation including insertion of an outer tube into a stoma, according to some embodiments of the invention; 
         FIG.  49 A  is a simplified schematic cross sectional view of an inner bolster attached to an outer tube being inserted through an esophagus, according to some embodiments of the invention; 
         FIG.  49 B  is a simplified schematic cross sectional view of an inner bolster attached to an outer tube where the outer tube is installed within a stoma, according to some embodiments of the invention; 
         FIG.  49 C  is a simplified schematic section view of device installation including insertion of an outer tube into a stoma according to some embodiments of the invention; 
         FIG.  49 D  is a simplified schematic cross sectional view of a inner bolster connected to an outer tube being inserted through an esophagus, according to some embodiments of the invention; 
         FIGS.  50 A- 50 B  are flow charts of a method of use of an ostomy device, according to some embodiments of the invention; 
         FIG.  51    is a photograph illustrating a device with a pivoting external bolster inserted at an angle through simulated tissue in accordance with some embodiments of the current invention; 
         FIG.  52    is a simplified perspective view of a device with a pivoting external bolster inserted at an angle to an external body surface in accordance with some embodiments of the current invention; 
         FIG.  53    is a cross sectional view of a device with a pivoting external bolster inserted at an angle to an external body surface in accordance with some embodiments of the current invention; 
         FIG.  54    is a block diagram of an adjustable bolster  5100  in accordance with an embodiment of the current invention; 
         FIG.  55 A  is a flow chart illustration of a measuring the depth from a base site to a location inside a living organism in accordance with some embodiments of the current invention; 
         FIG.  55 B  is a flow chart of a process for measuring the depth from a base site on the outer surface of the skin to a location inside a stomach in accordance with some embodiments of the current invention; 
         FIGS.  56 A- 56 C  are perspective views of measurement sheaths and inserter needles in accordance with some embodiments of the current invention; 
         FIGS.  57 A- 57 B  are schematic views of elastic distancers in accordance with some embodiments of the current invention; 
         FIGS.  58 A- 58 B  are perspective views of a pushing device in accordance with some embodiments of the current invention; 
         FIGS.  59 A- 59 C  are perspective views of a disassembly tool  5968  and socket in accordance with some embodiments of the current invention; 
         FIG.  60    is a perspective view of an anti rotational connector for an outer bolster to a tube in accordance with some embodiments of the current invention. 
         FIGS.  61 A and  61 B  are schematic views of an ostomy device with an outer tube having a flared internal section in accordance with some embodiments of the current invention; 
         FIGS.  62 A- 62 C  are schematic views of an internal bolster in accordance with some embodiments of the current invention; 
         FIGS.  63 A- 63 D  are schematic views of an inner tube portion of an ostomy device, in accordance with some embodiments of the current invention; 
         FIGS.  64 A- 64 E  are schematic views of an external bolster of an ostomy device in accordance with some embodiments of the current invention; 
         FIGS.  65 A- 65 B  are schematic views of a high-profile ostomy device in accordance with some embodiments of the current invention; 
         FIGS.  65 C- 65 E  are schematic views of an ostomy device with an elongated inner tube in accordance with some embodiments of the current invention; 
         FIG.  65 F  is a schematic illustration of an ostomy device with an elongated inner tube extending into the small intestine in accordance with some embodiments of the invention; 
         FIG.  65 G  is a schematic illustration of an ostomy device with an elongated inner tube ending positioned above the stomach content in accordance with some embodiments of the current invention; 
         FIG.  66 A  is a flow chart of a process for draining the content of a stomach in accordance with some embodiments of the current invention; 
         FIG.  66 B  is a block diagram of a device for draining the content of the stomach, in accordance with some embodiments of the current invention; 
         FIG.  66 C  is a schematic illustration of a device for draining the content of a stomach inside the body in accordance with some embodiments of the current invention; and 
         FIGS.  67 A- 67 D  are schematic views of an inner tube and a grinder of a device for draining the content of a stomach in accordance with some embodiments of the current invention. 
     
    
    
     DESCRIPTION OF SPECIFIC EMBODIMENTS OF THE INVENTION 
     The present invention, in some embodiments thereof, relates to ostomy devices and procedures and, more particularly, but not exclusively, to devices and procedures for percutaneous endoscopic gastronomy. 
     Overview 
     An aspect of some embodiments of the invention relates to an port device including an external and/or an internal bolster connected to a tube forming a channel through a stoma into a lumen (e.g. stomach) where one or both bolsters do not contact tissue and/or opening/s of the stoma. 
     For example, in some embodiments, an external bolster connected to the tube holds the tube by contacting a patient outer abdominal surface at an axial distance (e.g. distance from a long axis of the tube) from an opening of the stoma and/or from an opening of the tube. The opening of the stoma and/or the opening of the tube may optionally project from the abdominal outer surface and/or be on the abdominal outer surface. In some embodiments, the external bolster contacts the patient outer abdominal surface only at a separation from the opening of the stoma on the patient outer abdominal surface at a distance from the stoma of between 2-30 mm, between 5-25 mm, or between 5-15 mm, or smaller, or larger, or intermediate distances. In some embodiments, the external bolster mainly contacts the outer abdominal surface at a distance, where over 80%, or over 90%, or over 95%, or lower, or higher, or intermediate percentages, of a surface area of the external bolster contacting the outer abdominal surface is at a distance of between 2-30 mm, between 5-25 mm, or between 5-15 mm, or smaller, or larger, or intermediate distances. 
     Contact of the external bolster at a distance from the opening of the stoma prevents irritation and/or inflammation at the stoma opening from pressure applied to and/or movement of the external bolster. 
     In an exemplary embodiment, the ostomy device is a PEG feeding device, where fluid food and/or liquid are supplied directly to the stomach through the channel. 
     In some embodiments, an underside of the external bolster (e.g. facing the inner bolster e.g. a portion facing the tube), includes a shape that extends away from a long axis of the tube and towards the inner bolster (for example, an underside the external bolster is concave e.g. dome shaped). 
     In some embodiments, an underside of the external bolster includes one or more concave portion (e.g. hollow  210   h ,  FIG.  2 A ). In some embodiments, an underside of the internal bolster includes one or more concave portion (e.g. hollow  3208   h ,  FIG.  32 A ). 
     In some embodiments, the external bolster includes portions separated by spaces. In some embodiments, the external bolster contacts the outer abdominal surface at discrete points. In some embodiments, spaces between contacting points of the external bolster allow aeration and/or venting and/or facilitating cleaning of skin under the external bolster. 
     Optionally, the device includes an (optionally replaceable) inner tube (e.g. as described herein) disposed within the tube, where flow of material between the lumen and outside of the patient is through the inner tube. Optionally, the device includes soft and/or flexible inner bolster, for example, in some embodiments, the inner bolster is removable from the lumen through the stoma. For example, the inner bolster may be removed by pulling on the tube (directly or indirectly). 
     A broad aspect of some embodiments of the invention relates to an ostomy device with an adjustable axial length where, for example, a smallest separation between inner and external bolsters is adjustable. In some embodiments, the smallest separation between inner and external bolsters is adjustable by 5-30 mm. 
     In some embodiments, a device is installed within a patient by initially inserting a tube into a stoma where the tube is approximately sized for the stoma, for example, the tube is longer than the stoma. In some embodiments, a smallest separation between bolsters connected one on each end of the tube is adjusted, for example, fitting the device including an approximately sized tube to patient anatomy. 
     In some embodiments, adjustment is by moving a position of attachment of a bolster with respect to the tube, e.g. a position of an external bolster with respect to a connector connecting the external bolster to the tube. 
     In some embodiments, position of bolster/s is adjusted when the device is installed within a patient. In some embodiments, position of bolster/s is adjusted periodically for example, in response to a change in patient anatomy e.g. weight change and/or swelling. 
     In some embodiments, adjustment is through elasticity of one or more of the internal bolster, external bolster and tube, an axial length of the device thereby automatically adjusting to a range of lengths of stoma. In some embodiments, the tube includes a portion which is axially elastic. In some embodiments, one or more bolster includes a deflectable portion. Optionally the deflectable portion may be elastic. In some embodiments, one or more part elastically moves, changing a minimum separation between the bolsters. In some embodiments, a minimum separation between changes, fitting the device to the stoma, for example, during changes in stoma length, e.g. before, during and after post operative swelling of tissue around a stoma and/or patient weight gain and/or patient tissue change in fat percentage. 
     In some embodiments, a bolster (e.g. inner and/or external bolster) includes one or more portion which elastically bends and/or flexes. In some embodiments, the portion/s bend at pressures which are physiologically acceptable to patient tissue. For example, in some embodiments, a portion of a bolster in contact with patient tissue deflects before a pressure which causes damage and/or pain and/or discomfort to the patient tissue. In some embodiments, deflection of one or more elastic portion of a bolster changes a minimum axial separation between the bolsters. For example, in some embodiments, an elastic portion of a bolster extends towards the other bolster, a minimum separation between the bolsters defined from the elastic portion, deflection of the elastic portion changing the minimum separation between bolsters. 
     In some embodiments, the external bolster (and/or inner bolster) includes separate protrusions (e.g. petals) which, in some embodiments, elastically bend and/or flex and/or deflect independently (e.g. to different extents), for example, fitting the device to non-planar patient anatomy. 
     In some embodiments, the internal bolster includes inlets between separate parts (e.g. petals), for example allowing bending and/or flexing of the parts without overlapping of the parts. 
     In some embodiments, axial elasticity and/or flexibility of the internal bolster, where, for example, portion/s of the internal bolster bend under pressure (e.g. from the lumen walls), for example, bending towards an inner shaft of the internal bolster. In some embodiments, deflection of portion/s of the inner bolster prevents high pressure (e.g. associated with irritation of the lumen walls and/or the inner bolster becoming embedded in the lumen walls). 
     In an exemplary embodiment, the internal bumper includes portions (e.g. deflectable portions) with stiffness of 40-70 shore A, or 40-80 shore A, or 50-70 shore A, or lower, or higher, or intermediate stiffness. 
     In an exemplary embodiment, the internal bumper includes portions (e.g. deflectable portions) with stiffness of 40-70 shore A or 40-80 shore A, or 50-70 shore A, or lower, or higher, or intermediate stiffness. 
     In some embodiments, a force required to fully deflect deflectable portions of the external bumper is less than 10N, or less than 5N, or 1-10N. 
     In some embodiments, during delivery of the internal bolster through the esophagus to the stomach portion/s of the inner bolster bend and/or fold, optionally elastically, for example, reducing an extent of the inner bolster. In some embodiments, deflectable internal bolster portions have a maximum deflection, where, for example, in some embodiments, the internal bolster includes one or more blocking part which prevents bending beyond a maximum deflection. 
     In some embodiments, a spacer prevents the internal bolster from irritating the stomach wall, and/or for example, a compressible component (e.g. inflatable balloon, sponge, spring) placed (e.g. during installation of the ostomy device) between the internal bolster and the stomach. 
     In some embodiments, a spacer positioned between the inner bolster and lumen wall is adjusted from outside the body, for example, by pulling and/or releasing a component attached to the compressible component. 
     Optionally, in some embodiments, one or component deflects and/or extends non-elastically (e.g. plastically), for example, fitting the device to an expanding stoma. 
     Optionally, the device with adjustable axial length includes an (optionally replaceable) inner tube (e.g. as described herein) disposed within the tube, where flow of material between the lumen and outside of the patient is through the inner tube. 
     Optionally, the device with adjustable axial length includes soft and/or flexible inner bolster, for example, in some embodiments, the inner bolster is removable from the lumen through the stoma by pulling on the tube (directly or indirectly). 
     A broad aspect of some embodiments of the invention relates to an ostomy device including an outer tube and an inner tube, the inner tube forming a channel to a patient lumen. In some embodiments, the inner tube is removable for replacement and/or cleaning. In some embodiments, cleaning extends a life time of the ostomy device within the patient. 
     In some embodiments, the inner tube extends into the stomach. In some embodiments, the inner tube extends into the stomach and through the stomach to the jejunum, e.g. for feeding directly into the jejunum, the inner tube, being 1-30 cm long or 5-25 cm long, or shorter, or longer, or intermediate lengths or ranges. 
     In some embodiments, a seal (e.g. between the inner and outer tube) prevents flow within the outer tube around the inner tube. 
     An aspect of some embodiments of the invention relates to an inner tube which includes one or more protrusion where, for example, during insertion and/or removal of the inner tube from the outer tube, the protrusion/s contact the outer tube, for example, cleaning the outer tube. 
     Optionally, in some embodiments, the device including an inner tube includes soft and/or flexible inner bolster, for example, in some embodiments, the inner bolster is removable from the lumen through the stoma by pulling on the tube (directly or indirectly). 
     A broad aspect of some embodiments of the invention relates to an ostomy device including an internal bolster including a plurality of separate coupled parts. In some embodiments, the ostomy device is removed by decoupling the separate parts of the inner bolster to dismantle the inner bolster. 
     In some embodiments, the inner bolster includes a plurality of optionally flexible parts (herein termed petals) connected by optionally rigid connectors. In some embodiments, flexible petals are held between rigid connectors. 
     In an exemplary embodiment the petals substantially do not overlap. For example, the petals may substantially not overlap axially (overlap being where petals contact each other in a planes approximately perpendicular to the long axis of the tube). In some embodiments, petals at most overlap axially with adjacent (e.g. radially adjacent) petals. 
     In some embodiments, residue (e.g. stomach contents) coating the inner bolster (e.g. coating contact areas between petals) prevents and/or slows disassembly of inner bolster petals. In some embodiments, the inner bolster includes one or more notch and/or inlet separating portions of the inner bolster e.g. between petals. For example, reducing an area of contact between petals potentially reduces friction of movement of petals away from each other. 
     In some embodiments, the internal bolster includes a plurality of petals which are held by one or more connectors (e.g. in some embodiments, petals are held between two or more connectors) where disconnecting the connectors decouples the petals. 
     In some embodiments, the device includes a channel between an inner bolster dismantling mechanism and another portion of the device (e.g. the outer bolster). In some embodiments, the inner and/or outer tube forms the channel to the inner bolster. For example, in some embodiments, a user dismantles the inner bolster by accessing the internal bolster through the dismantling mechanism channel, from outside the patient (e.g. an endoscopic procedure is not required to dismantle the inner bolster). 
     In some embodiments, the inner bolster is dismantled by breaking at least a portion of a connector, for example, by applying pressure to the portion of the connector for example, applying pressure e.g. with a shaft. In some embodiments, the inner bolster is dismantled by moving and/or deflecting at least a portion of a connector, for example, moving an interlocking element, for example, by applying pressure e.g. with a shaft. 
     In some embodiments, pressure is applied by a non-designated tool, for example a hypodermic needle shaft or syringe. 
     In some embodiments, petals are coupled by a rotation attachment mechanism (e.g. screw mechanism, e.g. a mechanism with an open rotational configuration and a closed rotational configuration). In some embodiments, dismantling of the inner bolster includes rotating an inner bolster connector (e.g. unscrewing) to release petals of the inner bolster. 
     Optionally, the device with an inner bolster including a plurality of connected portions includes an (optionally replaceable) inner tube (e.g. as described herein) disposed within the tube, where flow of material between the lumen and outside of the patient is through the inner tube. 
     An aspect of some embodiments of the invention relates to an ostomy device where a flexible tube is connected to one or both bolsters by rigid connector/s. In some embodiments, a flexible tube is connected to a bolster including flexible part/s by connection (e.g. snap lock) of two rigid connector elements, one connected to the outer tube and the second to the flexible bolster. 
     In some embodiments, the tube has hardness of at least 40 shore A, or 50-80 shore A, or lower, or higher, or intermediate hardness. In some embodiments, the tube has a maximum radius of curvature of 1-25 mm, or 5-15 mm, or approximately 10 mm. 
     In some embodiments, a rigid connector is partially disposed within the flexible tube, for example, elasticity of the tube and/or a fitted friction fit of the connector holding the connector and tube together. In some embodiments, one or more connector is attached to the tube by injection molding the tube and connector as one part (optionally, where the connector includes different material to the tube). In some embodiments, one or more connector is attached to the tube by adhesion (e.g. gluing, heat treatment). In some embodiments, the tube is not folded around a connector. 
     In some embodiments, connection between the connector/s and the outer tube is non-smooth. For example, a diameter of the connector within the tube is less than a diameter of the tube, for example there is a step between the outer tube and the connector of 0.05 mm-1 mm, or 0.05 mm-0.5 mm, or lower, or higher, or intermediate values or ranges. In some embodiments, the inner tube prevents issues that would otherwise be associated with a non-smooth topography between the outer tube and the connector within the outer tube (e.g. build up of residue in the step). 
     Optionally, the device with adjustable axial length includes an (optionally replaceable) inner tube (e.g. as described herein) disposed within the flexible tube, where flow of material between the lumen and outside of the patient is through the inner tube. 
     Optionally, in some embodiments, the inner tube is flexible. In some embodiments, the inner tube has a maximum radius of curvature of 1-50 mm, or 5-25 mm, or approximately 20 mm. 
     In some embodiments, connection is to the flexible tube, which is non-smooth (e.g. stepped), while the flow of material to the lumen is through a smooth walled channel (e.g. the inner tube). 
     In some embodiments, the flexible inner tube (e.g. attached to rigid connector/s) includes a mesh of rigid material (e.g. within a sealing sheath) where free space within the mesh maintains tube flexibility. 
     An aspect of some embodiments of the invention relates to an ostomy device where a flexible tube is connected to one or both bolsters by a variable angle joint. For example, the variable joint may compensate for differences between the axis of the tube to the surface of the tissue and/or for changes and/or for movement of the surface. For example the angle of the joint may vary over a range of between 0 to 5 degrees and/or between 5 to 15 degrees and/or between 15 to 40 degrees and/or between 40 to 60 degrees. Optionally the bolster may float freely over the joint. Alternatively or additional the bolster may be biased to a particular angle (for example with the axis of bolster parallel and/or concentric to the axis of the tube and/or may be biased to one side for example to increase pressure on that side and/or decrease pressure on an opposite side). 
     In some embodiments, the tube may have a single unambiguous axis. For example the tube may be straight and/or have substantially the form of a right circular cylinder and/or have a-circular cross-section. In some embodiments, the tube may be curved and/or non-cylindrical and/or flexible and/or have a non-circular cross-section and/or may not have a single unambiguous axis. For the sake of the this disclosure, where the tube does not have a clearly defined unambiguous single longitudinal axis, the longitudinal axis of the tube will refer to a line joining the center of gravity of the cross section of the tube where it intersects the outer surface of the tissue (e.g. the outer surface of the abdomen of a patient) to the center of gravity of the cross section of the tube where it intersects the inner surface of the tissue (e.g. the inner surface of the stomach of the patient). An outer axis of the tube will refer to an axes perpendicular to the cross section of the tube and passing through the center of gravity of the cross section along a plane where the tube meets the outer surface of the tissue. An inner axis of the tube will refer to an axes perpendicular to the cross section of the tube and passing through the center of gravity of the cross section along a plane where the tube meets the outer surface of the tissue. 
     In some embodiments, the ostomy device is additionally or alternatively used to collect material (e.g. waste) from a lumen. For example, in some embodiments, the ostomy device is used to collect and/or release material from the stomach, optionally in addition to providing food to the stomach. In some embodiments, the ostomy device is used to reduce pressure within the stomach (e.g. by allowing material e.g. gas and/or food to escape through the device). 
     An aspect of some embodiments of the invention relates to measuring the depth from a base site to a location inside a living organism. For example the device may be used to measure a distance between two ends of a stoma and/or a port and/or a passageway into living tissue and/or a lumen of living organism. Optionally a marker (optionally including graduations) is inserted into the organism to the measurement location. For example, the marker may indicate a distance to a guide element. Optionally the guide element is placed at a base site. The marker may be positioned by viewing and/or sensing in the lumen. For example, placement of the marker may be without stressing the lumen tissue. The distance from the location in the organism to the base site is optionally measured by reading a graduation of the marker at the location inside the organism. For example, the method may be used to measure the length of a stoma and/or a port from an opening outside the lumen to an opening on the inner wall of the lumen. 
     An aspect of some embodiments of the invention relates to elastic distancers are sized and shaped to provide even pressure between a bolster and tissue of a subject over significant axial and/or rotational displacements. Optionally, an elastic element may have a form that distributes stresses evenly along the element. For example, the distance may have the shape of a petal. The distancer is optionally curved. For example the distance may be concave towards a tissue interface and/or concave away from the tissue interface. 
     Embodiments of this device may be included in various access ports to lumens or tissue. For example, a device may include a jejunal tube, for example in the form of a long inner tube passing through a stoma and/or a outer PEG access tube. The current invention may serve as an access port to another lumen, for example a thoracic cavity and/or a kidney and/or bladder. 
     An aspect of some embodiments relates to an internal bolster with at least a partially rigid core. In some embodiments, the internal bolster comprises a central shaft, optionally a rigid central shaft. In some embodiments, the central shaft hardness is at least 40 shore A, for example 50 shore A, 60 shore A, 70 shore A or 90 shore A, or intermediate, smaller or greater hardness. Alternatively, the central shaft is completely rigid or having a hardness level of 90 shore A and larger. In some embodiments, the internal bolster comprises at least two petals, connected to the central shaft. In some embodiments, at least some of the petals have a gradual increase in width or in cross-sectional geometry between the outer end of the petals in the circumference of the internal bolster and the inner end of the petals facing the central shaft. In some embodiments, the cross sectional geometry of inner end of the petals is at least 5% larger than the outer end of the petals, for example 15% larger, 20% larger or 50% larger, or intermediate, smaller or greater percentages. In some embodiments, the increase in width towards the inner end of the petals leads, for example to a gradual increase in rigidity. In some embodiments, the inner end of the petals is at least 10% more rigid compared to the outer end of the petals, for example 15% more rigid, 20% more rigid, 50% more rigid or 100% more rigid, or intermediate, smaller or greater percentages. Alternatively, the petals comprise a rigid section in the connection between the petals and the central rigid shaft, which is at least 10% more rigid than the rest of the petal, for example 10%, 20%, 30%, 50%, 100% or intermediate or smaller or greater percentages of increased rigidity. 
     In some embodiments, having an internal bolster with a central rigid shaft and/or at least some petals with an inner rigid section allows for example, to resist bending forces applied on the internal bolster, for example when the internal bolster passes through the esophagus. In some embodiments, the less rigid outer end of the petals allow the petals to bend and twist, while the more rigid inner end of the petals maintain the petals structure and the connection of the petals to the internal bolster during such travel. In some embodiments, the central rigid shaft is a flared shaft, with a wider diameter in the shaft ending placed within the stomach. 
     In some exemplary embodiments of the invention, additional rigidity is provided by geometrical changes and/or change sin processing of the material (e.g., polymer). Optionally or alternatively, rigidity and/or hardness are varied by mixing the material (e.g., polymer) with an additive (e.g., fibers) or by using a different material (e.g., a different polymer). 
     An aspect of some embodiments relates to a flared outer tube of an ostomy device. In some embodiments, the flared section of the outer tube is at least partially positioned within the stomach. In some embodiments, the flared section positioned at least partially within the body allows, for example to minimize the possibility of the tube to be pulled outside from the body by having a tube ending inside the stomach lumen that is wider than the stoma. In some embodiments, the diameter of the tube ending within the stomach is at least 4% larger than stoma diameter, for example 5%, 20%, 35% larger or intermediate or greater percentages. 
     A potential advantage of a flared shaft is avoiding sudden changes in tube diameter caused by the attachment of the inner bolster, which sudden changes might irritate tissue, for example, during tube retraction. 
     An aspect of some embodiments relates to connecting an ostomy device and a body with a stronger connection force compared to the connection of an external tube to the ostomy device. In some embodiments, the connection between an inner tube portion and an outer tube portion of an ostomy device is weaker than the connection between an external feeding tube and the inner tube portion. A potential advantage of having a weaker connection between the inner tube portion and an outer tube portion is, for example, ensuring that the ostomy device remains within the stomach while allowing detachment of a tube connected to the ostomy device, for example an external feeding tube. In some embodiments, the connection between the ostomy device and the body is at least 30% stronger, for example 75% stronger, 100% stronger, 2000% stronger, or intermediate or greater percentages, than the connection between the ostomy device and an external tube connected to the ostomy device. In some embodiments, the connection between the ostomy device and the body resists axial forces, for example axially forces pulling the ostomy device outside from the stomach. In some exemplary embodiments of the invention, the connection between the device and the body is exemplified by the inner bolster, e.g., its width not deforming under disconnect forces to allow the inner bolster to be pulled out of the stomach. In some exemplary embodiments of the invention, the connection is exemplified by the connection between the external bolster and the tube, such that retracting the feeding tube attached to the external bolster cannot disconnect the external bolster with a resulting possible ingress of the tube into the body. 
     An aspect of some embodiments relates to an ostomy device attached to the stomach and reaching into the small intestine. In some embodiments, an elongated inner tube is connected on one end to the inner portion of the ostomy device, and the other end of the elongated inner tube is placed within the small intestine, for example within the jejunum or in the duodenum. Alternatively, the inner tube portion comprises an elongated inner tube, for example to allow positioning of the inner tube end at the jejunum or in the duodenum. In some embodiments, the inner tube end is positioned, optionally using imaging techniques, in the jejunum or in the duodenum to allow, for example directly feeding into the small intestine. In some embodiments, the length of the elongated inner tube (e.g., the part designated to be inside of the inner bolster) is at least 5 cm, for example, 10, 20, 30 cm or shorter, intermediate or greater lengths. Optionally, when the inner tube is removed, the outer tube (e.g., the ostomy device) does not extend significantly (e.g., extends less than, for example, 2 cm or 1 cm) inwards of the stomach wall. 
     An aspect of some embodiments relates to an ostomy device with an elongated inner tube portion positioned above the stomach content level, for example for stomach decompression. In some embodiments, the inner tube end is positioned within the stomach above the stomach content level, for example to allow gas to exit through the inner tube portion. Optionally, the tube is pre-bent or a stylet is provided to bend the inner tube. Optionally, the inner tube is rotationally locked to the ostomy device so that rotation of such stylet (or insertion of a bent tube) can have a known reach direction in the stomach (e.g., above or below the ostomy device, as desired). 
     An aspect of some embodiments relates to draining the content of a stomach through a replaceable inner tube placed within a fixed ostomy device. In some embodiments, the inner tube comprises an expandable filter at the tube ending placed within the stomach. In some embodiments, the filter comprises openings or gaps that prevent food particles larger than, for example, 90% of the inner tube diameter to enter into the tube from the stomach lumen and potentially clog the tube and/or other parts of a food removal system. 
     In some embodiments, the ostomy device further comprises a grinder placed at least partly within the ostomy device. In some embodiments, the grinder is placed at least partially within an inner tube of the ostomy device. In some embodiments the grinder grinds the food that is found within the ostomy device. Optionally, the grinder grinds the food found within the inner tube. Alternatively or additionally, the grinder extends at least partially out from the tube into the stomach lumen, for example to grind food found within the stomach lumen. 
     In some embodiments, a motor is connected to the external part of the ostomy device. Optionally, the motor is connected to the grinder, for example to rotate the grinder. In some embodiments, rotating the grinder within the inner tube propels food out from the stomach. 
     Before explaining at least one embodiment of the invention in detail, it is to be understood that the invention is not necessarily limited in its application to the details of construction and the arrangement of the components and/or methods set forth in the following description and/or illustrated in the drawings and/or the Examples. The invention is capable of other embodiments or of being practiced or carried out in various ways. 
     Ostomy Device 
       FIG.  1 A  is a simplified schematic cross section of an ostomy device  100  which provides a channel  102  between an internal patient lumen  104  and an outer abdominal surface of the patient  106 , according to some embodiments of the invention. 
     In an exemplary embodiment, ostomy device  100  is a device for insertion during PEG, and lumen  104  is a patient stomach. In some embodiments, channel  102  passes through stomach wall  104   a  and abdominal wall  104   b.    
     In some embodiments, tube  112  is at least partially disposed within a stoma  105  between lumen  104  and patient outer abdominal surface  106 . 
     In some embodiments, ostomy device  100  includes an internal bolster  108  and an external bolster  110  which are each attached to tube  112 . In some embodiments, bolsters  108  and  110  are attached at opposite ends of tube  112 . 
     In some embodiments, inner bolster  108  is larger, in at least one direction perpendicular to an opening of the stoma within lumen  104 , such that inner bolster  108  prevents tube  112  from falling out of stoma  105 . In some embodiments, inner bolster  108  is larger, in at least one direction perpendicular to an opening of the stoma within outer abdominal surface  106 , for example, preventing tube  112  from moving into the lumen. 
     In some embodiments, stoma  105   a  does not follow a straight path between the lumen  104  and outer abdominal surface  106  (e.g. as illustrated in  FIG.  1 B ). In some embodiments, the stoma is non-perpendicular to the lumen wall and/or outer abdominal surface. In some embodiments, a flexible tube (and/or bolster flexibility e.g. a described below) prevents pressure of the device on patient anatomy due to such non-planar patient anatomy. In some embodiments, one or more portions of the inner and/or outer bolster adjust to non-planar patient anatomy (e.g. as described below). In some embodiments, connection between the tube and the inner and/or outer bolster adjusts to non-planar patient anatomy. 
       FIG.  1 B  is a simplified schematic cross section of an ostomy device with a flexible tube  112   a , according to some embodiments of the invention. In some embodiments, the patient moves without device  100  causing discomfort and/or injury, for example, due to tube  112  flexibility. 
     Inner Tube 
     In some embodiments, an ostomy device includes an inner tube providing a channel through which material passes e.g. from outside the patient into a patient lumen.  FIG.  2 A  is a simplified schematic sectional view of ostomy device  200  including an inner tube  214 , according to some embodiments of the invention. In some embodiments, ostomy device  200  is deployed in a patient where an internal bolster  208  is within a patient lumen (not illustrated) and an external bolster  210  is outside the patient and where an outer tube  212  and an inner tube  214  pass between the lumen and the outside of the patient e.g. as illustrated by tube  112  in  FIG.  1 A . 
     In some embodiments, inner tube  214  is disposed within outer tube  212  where inner tube  214  provides a channel  202  from outside a patient to a lumen (e.g. stomach). 
     In some embodiments, inner tube  214  and/or outer tube  212  are flexible, in some embodiments, bending of the outer tube causing the inner tube to bend, for example preventing stress between the two components and/or surrounding tissue. For example, preventing damaging stress (e.g. sufficient to cause necrosis) between outer tube  212  and 
     In some embodiments, inner tube  214  is removable, for example, allowing cleaning of the inner and/or outer tube and/or replacement of inner tube  214 . 
     In an exemplary embodiment, inner tube is sufficiently rigid for insertion of the inner tube  214  into the outer tube  212 . 
     In an exemplary embodiment, inner tube  214  and/or outer tube  212  are sufficiently rigid (e.g. axially rigid) such that movement of the patient and/or movement of the outer bolster and/or pressure of patient tissue on the tubes do not cause buckling and/or collapse of outer tube  212  and/or inner tube  214 . In some embodiments, inner tube  212  is sufficiently rigid to prevent closure of the channel, for example, due to pressure from patient tissue and/or collapse of the outer tube. 
     In an exemplary embodiment, inner tube  112  is part of an inner tube portion which, in some embodiments, is removed and replaced or cleaned e.g. to provide a clean channel.  FIG.  2 B  is a simplified schematic side view of an ostomy device body  200   a  and an inner tube portion  216 , according to some embodiments of the invention. In some embodiments, ostomy device body  200   a  includes an internal bolster  208 , an outer tube  212  and an external bolster  210 . 
     Exemplary Method of Feeding 
       FIG.  3    is a flow diagram of a method of feeding, according to some embodiments of the invention. 
     At  302 , a food reservoir, for example, bag of fluid nutritional supplement, is attached to an ostomy device tube (e.g. inner tube  214 ). Exemplary contents of a food reservoir include liquid (e.g. water) and/or medication and/or any other substance desired for direct insertion into the stomach. 
       FIG.  4 A  is a simplified schematic of a patient  422  with an installed ostomy device  400 , and a feeding device  423 , according to some embodiments of the invention. In some embodiments, feeding device  423  includes a food reservoir  424  and a connector  426 . 
       FIG.  4 B  is a simplified schematic of a patient  422  with an installed ostomy device  400 , where a feeding device  423  is connected to ostomy device  400 , according to some embodiments of the invention. 
     In some embodiments, food reservoir  424  is attached to an inlet  430  of an ostomy device tube (e.g. inner tube  214  illustrated in  FIGS.  2 A- 2 B ) by connector  426 . In some embodiments, connector  426  includes a pipe  428  through which food flows from food reservoir  424  into the patient  422 . In some embodiments, connector  426  and/or fluid reservoir  424  and/or pipe  428  are commercially available components, used with PEG feeding devices. 
     In some embodiments, a feeding device includes a connector which is sized and shaped to fit into an ostomy device outer tube (e.g. outer tube  212 ), optionally forming a seal (e.g. as described herein). In some embodiments, the feeding device connector, when inserted into the ostomy device outer tube (e.g. outer tube  212 ) forms an inner tube of the ostomy device.  FIG.  5 A  is a simplified schematic of a patient  522  with an installed ostomy device  500 , and a feeding device  523 , according to some embodiments of the invention.  FIG.  5 B  is a simplified schematic of a patient  522  with an installed ostomy device  500 , where a connector  526  forms an ostomy device inner tube, according to some embodiments of the invention. In some embodiments, connector  526  (which optionally includes a pipe  528 ) connects a food reservoir  524  to a patient stomach. 
     In some embodiments, a connector (for example connect  526  is configured to release when a dangerous force is applied to an external device (such as tube  528 ). For example when tube  528  is pulled with a force strong enough to pull ostomy device  400  out of a stoma, connector  526  releases tube  528 . Optionally, tube  528  will be pulled away, but device  400  will remain in position. 
     In some embodiments, the method of feeding includes removing an inner tube portion (e.g. inner tube portion  216  illustrated in  FIGS.  2 A- 2 B ) and then attaching a food reservoir to ostomy device  430 . 
     In some embodiments, the connector is directly attached to the food reservoir (e.g. the feeding device does not include a tube).  FIG.  6    is a simplified schematic of a feeding device  623  where a connector  626  is directly attached to a food reservoir  624 , according to some embodiments, of the invention.  FIG.  7    is a simplified schematic of a feeding device  723  where a connector  724 , which includes a tube  714 , is directly attached to a food reservoir  724 , according to some embodiments, of the invention. 
     Returning back to  FIG.  3   , at  304 , food (e.g. fluid food) flows from the food reservoir through a channel (e.g. channel  202 ) into the patient&#39;s stomach. In some embodiments, fluid flows into the stomach under gravity, for example the food reservoir is raised above height of the patient&#39;s stomach. In some embodiments, pressure is applied e.g. to the food reservoir, to dispense fluid into the stomach e.g. the fluid reservoir is a syringe, e.g. a patient or caregiver manually squeezes on the food reservoir. 
     In some embodiments, a feeding device (e.g.  423 ,  523 ,  626 ,  623 ) includes a feeding pump (e.g. a commercially available feeding pump) which regulates, for example, rate and/or quantity and/or pressure of fluid introduced into the patient through the ostomy device. 
     In some embodiments, once feeding is completed, the feeding device is removed, for example, from a body of the device, which remains in situ (e.g. partially within the patient, e.g. the inner tube is removed while the outer tube remains in position at least partially within the stoma). 
     In some embodiments, the inner tube is removed and cleaned or replaced periodically (e.g. every feed, once a day, once a week, once a month, or shorter, or longer, or intermediate time periods). 
     Inner Tube Portion 
     Exemplary Seal Between Inner Tube and Outer Tube 
     Returning back to  FIGS.  2 A- 2 B , in some embodiments, sealing between inner tube  214  and another part of the device prevents flow and/or material accumulating within tube  212  (e.g. outwards from the stomach) around inner tube  214 . In some embodiments, sealing is of an opening into the lumen of the outer tube. In some embodiments, sealing is between inner tube  214  and outer tube  212 . Alternatively, in some embodiments, sealing is between other parts preventing flow within the outer tube around the inner tube, for example, in some embodiments, sealing (e.g. a sealing element) is between the internal bolster (e.g.  208 ) and the inner tube (e.g.  214 ). 
     In some embodiments, e.g. as illustrated in  FIGS.  2 A- 2 B , inner tube  214  closely fits outer tube  212 , preventing flow around inner tube  214 . 
     In some embodiments, device  200  includes a sealing portion between inner tube  214  and outer tube  212 . 
       FIG.  8    is a simplified schematic cross sectional view of a tip of a portion of an ostomy device including a sealing element  832  between an inner tube  814  and an outer tube  812 , according to some embodiments of the invention. In some embodiments, sealing element  832  is a ring of flexible material (e.g. rubber, silicone rubber) around inner tube  814 . In some embodiments, sealing element  832  is mounted on (e.g. attached to) inner tube  814 . Alternatively, in some embodiments, sealing element  832  is mounted on (e.g. attached to) outer tube  812 . 
     In some embodiments, sealing is axial, for example, a seal between inner tube (e.g.  214 ) and outer tube (e.g.  214 ) is between a portion of the inner tube and a tip of the outer tube. 
     In some embodiments, axial sealing is achieved by the inner tube including an expanding sealing element (e.g. elastic and/or compressible and/or inflatable).  FIG.  9 A  is a simplified schematic cross sectional view of a portion of an ostomy device during insertion of an inner tube  914  which includes an expanding sealing element  932 , according to some embodiments of the invention.  FIG.  9 B  is a simplified schematic cross sectional view of a portion of an ostomy device and an expanded sealing element  932 , according to some embodiments of the invention. In some embodiments, once inner tube  914  is inserted such that expanding sealing element  932  emerges from the ostomy device (e.g. as described herein) outer tube  912 , expanding sealing element  932  unfolds or expands to close, e.g. at the stomach end of outer tube  912 , a channel between outer and inner tubes  912 ,  914 . In some embodiments, sealing element  932  and a rim  934  of outer tube  912  are sized and shaped such that pressure P of stomach contents on sealing element  932  holds and/or pushes sealing element to rim  934  of outer tube  912 , improving sealing. 
       FIG.  10    is a simplified schematic of a portion of an ostomy device including a sealing element  1032 , according to some embodiments of the invention. 
     In some embodiments, a portion of the outer tube which in contact with the sealing element is sized and shaped to provide an increased surface area over which sealing occurs.  FIG.  11    is a simplified schematic of a portion of an ostomy device including a sealing element  1132  and an angled outer tube edge  1134  in contact with the sealing element, according to some embodiments of the invention. The angled end of the outer tube, in contrast to a straight cut outer tube end, provides an increased contact area between the outer tube and the sealing element, and potentially a stronger seal associated with this larger surface area. In some embodiments, the angled end of the outer tube enables tube pull-out of the inner tube, for example, by facilitating retraction of the expanding portion of the inner tube. 
     In some embodiments, sealing element  1132  extends beyond outer tube  1112 , the additional surface area under pressure from the stomach contents potentially increasing the force between sealing element  1132  and outer tube edge  1134 . 
     In some embodiments, sealing is between walls of the outer and inner tube, e.g. as illustrated in  FIG.  8    and  FIG.  13 A . Alternatively, or additionally, in some embodiments, sealing is between an edge or rim of the outer tube and the inner tube, e.g. as illustrated in  FIG.  9 B ,  FIG.  10    and  FIG.  11   . In some embodiments, sealing is between a surface of the outer tube and the inner tube, for example, in some embodiments, a sealing element wraps around and/or folds over the outer tube. 
     In some embodiments, a sealing element provides tactile feedback to a user that the inner tube portion is in position. For example, in some embodiments, the inner tube inserts freely until the sealing element engages, resistance of movement of the inner tube is increased. 
     Exemplary Inner Tube which Cleans Outer Tube 
     In some embodiments, the inner tube portion (e.g.  216 ) includes one or more portion for cleaning the outer tube, for example, on insertion and/or removal of the inner tube. In some embodiments, an inner tube sealing element also acts as a cleaning portion. 
     In some embodiments, a sealing element also cleans the outer tube, for example, on insertion and/or removal of the outer tube. For example, in some embodiment sealing element  832  ( FIG.  8   ) is a cleaning and/or sealing element. 
       FIG.  12 A  is a simplified schematic cross sectional view of an inner tube  1214  before insertion into an outer tube which has accumulated residue  1236  (e.g. food residue), according to some embodiments of the invention.  FIG.  12 B  is a simplified schematic cross sectional view of an inner tube  1214  during insertion into an outer tube which has accumulated residue  1236 , according to some embodiments of the invention.  FIG.  12 B  illustrates that residue  1236  has been cleaned from outer tube  1212 , by cleaning portion  1232 , and, in some embodiments, is removed from the ostomy device by pushing into the patient&#39;s stomach (e.g. if inner tube  1214  is inserted to a tip of outer tube  1212 ). In some embodiments, cleaning portion  1232  pushes against outer tube walls, potentially elasticity improving cleaning the outer tube (e.g. cleaning portion is elastic and is elastically compressed within outer tube). Flexibility and/or elasticity of cleaning element/s is illustrated by bending of cleaning elements  1432  in  FIG.  14 A . 
       FIG.  13 A  is a simplified schematic cross sectional view of a portion of an ostomy device where an inner tube  1314  is disposed within an outer tube  1312  which has accumulated residue  1336 , according to some embodiments of the invention.  FIG.  13 B  is a simplified schematic cross sectional view of an inner tube  1314  during removal from an outer tube  1312  which has accumulated residue  1336 , according to some embodiments of the invention.  FIG.  13 B  illustrates that residue  1336  has been cleaned from outer tube  1312 . In some embodiments, residue  1336  is removed from the ostomy device during removal of inner tube  1314 . 
     In some embodiments, an inner tube includes more than one cleaning element (and/or sealing element).  FIG.  14 A  is a simplified schematic cross sectional view of insertion of an inner tube  1414  including multiple cleaning elements  1432  (which, in some embodiments are alternatively or additionally sealing elements) into an outer tube  1432 , according to some embodiments of the invention.  FIG.  14 B  is a simplified schematic cross sectional view of an inner tube  1414  including multiple cleaning elements  1432  after exiting an outer tube  1432 , according to some embodiments of the invention. 
     Additionally or alternatively, in some embodiments, a cleaning device for example, including a cleaning element (e.g. as described above) is used to clean the outer tube. For example, the inner tube is removed; a cleaning tool is inserted and removed (optionally more than one time). 
     Exemplary Valve 
     Returning back to  FIGS.  2 A- 2 B , in some embodiments, ostomy device  200  includes one or more valve. 
     In an exemplary embodiment, a valve  218  is disposed in channel  202 . In some embodiments, valve  218  is a one way valve, for example, allowing flow of food from a food reservoir to the stomach, but preventing back-flow from the stomach outwards. Alternatively, in some embodiments, valve  218  is a one way valve, allowing flow from the lumen out of the ostomy device, but preventing flow into the lumen. In some embodiments, valve  218  is a two directional valve, for example, which allows flow into the lumen of fluid and prevents flow in the opposite direction, below a certain pressure, once reached valve  218  allows flow out of the lumen (e.g. providing venting of the lumen potentially preventing pressure build up in the lumen). 
     In some embodiments, channel is connected to a component including two branches, each including a valve. For example, in some embodiments, a first valve, disposed in a first branch is a one way valve only allowing movement of material into the valve. In some embodiments, a second valve, disposed in a second branch is a one way valve only allowing movement of material out of the valve e.g. once a threshold pressure is exceeded. 
     In some embodiments, the ostomy device (e.g. as described herein) is used to depressurize the stomach, continuously and/or periodically, e.g. by allowing flow of material out of the stomach e.g. gas and/or other stomach contents. 
     In some embodiments, valve  218  remains closed until a feeding device (e.g.  423 ,  523 ) is attached to ostomy device  200 , the attachment of which, in some embodiments, opens valve  218 . Alternatively or additionally, in some embodiments, ostomy device  200  includes a closing element for example, a plug which is inserted into and/or over outlet  230  between feeds. For example, plug  3772  illustrated in  FIG.  37 A . 
     In an exemplary embodiment, valve  218  is located within head  220 . 
     Exemplary Coupling of Inner Tube to Body of Ostomy Device 
     In some embodiments, inner tube  214  is attached at one or more point to one or more portion of a body of the ostomy device  200 , for example, preventing movement of the inner tube. 
     For example, as described previously, in some embodiments, inner tube  214  is coupled (e.g. to outer tube  212  and/or to internal bolster  208 ) by a sealing element, e.g. the inner tube is coupled to the outer tube by a sealing element (e.g. as illustrated in  FIGS.  8 ,  9 A- 9 B,  10  and  11   ). 
     In some embodiments, an inner tube portion  216  includes inner tube  214  and a head  220  which attaches to external bolster  210 . In some embodiments head  220  is rigid. In some embodiments, head  220  is larger in a direction perpendicular to a long axis of the inner tube, providing a larger surface area for attachment to external bolster  210  and/or for attachment to a feeding device. In some embodiments inner tube portion  216  including inner tube  214  and head  220  is a single piece (e.g. molded as a single piece and/or assembled by connecting tube  214  and head  230 ). For example, some embodiments, inner tube  214  and head  220  are formed of the same material (e.g. silicone and/or polyurethane), where inner tube  214  (e.g. due to thickness of walls of the inner tube) is flexible and head  220  is a substantially rigid part (e.g. due to thickness of material in the part), for example forming a stable connector to other portions e.g. external bolster  220  and/or a feeding device. 
     In some embodiments, connection of the inner tube is by connection of the inner tube both at a lumen end of the inner tube (e.g. by a sealing element) and by connection of the inner tube (or inner tube portion) to the external bolster. 
     In an exemplary embodiment, a sealing ring is disposed in a ridge between the outer tube and a connector connecting the outer tube to a bolster (e.g. the inner bolster). In some embodiments, a connector connecting the outer tube to a bolster (e.g. the inner bolster) itself forms a sealing element against the inner tube. 
     In some embodiments, inner tube  214  is coupled to external bolster  210 . In some embodiments, an elastic element couples an inner tube portion (e.g.  216 ) to an external bolster (e.g.  210 ).  FIG.  15 A  is a simplified schematic cross section of a bolster  1510  coupled to an inner tube by an elastic element  1538 , according to some embodiments of the invention.  FIG.  15 B  is a simplified schematic cross section of an inner tube released from an elastic element  1538 , according to some embodiments of the invention. 
     In some embodiments, elastic element  1538  is relaxed when an elastic element cross section smallest dimension, D, is larger than the diameter (D 1 ) of inner tube portion  216 , such that, when inner tube portion  216  is disposed inside elastic element  1538  (e.g. as illustrated in  FIG.  15 A ) the elastic element holds the inner tube portion (with elastic element cross section smallest dimension D 1 &gt;D). To remove inner tube portion  216 , in some embodiments, buttons  1540 ,  1542  are pushed inwards by pressure, P (e.g. applied by a user) which deforms elastic element  1538  into a shape (e.g. a more circular shape) with larger cross section smallest dimension, D 2 . Elastic element  1538  no longer holds inner tube portion  1516  and, in some embodiments, inner tube portion  1516  is free to be removed. 
     In some embodiments, elastic element  1538  holds the inner tube itself (e.g.  214  as illustrated in  FIGS.  2 A- 2 B ). Alternatively, in some embodiments, elastic element  1538  holds an element connected to the inner tube (e.g. head  220  as illustrated in  FIGS.  2 A- 2 B ). 
     In some embodiments, elastic element  1538  holds inner tube portion  1516  in an inlet of inner tube portion  1516 . Returning back to  FIG.  2 B , in an exemplary embodiment, an elastic element  238 , when inner tube portion  216  is inserted into the body of ostomy device  200 , is located within a groove  221  in the inner tube portion. 
     In some embodiments, an inner tube portion is held in position by an external bolster including two portions, a first external bolster portion fitting over the inner tube portion (e.g. overlaps axially inner tube portion head  220 ).  FIG.  16    is a simplified section view of an external bolster including a portion  1610   a  which fits over an inner tube portion  1616 , according to some embodiments of the invention. In some embodiments, external bolster  1610  holds inner tube portion  1616  against the outer tube  1612 . In some embodiments, external bolster  1610  is a flexible component which elastically holds inner tube portion  1616  onto an external bolster second portion  1636  attached to an outer tube  1612 . In some embodiments, when inner tube portion  1616  is removed and/or replaced, external bolster  1610  is detached and/or a portion of the external bolster which holds inner tube portion  1616  is moved. 
     In some embodiments, first external bolster portion  1610   a  is an axially flexible portion, (e.g. as described herein) and second external bolster portion  1636  is sized to prevent movement into the stoma. 
     In some embodiments, an inner tube portion attaches to an external bolster by a protruding portion of the inner tube portion plugging into a hollow (also herein termed recess) in the external bolster (e.g. a plug-socket mechanism). In some embodiments, more than one protrusion plugs, each protrusion into a matching hollow or recess. Alternatively, in some embodiments, the inner tube portion includes one or more recess and the external bolster includes matching plug/s. 
     In some embodiments, one or more part of an inner tube plug is elastic, holding the inner tube plug in position within a bolster socket, for example, inner tube plug includes a by an interference mechanism (e.g. push-lock mechanism). 
     In some embodiments, an inner tube portion is held in position by an interference mechanism (e.g. push-lock mechanism).  FIG.  17    is a simplified schematic cross sectional view of a connection between an inner tube portion  1716  and an external bolster  1710 , according to some embodiments of the invention. In some embodiments, as inner tube portion  1716  is pushed into an outer tube (not illustrated) protrusions of the inner tube portion enter into hollows in the external bolster, elastic portions of the inner tube portion  1740 ,  1742  and/or interlocking shape of the hollows and protrusions holding inner tube portion and external bolster together (e.g. by an interference mechanism (e.g. push-lock mechanism)).  FIG.  33    illustrates a side view of the inner tube portion illustrated in  FIG.  17 ,  1716    inserted into an external bolster  3310 . In some embodiments, a user pushes, P on inner tube portion  1740 ,  1742 , separating at least some inner tube portion and external bolster interlocking portion/s to free the inner tube portion. 
     In some embodiments, inner tube portion is connected indirectly to the external bolster by connection to a rigid connector.  FIG.  18 A  is a simplified isometric view of an ostomy device  1800  including a plug-socket connection between an inner tube portion  1816  and an rigid connector  1810   b , according to some embodiments of the invention. 
       FIG.  18 B  is a simplified schematic section view of an ostomy device  1800  including a plug-socket connection between an inner tube portion  1816  and an rigid connector  1810   b , according to some embodiments of the invention.  FIG.  18 B  illustrates the section taken along line C-C in  FIG.  18 A . 
       FIG.  18 C  is a simplified schematic section view of an ostomy device inner tube portion  1816  including a plug connector, according to some embodiments of the invention. 
     In some embodiments, rigid connector  1810   b  forms a base for connection of flexible devices, for example, external bolster  1810  and/or outer tube  1812  and/or inner tube  1814  (connected via inner tube head  1820 ). In some embodiments, inner tube portion  1816  is held in position by a by an interference mechanism (e.g. push-lock mechanism) where elements of head  1820  interlock with elements of connector  1810   b . In some embodiments, a user pushes, P on inner tube portion buttons  1840 ,  1842 , separating at least some inner tube portion and external bolster interlocking portion/s to remove the inner tube portion from the device. 
     In some embodiments, the connection between the inner tube portion and the external bolster is shaped such that, upon release of the inner tube portion (e.g. by pressing on buttons  1840 ,  1842 ) the inner tube portion moves outwards (e.g. partially) from the inner tube portion. 
     In some embodiment, removal of the inner tube portion includes releasing a connection between the inner tube portion and the external bolster (e.g. pressing on one or more button (e.g. pressing concurrently on two buttons)). In some embodiments, release of the inner tube portion is followed by pulling on the inner tube portion to remove it from the body of the ostomy device. In some embodiments, release and removal of the inner tube portion is performed concurrently e.g. release of the inner tube portion from connection with the external bolster includes pulling on the inner tube portion. 
     In some embodiments, a connector for to an ostomy device is designed to release when a high tension is applied. For example if a inner tube portion is pulled with a force hard enough to pull an inner bolster out of a stoma, connector  1810   b  is configured to release so that inner tube is pulled out of the outer tube, but the outer tube and bolsters remain in place in the stoma. For example, the maximum force before the tube is release may range between 5 to 10 N and/or between 10 to 20 N and/or between 20 to 50 N and/or between 50 to 100N. 
     In some embodiments, a connector is resistant to twisting forces. For example since inner tube portion  1816  is not connected to ostomy device  1800  by a threaded connector, twisting tube portion  1816  will not cause it to be disconnected. 
     Exemplary Anti-Rotation 
     In some embodiments, one or more part of an ostomy device (e.g.  200 ,  1800 , as described herein) includes anti-rotation feature/s to prevent rotation of parts of the device with respect to each other. 
     In some embodiments, anti rotation feature/s ensure that torque applied to a part of the device transfers axially along the device. For example, in some embodiments, rotating external portion/s of the device (e.g. external bolster) causes internal portions of the device (e.g. inner bolster and/or outer tube) to rotate. 
     In some embodiments, an inner bolster is rotated periodically (e.g. by rotating the outer bolster), for example, as part of a care protocol, e.g. to prevent encapsulation of the inner bolster into the stomach wall. 
     In some embodiments, anti-rotation element/s facilitate attachment of feeding device connector/s via rotation, for example, in some embodiments, attachment of a feeding device to an inner tube by rotation (e.g. screw attachment) is assisted by lack of rotation of the inner tube within the device. 
     In some embodiments, one or more anti-rotation element prevents rotation of the inner tube within the device. 
     In some embodiments, one or more anti-rotation element prevents rotation of one or more bolster with respect to the outer tube. 
     In some embodiments, rotation of inner tube portion  216  with respect to the ostomy device body and/or external bolster  210  is prevented by anti-rotation elements on inner tube portion  216  and/or external bolster  210 . In some embodiments, lack of rotation of the inner tube portion prevents twisting and/or tangling (e.g. associated with constricted flow and/or loosening of attachment of the feeding device) of portions of a feeding device attached to the ostomy device (e.g. twisting and/or tangling of feeding device tube  428 ,  528  closing and/or collapsing the tube). 
     In some embodiments, one or more part of an ostomy device (e.g.  200 ,  1800 , as described herein) includes anti-rotation features to prevent rotation of the inner tube within a body of the ostomy device (body of the device including internal bolster, outer tube and external bolster). 
     Returning back to  FIG.  15 A  and  FIG.  15 B  protrusions  1544 ,  1546  of or connected to elastic element  1538  fit within indentations  1548 ,  1550  respectively hold elastic element  1538  in axial and/or rotational position, e.g. preventing rotation of external bolster  1510  and inner tube portion  1520  with respect to each other. Additionally or alternatively, in some embodiments, protrusions  1544 ,  1546  and indentations  1548 ,  1550  prevent movement and/or slipping of elastic element with respect to external bolster  1510 , e.g. during insertion and/or removal of inner tube portion  1516 . 
     In some embodiments, at least a portion of buttons  1530 ,  1542 , fit through holes in external bolster  1510 . In some embodiments, buttons  1530 ,  1542 , additionally or alternatively prevent rotation external bolster  1510  and inner tube portion  1520  with respect to each other. 
     In some embodiments, anti-rotation elements include interlocking elements.  FIG.  20 A  is a simplified schematic of an external bolster  2010  including a hollow  2052 , according to some embodiments of the invention.  FIG.  20 B  is a simplified schematic of an inner tube portion head  2020  including a protrusion  2054 , according to some embodiments of the invention. When inner tube portion head  2020  is within external bolster, protrusion  2054  fits within hollow  2052  preventing rotation of inter tube portion head  2020  with respect to external bolster  2010 . 
     In some embodiments, connected portions include more than one interlocking element. In some embodiments an external bolster includes protrusions and the inner tube portion includes hollows.  FIG.  21    is a simplified schematic side view of an inner tube portion head  2120  including more than one hollow  2156 , according to some embodiments of the invention. In some embodiments, each of a pair of connected pieces includes both hollows and protrusions. 
     In some embodiments, connection between an outer tube (e.g.  212 ) and a bolster include anti-rotation element/s, for example texture and/or interlocking elements.  FIG.  19    is a simplified schematic of an outer tube  1912  including anti-rotation elements  1954 , according to some embodiments of the invention. In some embodiments, anti-rotation elements  1952  are serrations on an outer surface of outer tube  1912  and/or on an outer surface of a connector attached to the outer tube. Alternatively or additionally, in some embodiments, a bolster and/or or connector attached to a bolster includes anti rotation elements, e.g. serrations shaped to interlock with serrations  1954 . 
     Other anti-rotation mechanisms on connecting portions, for example connection between bolster/s and the outer tube and connection of the inner tube to bolster/s and/or the outer tube are envisioned and encompassed by the present invention. For example, matching hollows/protrusions and/or other anti-rotation shapes such as non cylindrical cross section, e.g. triangular, square, octagonal, oval. 
     Exemplary Connection of Flexible Parts 
     In some embodiments, a device outer tube (e.g.  112 ) is flexible and/or portion/s of an internal bolster and external bolster are flexible (e.g. as described herein). 
     In some embodiments, bolsters (e.g.  108 ,  110 ) are connected to tube  112 , where connection between the bolsters and the tube is sufficiently strong such that movement of the patient and/or connection and disconnection of a feeding device (e.g.  423 ,  523 ,  623 ,  723 ) do not cause loosening and/or disassembly of bolsters  108 ,  110  from tube  112 . 
     In some embodiments, secure connection of flexible components is using rigid connectors. 
     In some embodiments, flexible portion/s of each bolster (e.g.  208 ,  210 ) are connected to a flexible outer tube (e.g.  212 ) by one or more rigid connecting element (e.g.  234 ,  236 ). 
     In some embodiments, more than one (optionally rigid) connecting element is used to connect two parts (e.g. flexible parts) where a first connecting element connects to a first flexible part (e.g. a bolster), a second connecting element connects to a second flexible part (e.g. an outer tube) and the connecting elements then connect together (e.g. with a snap lock mechanism, e.g. with a screw mechanism). 
     In some embodiments, a connection between a bolster (e.g.  208 ,  210 ) and the outer tube (e.g.  212 ) includes a first rigid connecting element attached to the outer tube which attaches to a second rigid connecting element attached to the bolster. For example, referring to  FIGS.  2 A- 2 B , connecting element  236  attached to the inner tube connects. 
     In some embodiments, one or more connector attaches to a bolster with a snap lock connection for example, as illustrated by connection between connector  234  and external bolster  210 . 
     In an exemplary embodiment, connector  234  is permanently connected to internal bolster  208 , for example by injection molding and/or adhesion (e.g. by gluing). Alternatively, in some embodiments, connector  234  and internal bolster  208  are one part. In some embodiments, internal bolster  208  and outer tube  212  are one part. 
     In another exemplary embodiment, connector  236  is permanently connected to external bolster  210 , for example by injection molding and/or adhesion (e.g. by gluing). Alternatively, in some embodiments, connector  236  and external bolster  210  are one part. Alternatively, in some embodiments, internal bolster  210  and outer tube  212  are one part. 
     In some embodiments, a same material is used to form both rigid and flexible parts. For example, in some embodiments, a single material component including a flexible bolster and a rigid connector (e.g. molded as one piece) where the bolster is sized such that it is flexible and the connector is sized such that it is rigid. For example, in some embodiments, flexible inner bolster  208  and rigid connecter  234  are one molded part. 
       FIG.  22    is a simplified schematic cross sectional view of a portion of an internal bolster  2208  connected to an outer tube (not illustrated) by interlocking connecting elements  2234   a ,  2234   b , according to some embodiments of the invention. An exemplary axis of symmetry of the device is illustrated as a dash-dot line. In some embodiments a first connecting element  2234   a  connects an (optionally flexible) internal bolster portion  2208  to a second connecting element  2234   b , where second connecting element  2234   b  is connected to the outer tube. In some embodiments, connecting elements  2234   a ,  2234   b , are rigid. In some embodiments, connecting elements  2234   a ,  2234   b , connect by a snap lock mechanism where one of connecting elements  2234   a ,  2234   b , includes one or more protruding portion which interlocks with one or more hollow in the other portion. For example, in some embodiments, first connecting element  2234   a  includes a protruding portion. As connecting element  2234   b  is inserted into connecting element  2234   a , connecting element  2234   a  elastically deflects the elastic return force pushing protruding portion  2234   c  into hollow  2234   d.    
       FIG.  23    is a simplified schematic cross sectional view of an ostomy device, according to some embodiments of the invention. An exemplary axis of symmetry of the device is illustrated as a dash-dot line. In some embodiments, an internal bolster  2308  is permanently attached to outer tube  2312  by gluing and/or injection molding of internal bolster  2308  and outer tube  2312  with an optionally rigid connector  2334 . In some embodiments, connection between an external bolster  2310  and outer tube  2312  is by a snap lock connection between the two parts, e.g. between a rigid connector and a flexible part (e.g. connector  2336  is rigid and external bolster  2310  is flexible) and/or between two rigid parts (e.g. connector  2336  is rigid and external bolster  2310  is rigid). 
     In some embodiments, one or more alternative or additional methods and/or types of connector of attachment between bolsters and the inner tube is used, for example, screw attachment, other types of rotation locking, collet, adhesion (e.g. gluing). 
     Exemplary Connection of Flexible Tube to Rigid Connector/s 
     Referring back to  FIGS.  2 A- 2 B , in some embodiments, connecting elements  234  and  236  connect to the outer tube by contacting the inside of the outer tube  212 . For example, in some embodiments tube  212  is stretched around a connector (e.g.  234 ,  236 ), a reactive force (e.g. elastic reactive force) from the tube holding the connector in place. 
     In some embodiments, tube  212  and/or one or more connector  234 ,  236  are shaped such that a force required to insert the connector into the tube is less than that required to remove the connector. For example, in some embodiments connector/s  234  and/or  236  attach to outer tube  212  by tapered friction fit components, for example, the connectors have one or more angled (e.g. serrated) edge or component. 
     In some embodiments, connection between outer tube  212  and connector/s and/or other parts of the device is by gluing and/or clamping the outer tube between two rigid parts. 
     In some embodiments, connection between a flexible outer tube, for example connected to one or more rigid connector (e.g. tube  212  and connectors  234  and/or  236 ) includes an internal structure (e.g. providing support to the connectors).  FIG.  24    is a simplified schematic of a tube  2412  including a mesh  2412   a  and connectors  2434 ,  2436 , according to some embodiments of the invention. 
     In some embodiments, an ostomy device tube is reinforced by elongated elements (e.g. wires).  FIG.  25    is a simplified schematic of a wire-reinforced tube  2512  and connectors  2534 ,  2536 , according to some embodiments of the invention. 
     In some embodiments, a tube includes an internal structure (e.g. mesh  2412 , elongated elements  2512 ) within a sheath and/or coating (e.g. silicone), for example, the internal structure providing structural strength (e.g. crush resistance and/or axial tensile strength) and the sheath providing sealing. In some embodiments, a tube includes an internal structure with a high percentage of open space on the outer surface of the tube (e.g. more than 30%, more than 50%, more than 80% open space, or lower, or higher or intermediate percentages of open space). For example, in some embodiments, a tube internal structure provides a stable base (e.g. internal structure is of metal) for while high percentage of open space maintains tube flexibility. 
     In some embodiments, an ostomy device tube is reinforced by thickened walls adjacent to and/or overlapping connectors.  FIG.  26    is a simplified schematic cross sectional view of tube  2612  including thickened tube wall portions  2612   a ,  2612   b , and connectors  2634 ,  2636 , according to some embodiments of the invention. 
     Exemplary Support from Bolsters 
     As described previously, bolsters, in some embodiments, reduce and/or prevent moving and/or sliding of the outer tube within the stoma. In some embodiments, one or both bolsters are shaped such that a portion of patient tissue that the bolster contacts is at a distance from the opening of the stoma. A potential advantage may include reduction in irritation and/or inflammation to the delicate tissue around the stoma. 
     In some embodiments, one or more bolster has a shape where a contour of the bolster facing to the patient tissue surface (e.g. the bolster underside contour) extends away from a central axis of the device (central axis passing through the patient stoma) and towards the patient tissue surface such that contact areas of the bolster with the patient tissue surface (abdomen surface for external bolster, stomach lining for internal bolster) are at a distance from the opening of the stoma. 
     For example, in some embodiments, contact point/s between the external bolster and the patient outer abdominal surface is at a distance from an opening of the stoma on the patient outer abdominal surface between 2-30 mm, between 5-25 mm, or between 5-15 mm, or smaller, or larger, or intermediate distances. 
     For example, in some embodiments, contact point/s between the internal bolster and the lumen inner wall is at a distance from an opening of the stoma inside the lumen of between 1-15 mm, and/or between 2-10 mm, and/or smaller, and/or larger, and/or intermediate distances. 
     In some embodiments, the external and/or internal bolster are dome shaped, with the peak of the dome connected to the outer tube, where contact between the bolster and the tissue surface is a ring, for example as illustrated in  FIG.  2 A  and  FIG.  49 B . 
     In some embodiments, contact between the external bolster and the patient outer abdominal surface provides support to the ostomy device. In some embodiments, the external bolster, at least when it is elastically relaxed, includes a shape with a planar end edge, potentially providing a continuous contour of contact with patient outer abdominal surface (e.g. skin surface). For example, returning back to  FIGS.  2 A- 2 B  where contact between external bolster  210  and patient skin is a ring shape corresponding to a rim of the external bolster). In some embodiments, the external bolster includes a dome shape. 
     Alternatively, in some embodiments, e.g. as described herein, the external and/or internal bolster include separate sections. For example, in some embodiments, contact between the bolster and the tissue surface is at more than one discrete points, for example, providing aeration to an area of skin under the external bolster, for example allowing different portions of the stomach lining to support the device at different times (e.g. the inner bolster, in some embodiments, is rotated periodically, portions of the stomach lining contacting the inner bolster changing with the rotation). 
     In some embodiments, an external bolster includes a plurality of petals, for example, as illustrated in  FIG.  18 A  which illustrates a device with three petals  1899 . In some embodiments, the external fixation device has two petals, or more than three petals, e.g. four petals, up to 10 petals, up to 20 petals. 
     Alternatively or additionally, in some embodiments, external bolster includes notches and/or ducts and/or or holes e.g. to provide aeration.  FIG.  33    is a simplified schematic side view of an external bolster including a plurality of notches  3360 , according to some embodiments of the invention. 
     Exemplary Adjustable Length of Ostomy Device 
     In some embodiments, an ostomy device (e.g. as described herein) is deployable into a range of thicknesses of stoma, where bolsters hold the device in position. In some embodiments, a height of one or both bolsters is set, for example, upon installation of the device. 
     Exemplary Adjustable Position of External Bolster 
     In some embodiments, an axial length of an ostomy device (e.g.  100 ,  200 ,  1800  as described herein) is adjustable, for example, when installing the device within a patient and/or when the device is installed within a patient. 
     In some embodiments, a position of attachment of one or more bolster (e.g. the external bolster) with respect to the outer tube is adjustable meaning that a single device is adjustable to different lengths of stoma.  FIG.  27    is a simplified schematic cross section of an ostomy device  2700  with an adjustable tube length within the patient body, according to some embodiments of the invention. A position of an external bolster is adjustable from position illustrated by  2710  on tube  2712  when patient outer abdominal surface is at  2706  to a position illustrated by  2710   a.    
       FIG.  28 A  is a simplified schematic section view of a portion of an ostomy device, according to some embodiments of the invention.  FIG.  28 A  illustrates an embodiment where an outer tube  2812  is connected to an external bolster  2810  by a connector  2836 . In some embodiments, external bolster  2810  is a flexible component coupled to connector  2836  by elastic tension of external bolster  2810 . In some embodiments, the position of external bolster  2810  in an ostomy device axial direction is adjustable e.g. by manually moving the bolster. 
     In some embodiments, a position of an external bolster (e.g.  2810 ) with respect to a connector (e.g.  2836 ) and/or an outer tube (e.g.  2812 ) is adjustable by a screw mechanism. For example, external bolster  2810  and a connector  2836  include matching thread. 
     In some embodiments, connection between external bolster  2810  and connector  2836  where a position of external bolster  2810  on connector  2836  is optionally axially adjustable, is strengthened by interlocking elements (e.g. by increasing resistance to axial movement of the external bolster).  FIGS.  28 B- 28 D  are simplified schematic cross sectional views of exemplary interlocking connection between external bolster and connector, according to some embodiments of the invention.  FIGS.  20 A- 20 B  also illustrate interlocking connection between an external bolster  2010  and a portion connected to the external bolster  2020 ; interlocking threads  2090 ,  2091 . 
     In some embodiments, the external bolster is connected to one or more additional part and/or is not attached to a tube connector. For example, in some embodiments the external bolster is connected to an inner tube portion head (e.g. as described herein). 
     In some embodiments, position of the external bolster on the tube is adjustable by up to 50 mm, or up to 30 mm, or 10-40 mm, or lower, or higher, or intermediate ranges or distances. 
     Exemplary Adjustable Position of Inner Bolster 
     In some embodiments, a position of one or more portion of an inner bolster is adjusted, for example, adjusting a minimum dimension between the inner and outer bolsters. In some embodiments, adjustment is during installation, and/or once the ostomy device is installed (e.g. periodically). In some embodiments, the inner bolster is adjusted from outside the patient. 
     For example, referring to  FIG.  32 A , in some embodiments, an element attached to one or more petal  3208   a  (and e.g. running through the inner bolster is used to adjust a deflection of the petal (e.g.) from a relaxed position illustrated by  3208   a . In some embodiments, the element is connected to bumper  3258  and, for example, pulling on the element deflects the petal, releasing the element reduces deflection of the petal. 
     Exemplary Axial Length of Device Related to Pressure on Bolsters 
     In some embodiments, an axial length of the tube within patient tissue and/or a minimum separation between an inner and an external bolster changes in reaction to a pressure applied to the internal and/or external bolsters by the patient tissue therebetween, for example, pressure related to swelling and/or reduction in swelling of patient tissue. 
       FIG.  29 A  is a simplified schematic cross section of an ostomy device  2900  with adjustable axial length, according to some embodiments of the invention. Ostomy device  2900  is installed within a stoma  2905 , with internal and external bolsters,  2908  and  2910  respectively holding a tube  2912  in position within stoma  2905 . A length of tube  2912  within the stoma is L 1 . 
     In some embodiments (e.g. post operatively) patient tissue swells around stoma  2912 .  FIG.  29 B  is a simplified schematic cross section of an ostomy device  2900  with adjustable axial length within swollen tissue, according to some embodiments of the invention. In some embodiments  FIG.  29 B  illustrates the device of  FIGS.  29 A- 29 B  where patient tissue has swollen, increasing a length of stoma  2905  to L 2  (L 2 &gt;L 1 ). In some embodiments, under pressure from patient tissue internal bolster  2908  and/or external bolster  2910  ( FIG.  29 B  illustrates both) bend (optionally elastically) and/or pivot to increase a length of tube  2902  within stoma  2905  (e.g. by reducing a height of the bolster/s above the lumen wall/patient outer abdominal surface). Alternatively or additionally, in some embodiments, tube  2902  is axially elastic, elastically increasing a tube length e.g. upon tissue swelling and/or decreasing a tube length e.g. upon subsidence of tissue swelling. 
       FIG.  30    is a simplified schematic section view of a portion of an ostomy device where a protrusion of the device above a patient outer abdominal surface is adjustable, according to some embodiments of the invention. In some embodiments, adjustment is by bending and/or deflection of the bolster.  FIG.  30    illustrates elastic bending of an external bolster  3010  to change a tube length within the patient. This adjustment corresponds to a change in height of the device above the patient outer abdominal surface. External bolster  3010  bends to a second position  3010   a  decreasing a height of the device above a patient outer abdominal surface from H 1  to H 2 , corresponding to a change in height of ΔH=H 2 −H 1 . In some embodiments, change in height (ΔH) is 1-15 mm, or 2-10 mm, or 3-7 mm, or up to 5 mm, or up to 10 mm, or lower, or higher, or intermediate ranges or lengths. 
     In some embodiments, a bolster includes protrusions which are unattached, for at least a portion of the protrusion, and, in some embodiments, each protrusion deflects and/or bends (optionally elastically) to a different extent. 
     In some embodiments, the external bolster includes elastically deflectable petals which contact the patient outer abdominal surface at discrete points (e.g. petals  1899 ). In some embodiments, each petal  1899  elastically deflects a different extent, for example, the bolster to provide support in the case of non planar patient anatomy. 
     In some embodiments, different portions of an external bolster bending to different extents allow the device to fit an abdominal outer surface.  FIG.  31 A  is a simplified schematic section view of an external bolster  3110  bending to fit an abdominal outer surface  3106 , according to some embodiments of the invention. First petal  3199   a  bends to a larger extent than second petal  3106 , fitting external bolster  3110  to a non-planar topography of abdominal outer surface  3106 . Similarly, in some embodiments, different portions of an inner bolster deflect to different extents, fitting the inner bolster to non-planar topography of a lumen inner wall. 
       FIG.  31 B  is a simplified schematic section view of a device where an external bolster  3120  is bending to fit the device to a patient anatomy, according to some embodiments of the invention. In some embodiments, a lumen inner wall  3104   a  and an abdominal outer surface  3106  are non-parallel and, in some embodiments, external bolster petals  3199   a ,  3199   b  bend to different extents to fit the device to the patient anatomy. In some embodiments, bending of bolster portions is in addition to bending of a flexible outer tube. 
     Additionally or alternatively, in some embodiments, different portions of an inner bolster deflect to different extents, fitting the inner bolster to non-parallel patient anatomy. 
       FIG.  32 A  is a simplified schematic section view of a portion of an elastic internal bolster  3208 , according to some embodiments of the invention. 
       FIG.  32 A  illustrates elastic bending of an internal bolster  3210  to change a tube length within the patient. This adjustment corresponds to a change in height of the device above the patient outer abdominal surface. Petal  3264  bends to a second position  3264   a  decreasing a depth of the device within the lumen (e.g. stomach). In some embodiments, change in depth (ΔD) is 1-15 mm, or 2-10 mm, or 3-7 mm, or up to 5 mm, or up to 10 mm, or lower, or higher, or intermediate ranges or lengths. In some embodiments, internal bolster is designed to have a maximum change in depth, the device locking and becoming rigid. In some embodiments, internal bolster includes (e.g. for each petal of internal bolster) a bumper  3258  which is shaped to prevent bending (e.g. by contacting another portion of the device) of the bolster beyond a maximum change in depth, as illustrated by internal bolster  3208   a.    
     In some embodiments, such elasticity of the internal bolster prevents embedding of the internal bolster within the stomach wall. 
     In some embodiments, one or more compressible component for example, a sponge, a balloon, a spring (e.g. ring-shaped) disposed between the inner bolster and the lumen inner wall. 
     In some embodiments, a dimension (e.g. axial extent of the component between the inner bolster and the lumen wall) of the compressible component is adjustable during installation (e.g. a size of the component is selected before insertion at installation). In an exemplary embodiment, an axial dimension of the compressible component is adjustable after installation, for example, from outside the patient, e.g. without needing an endoscopic procedure. 
       FIG.  32 B  is a simplified schematic cross sectional view of an inner bolster  3208 , a lumen inner wall  3204   a  and a compressible component  3209  therebetween, according to some embodiments of the invention. In some embodiments, an elongated element  3209   a  is connected to compressible component  3209  and passes through an outer tube  3212  (alternatively, or additionally, in some embodiments, compressible component  3209  passes through an inner tube  3212  and/or a stoma  3205  and/or another abdominal incision). In some embodiments, an axial extent of compressible component  3209  is adjusted by pulling or releasing elongated element  3209   a  optionally, compressible component is pulled and/or released and then fixed in position, e.g. by a ratchet mechanism. In some embodiments, compressible component  3209  is elastic (e.g. it is a spring) optionally including plastic. 
     In an exemplary embodiment, an external bolster (e.g. as described herein) provides more axial elasticity than an internal bolster (e.g. as described herein), for example, with a maximum ΔH at least double a maximum ΔD. In some embodiments, external bolster holds ostomy device (e.g. as described herein) in position by applying gentle pressure to the patient skin. 
     In some embodiments, adjustable position of the external bolster and/or elasticity of the external bolster mean that the device is well fitting, e.g. at all times, and/or meaning that the device has a low profile, e.g. a small height above the patient outer abdominal surface, for example, 0.2 mm-18 cm, 0.5 mm-5 cm, 0.5 mm-3 cm, or lower, or higher, or intermediate ranges or values. 
     Exemplary Removal 
     Exemplary Method of Removal 
       FIG.  34    is a flow chart of a method of ostomy device removal, according to some embodiments of the invention. 
     At  3402 , an inner bolster (e.g. as described herein) is dismantled into more than one piece. In some embodiments, connector/s coupling portions of the internal bolster are loosened and/or removed, for example, releasing the portions. In some embodiments, the portions of the inner bolster then move away from the inner tube, for example, due to movement of the stomach and/or stomach contents. In some embodiments, a user moves the outer tube, for example, rotates and/or shakes the outer tube (e.g. by moving the external bolster) to separate the de-coupled inner bolster portions and/or move them from the inner tube. In some embodiments, removing the outer tube moves the inner bolster portions away from the outer tube. 
     In an exemplary embodiment, a user dismantles the internal bolster externally, for example, without approaching the device from within the lumen, (e.g. without performing an endoscopic procedure). In some embodiments, the dismantled portions of the internal bolster are free within the lumen (e.g. stomach), for example, then passing through the digestive system. Alternatively, in some embodiments, the disassembled portions are then removed from the lumen (e.g. by pulling through the stoma). 
     At  3404 , in some embodiments, once the internal bolster is dismantled, the outer tube and external bolster are removed e.g. by a user pulling on the external bolster. 
     Exemplary Dismantling of Internal Bolster 
     In an exemplary embodiment the petals substantially do not overlap, for example, substantially do not overlap axially (overlap being where petals contact each other in a planes approximately perpendicular to the long axis of the tube). In some embodiments, petals at most overlap axially with adjacent (e.g. radially adjacent) petals. 
     In some embodiments, residue (e.g. stomach contents) coating the inner bolster (e.g. coating contact areas between petals) prevents and/or slows disassembly of inner bolster petals. In some embodiments, the inner bolster includes one or more notch and/or inlet separating portions of the inner bolster e.g. between petals. For example, reducing an area of contact between petals potentially reduces friction of movement of petals away from each other. 
     In some embodiments, the internal bolster includes a plurality of petals which are held by one or more connectors (e.g. in some embodiments, petals are held between two or more connectors) where disconnecting the connectors decouples the petals. 
       FIG.  35 A  is a simplified schematic side view of an internal bolster  3508  including a plurality of petals  3564 , according to some embodiments of the invention.  FIG.  35 B  is a simplified schematic side view of a dismantled internal bolster  3508  including a plurality of petals  3564 , according to some embodiments of the invention. 
     In some embodiments, petals  3564  do not overlap. In some embodiments, each petal overlaps with one or both radially adjacent petals. In some embodiments, axial overlap between petals  3564  is small, for example, less than 20%, or less than 10%, or less than 5%, or less than 3%, or lower, or higher, or intermediate percentages, of a petal surface area is in contact with another petal, before dismantling. 
     Referring back to  FIG.  18 A , in an exemplary embodiment petals  1864  are separate, where the inner bolster includes notches  1865  separating petals  1864 . 
     In some embodiments, internal bolster  3508  dismantles into a plurality of parts (e.g. including petals  3564 ) upon release of a connecting cap  3562  which holds portions of the internal bolster together. In some embodiments, one or more part holding portion/s of the internal bolster together is rigid. 
     In an exemplary embodiment, internal bolster portions are held between two rigid parts. Referring back to  FIG.  18 B , a cap  1862  and connector  1834  hold between them internal bolster  1808 . 
     In some embodiments, cap  3562  holds internal bolster petals  3564  onto an internal bolster shaft  3566  and, in some embodiments, upon removal and/or of cap  3562 , petals  3564  are released. In some embodiments, internal bolster shaft  3566  is also a connector to outer tube  3512 . Alternatively, in some embodiments, internal bolster shaft  3566  (an optionally rigid part) attaches to a connector connecting internal bolster  3508  to outer tube  3512 . In some embodiments, the internal bolster shaft  3566  hardness is at least 40 shore A, for example 50 shore A, 60 shore A, 70 shore A or 90 shore A. In some embodiments having a rigid internal bolster shaft  3566  allows for example, to resist bending and/or twisting of the internal bolster  3508  moves through the esophagus into the stomach lumen. 
     Exemplary Dismantling Using a Tool 
     In some embodiments, dismantling of the internal bolster is by use of a tool. In some embodiments, a tool engages a connector connecting portions of the inner bolster, for example, disconnecting and/or loosening the connector, for example, by withdrawing and/or applying pressure and/or torque to the connector. 
     In some embodiments, cap  3562  is detached from petals  3564  and/or from an internal bolster shaft  3566  by a tool inserted through outer tube  3512  or inner tube  3514 . 
     In some embodiments, a tool accesses a hollow within a connector and applies a force (e.g. a torque) to the connector via the hollow (e.g. hollow  2291   FIG.  22 ,  2391     FIG.  23   ). 
     In some embodiments, an outer tube and/or an inner tube portion include a separate channel for insertion of a dismantling tool.  FIG.  36    is a simplified section view of a portion of an internal bolster including a tool channel  3674  for a dismantling tool  3668 , according to some embodiments of the invention. In some embodiments, channel  3674  is within inner tube  3612 . Alternatively, in some embodiments, inner tube portion (e.g.  216 , e.g. as described herein) includes two channels, a first channel for food and a second channel for insertion and/or guiding of a dismantling tool. 
     Exemplary Dismantling by Breaking an Attachment Element 
     In some embodiments, dismantling is by breaking of a cap attachment  3670 . In some embodiments, cap attachment  3670  is broken by pressure applied by a tool  3668 . In some embodiments, once cap attachment  3670  is broken, the tool is inserted further towards the lumen, for example, detaching cap  3662  from attachment  3670 . In some embodiments, cap hingendly opens e.g. around an interlocked portion  3676 , for example, before disengaging from other parts of the internal bolster (e.g. petals  3664 ). 
     In some embodiments, tool  3668  is a part sized and shaped for insertion into channel  3674 . In some embodiments, tool  3668  is a readily available medical tool, for example, a needle (e.g. syringe needle). In some embodiments, cap attachment  3670  is broken by application of hydraulic pressure (e.g. applied by a syringe). For example tool channel  3674  may run along and/or parallel to a feeding tube  3614 . 
     In some embodiments, an inner tube portion is shaped to accommodate tool channel  3674 .  FIG.  37 A  is a simplified schematic side view of an inner tube portion  3716  where inner tube  3714  is non-cylindrical, according to some embodiments of the invention. In this embodiment, tool channel  3774  is defined in a space between the outer tube (not illustrated) and inner tube  3714 . 
     In some embodiments, an inner tube portion inlet includes a tool guide.  FIG.  37 B  is a simplified schematic of an inner tube inlet including a tool guide  3678 , according to some embodiments of the invention. In some embodiments, a plurality of tool guides is disposed along a length of the outer tube. Alternatively, in some embodiments,  FIG.  37 B  illustrates an inner tube portion including two channels, a feeding channel  3702  and a tool channel  3774 . 
     Exemplary Turn Mechanism Dismantling 
     In some embodiments, an internal bolster is dismantled by turning and/or rotating a part with respect to another part, for example, by rotating (e.g. unscrewing) an internal bolster cap (e.g.  3562 ), for example, from a connector (e.g.  3566 ). 
       FIG.  38 A  is a simplified schematic section view of an internal bolster with a screw dismantling mechanism, according to some embodiments of the invention. 
       FIG.  38 B  is a simplified schematic side view of a screw dismantling mechanism tool  3868 , according to some embodiments of the invention. 
     In some embodiments, thread  3880  on a chamber within internal bolster, for example, within an internal bolster cap (e.g. cap  3862 ) matches thread  3882  on tool  3868 . In some embodiments, to dismantle internal bolster  3808 , tool  3868  is inserted through a tube (e.g. an inner and/or outer tube), and rotated to dismantle internal bolster  3808 . 
     In an exemplary embodiment, a tool for dismantling an internal bolster includes applies a torque onto a top portion  3993  of the internal bolster.  FIG.  39    is a simplified schematic of a portion of a bolster and an expanding dismantling tool  3968 , according to some embodiments of the invention. A dash-dot line illustrates an exemplary axis of symmetry of the device. In some embodiments, during insertion of dismantling tool  3968  arms  3967  of the tool are elastically compressed, once the arms exit outer tube the arms expand and a user applies torque to the top of the internal bolster by pulling and rotating the tool. In some embodiments, arms fit into a screw drive  3991  (e.g. two arms fit into a slot screw drive, four arms fit into a Phillips head screw drive). 
     In some embodiments, a tool including one or more expanding portion is used to apply force (e.g. not only torque) to the top of the internal bolster. 
       FIG.  40 A  is a simplified schematic side view of a disassembly tool  4068 , according to some embodiments of the invention.  FIG.  40 B  is a simplified schematic side view of a disassembly tool inserted into an internal bolster, according to some embodiments of the invention. In some embodiments, a torque multiplier is attached to disassembly tool to increase the torque which is applied. In some embodiments, disassembly tool  4068  includes a connector for attachment  4068   a  to a torque multiplier. 
     In some embodiments, disassembled portions of the internal bolster are removed from the stomach by pulling on element/s attached to the internal bolster portions.  FIG.  41 A  is a simplified schematic side view of an internal bolster where each petal  4164  of the internal bolster is attached, according to some embodiments of the invention. In some embodiments, internal bolster  4408  is a single piece including separations  4188   a  between petals  4164  where, in some embodiments, separations extend but do not reach a central area  4410   c  of the inner bumper. In some embodiments, separations  4188   a  are cut into inner bumper  4408  after the inner bumper is formed as a single piece. 
       FIG.  41 B  illustrates removal of disassembled internal bolster portions through an outer tube  4112  by pulling, force P on an elongated element (not illustrated) according to some embodiments of the invention. 
     Alternatively in some embodiments, internal bolster petals  4164  are attached one to another by connectors, for example, each petal is attached to adjacent petals by connectors (e.g. hinges and/or flexible portions which allow the petals to disassemble from each other) and, for example, a single petal is attached to an elongated element used to withdraw a chain of connected petals. In some embodiments, petal connectors are of the same material as the petals. Alternatively, in some embodiments, petal connectors are of different material to the petals. 
     Also illustrated in  FIG.  41 A  are hollows  4191  (e.g. screw drive) of a rotation disassembly mechanism. 
     In some embodiments, the internal bolster is dismantled by pulling on one or more elongated element  4188 . 
     Alternatively, in some embodiments, the internal bolster is sufficiently flexible to be removed by pulling on the tube from outside the stomach. Alternatively, in some embodiments, the device is dismantled during an endoscopic procedure where, for example, the internal bolster is detached from the tube and, is optionally then removed through the esophagus or the internal bolster attached to the tube is removed through the esophagus. 
     Installation 
     Exemplary Method of Installation 
       FIG.  42    is a flow chart of a method of ostomy device installation, according to some embodiments of the invention. 
     At  4201 , a stoma between a lumen (e.g. stomach) and an outer abdominal surface of the patient is created, for example, using an endoscopic procedure and/or laparoscopy. Alternatively, in some embodiments, a stoma is pre-existing. 
     In some embodiments, a stoma by making an initial channel with a needle (or other narrow instrument) and creating a stoma by pulling a dilator through the initial channel. In an exemplary embodiment a dilator is connected to one or more portion of the ostomy device and, for example, as the dilator is pulled through patient tissue, portions of the device are installed (e.g. outer tube is installed into the stoma). 
     In some embodiments, a dilator is pulled and/or pushed through patient tissue and the tube is then inserted into the stoma. 
     At  4202 , one or more portion of the ostomy device is inserted into the lumen (e.g.  104 ), for example, into the stomach by way of the esophagus. In some embodiments, one or more portion of the ostomy device and/or a dilator and/or pushing device are inserted into the lumen prior to creation of a stoma. In some embodiments, the pushing device is a guiding element which is sized and shaped to allow, for example to guide at least part of the ostomy device from the stomach lumen to the outer surface of the body through the stoma. Optionally, the pushing device is configured to push aside tissue as it passes through the stoma. In some embodiments, an internal bolster (e.g.  108 ) and optionally an outer tube (e.g.  112 ) are inserted into the lumen (e.g.  104 ). 
     In some embodiments, an internal bolster has hinged and/or flexible and/or elastic portions (e.g. petals as described herein) which move towards each other to contact a cross section of the bolster, for example, allowing the bolster to be inserted into the lumen through the esophagus. 
       FIG.  49 A  is a simplified schematic cross sectional view of an inner bolster  4908  attached to an outer tube  4912  being inserted through an esophagus  4986 , according to some embodiments of the invention. In some embodiments, petals  4964  bend and/or rotate towards each other, optionally elastically, contracting a cross section of inner bolster  4908 . 
       FIG.  49 B  is a simplified schematic cross sectional view of an inner bolster  4908  attached to an outer tube  4912  where the outer tube is installed within a stoma  4905 , according to some embodiments of the invention. 
     Alternatively or additionally, in some embodiments, the internal bolster is inserted into the stomach (e.g. through the esophagus) in several portions and the portions are then assembled within the stomach. 
     In some embodiments, the outer tube is also inserted into the stomach (e.g. through the esophagus), the outer tube is then attached to the internal bolster. Alternatively, in some embodiments, the internal bolster attached to the outer tube is inserted into the stomach through the esophagus. 
     At  4204 , in some embodiments, the outer tube is inserted into the stoma (e.g. as described above). In some embodiments, the outer tube (previously inserted into the lumen) is pushed and/or pulled through the surgically created stoma from the stomach. 
     In some embodiments, the tube is pulled through the stoma by pulling on one or more elongated element, (e.g. including wire and/or cord and/or cable and/or thread) coupled to the outer tube. In some embodiments, once the outer tube is in position, the elongated element is removed from the outer tube. 
     In some embodiments, a pushing device which is too large to be pulled through the outer tube is used to pull the outer tube (and optionally an internal bolster attached to the outer tube) through the stoma. In some embodiments, the pushing device is a guiding element which is sized and shaped to allow, for example to guide at least part of the ostomy device from the stomach lumen to the outer surface of the body through the stoma. In some embodiments, once the outer tube is in position, the pushing device is removed from the lumen (e.g. by pulling on an elongated component connected to the pushing device and extending out of the esophagus).  FIG.  43    is a simplified schematic cross sectional view of an outer tube  4312  being pulled into a stoma  4305  by a pushing device  4380 , according to some embodiments of the invention. In some embodiments a pulling force, F is applied to elongated element  4382   a  by a user to pull outer tube  4312  into position. In some embodiments a second elongated element  4382   b  is attached to pushing device  4380  and is used to extract pushing device  4380  from the patient (e.g. through the esophagus). 
     In some embodiments pushing elongated element  4305  (where elongated element optionally includes a dilator with a tapered portion) attaches to pushing device  4380  by a screw mechanism or a different connection mechanism e.g. snap lock, e.g. gluing. 
     In some embodiments, a single elongated element is used to pull the pushing device for insertion of the outer tube and is used to remove the pushing device from the lumen.  FIG.  44 A  is a simplified schematic side view of a pushing device  4480 , according to some embodiments of the invention.  FIG.  44 B  is a simplified schematic side view of a pushing device  4480  threaded with an elongated element  4482 , according to some embodiments of the invention. In some embodiments, change in direction of elongated element  4482  within pushing device  4480  is sufficient to hold the pushing device in position on the elongated element allowing the device to be moved by pulling on either end of elongated element  4282 . 
     In some embodiments, channels within pushing device  4480  change in radius along a length of the pushing device. In some embodiments, pushing device  4480  includes two components, A and B, where A plugs into B, channels C illustrated in fitting into plugs of D (or plugs C fitting into channels D). In some embodiments B fits into the tube and A plugs into portion B. 
     In some embodiments, the outer tube includes a sharp end and/or a sharp attachment is fitted to the outer tube and/or a tapered portion (also herein termed dilator), and the stoma is created by the insertion of the inner tube. 
     In some embodiments, a portion of a pushing device is sized to protrude from the outer tube.  FIG.  45 A  is a simplified schematic side view of a pushing device  4580  including a tapered end  4584 , according to some embodiments of the invention.  FIG.  45 B  is a simplified schematic side view of a pushing device within an outer tube  4512  attached to an internal bolster  4508  where a portion of the pushing device protrudes through the outer tube, according to some embodiments of the invention. In some embodiments, tapered end  4584  which protrudes from outer tube  4512  gradually opens and/or dilates stoma as the outer tube is inserted, for example reducing trauma of installation of the device on the stoma. 
       FIG.  46 A  is a simplified schematic side view of a pushing device  4680 , according to some embodiments of the invention.  FIG.  46 B  is a simplified schematic side view of a pushing device within an outer tube  4612  attached to an internal bolster  4608  where a portion of the pushing device protrudes through the outer tube, according to some embodiments of the invention. 
     In some embodiments, pushing device  4680  attaches to portions of the device using a screw attachment or other type of attachment optionally other than sizing (e.g. snap-lock connection, adhesion etc.). In some embodiments, pushing device  4680  includes thread  4681 , for example, for screw-mechanism attachment for attachment to a portion of the device (e.g. inner bolster  4608 ). Alternatively, in some embodiments, additional or alternative connection between the pushing device and the device are employed, e.g. snap lock, gluing. 
     In some embodiments, an incision is made from the stomach to the outer abdominal surface of a patient with a threaded needle. A loop  4683  (e.g. of thread, wire, cord) is attached to a suture and pulled through the incision, a tapered end  4484  (also herein termed “dilator”) of the pushing device acting as a dilator, dilating tissue e.g. to create a stoma. 
     At,  4206 , in some embodiments, an outer tube within the stoma is connected to a bolster. In some embodiments, once the outer tube is in position the external bolster is attached to the outer tube. 
       FIG.  47    is a simplified schematic side view of an ostomy device  4700  where an external bolster  4710  is being attached to an outer tube  4712 , according to some embodiments of the invention. In some embodiments, pulling force F 1  applied to an external element and a pushing force F 2  acting on external bolster  4710  act to connect outer tube  4712  (optionally connected to an internal bolster  4708 ) to external bolster  4710  e.g. with a by an interference mechanism (e.g. push-lock mechanism). Alternatively, in some embodiments other forces are applied to connect components e.g. torque to connect components with screw connectors. 
     In some embodiments, the internal bolster is attached to the outer tube after the tube is inserted into the stoma. The external bolster is then connected to the outer tube. 
     In some embodiments, the outer tube is not inserted into the stoma from the lumen, the outer tube (optionally pre-attached to an external bolster) is inserted from outside the patient into the stoma, and, in some embodiments, the internal bolster is then connected to the tube.  FIG.  48    is a simplified schematic section view of device installation including insertion of an outer tube  4812  into a stoma  4805 , according to some embodiments of the invention. In some embodiments, outer tube  4812  and an internal bolster  4808  are connected by concurrent insertion of the outer tube  4812  into stoma  4805  by applying a force F 2  and pulling by a force F 1  applied to an elongated element  4882 . 
     Alternatively, in some embodiments, outer tube  4812  is inserted into a stoma, from outside the patient, followed by connection of bolsters to the outer tube. 
     In some embodiments, an internal bolster connected to an outer tube is inserted into the stomach through the esophagus in a first direction (bolster first) with respect to the esophagus walls and then rotated inside the stomach for insertion in the opposite direction (outer tube first) to first direction (with respect to the stoma walls). 
     In some embodiments, the internal bolster is permanently attached (e.g. glue and/or injection molding) to the tube and/or internal bolster and outer tube are one part. 
       FIG.  49 C  is a simplified schematic cross sectional view of an internal bolster  4908  connected to an outer tube  4912  being inserted through an esophagus  4986 , according to some embodiments of the invention. 
     In some embodiments, one or more portion of internal bolster  4908  bends and/or pivots (e.g. one or more petal is hingendly attached) contracts under pressure exerted by walls of the esophagus  4986 . In an exemplary embodiment, petals  4964  elastically deflect towards outer tube  4912 . 
     In some embodiments, once an internal bolster connected to an outer tube (e.g.  4912  and  4908 ) reach the lumen (e.g. stomach) the internal bolster connected to the outer tube is positioned and inserted into a stoma, tube first.  FIG.  49 D  is a simplified schematic cross sectional view of an outer tube  4912  within a stoma connected to an internal bolster  4908 , according to some embodiments of the invention.  FIG.  49 B  illustrates an inner bolster  4908  where the bolster contacts patient tissue (stomach wall) at a distance from an opening of stoma  4905  into the stomach. 
     Returning now to  FIG.  42   , at  4208 , once the body of the device is installed, an inner tube portion is inserted. 
     Exemplary Materials 
     In some embodiments, an internal bolster and/or external bolster and/or outer tube (e.g. as described here) include and/or, and the internal bolster and/or outer tube optionally includes material in one or more portion. In some embodiments, an inner tube portion includes silicone and/or polyurethane, optionally with radiopaque material in one or more portion. In some embodiments, rigid portion/s of the device for example, connectors (e.g. as described herein) include plastic/s, for example acrylonitrile butadiene styrene (ABS), polyamide (PA), polycarbonate (PC), polyethylene (PE). 
     Exemplary Detailed Method of Use 
       FIGS.  50 A- 50 B  are flow charts of a method of use of an ostomy device, according to some embodiments of the invention. 
     At  5002 , in some embodiments, a stoma is surgically created between a desired lumen (e.g. stomach) and a patient outer abdominal surface. In some embodiments, the stoma site measured (e.g. a stoma position is selected based on measurement), for example, imaging, e.g. ultrasound and/or endoscopy and/or CT and/or MRI and/or X-ray imaging. 
     At  5004 , in some embodiments, the surgically created stoma is measured, optionally during creation of the stoma, for example, a length of the stoma is measured. In some embodiments, during surgical creation of the stoma, an element (e.g. needle) is inserted between the stomach and the outer abdominal surface of the patient. In some embodiments, markings on the needle (e.g. numbers, different colors) are used to measure the stoma (e.g. a stoma length). In some embodiment, measurement is taken from within the lumen (e.g. using endoscopic visualization) and/or from outside the patient. In some embodiments, the needle is anchored inside the stomach and measurement of a stoma length (e.g. using markings on the needle) is only taken at the abdominal outer surface of the patient. In some embodiments, a sheath with markings is inserted into the stoma, and measurement is made using the markings on the sheath. In an exemplary embodiment, a needle within a sheath (the sheath including markings) is inserted into tissue. In some embodiments, measurement of the stoma is alternatively or additionally made during imaging. 
     At  5006 , in some embodiments, a device is selected, optionally based on measurement of the stoma. In some embodiments, a length of an outer tube is selected based on measurements, for example, of the stoma length and/or of patient anatomy around the stoma (e.g. stoma site). In some embodiments, a length of the outer tube is selected to approximately for a length of the stoma, for example, a length of the tube being 10% or 20% or 30% or 40% longer or shorter than the stoma. In some embodiments, a length of the tube is selected to be longer than the stoma, for example % or 20% or 30% or 40% longer, for example, to allow for swelling of tissue surrounding the stoma. In some embodiments a size and/or shape and/or type of inner and external bolster are selected based on measurement and/or on treatment type and/or other patient parameters. In some embodiments, the device is selected based on an age and/or weight of a patient and/or prescribed feeding protocol (e.g. time, amount) and/or prescribed feed type. 
     At  5008 , in some embodiments, one or more portion of the device (e.g. as described herein) is inserted into a desired patient lumen (e.g. the stomach). 
     At  5010 , in some embodiments, the outer tube is inserted into the stoma. Optionally, in some embodiments insertion of the outer tube into patient tissue creates and/or or dilates the stoma. 
     At  5012 , in some embodiments, one or both bolsters are attached to tube, where at least one bolster is attached to the tube after the tube is inserted into the stoma. 
     At  5014 , in some embodiments axial dimensions of the device are adjusted, for example, compensating for miss-match between a length of the outer tube and length of the stoma. For example, in some embodiments, position of an inner bolster and/or outer bolster are changed with respect to the outer tube, thereby changing a minimum dimension between the bolsters. In some embodiments, compensating is by up to 2 mm, or up to 5 mm, or up to 10 mm, or lower, or higher, or intermediate values or ranges. 
     At  5016 , the device is optionally adjusted and/or self adjusts, for example to fit the patient. Optionally, the device may be passively adjusted (e.g. self adjusting) and/or actively adjusted. For example the distance between an inner and an outer bolster (e.g. the axial extent of the device) may be lengthened and/or shortened. Alternatively or additionally, an angle between a bolster and an axis of a tube may be adjusted. Alternatively or additionally, a radial extent of a petal and/or a radial distance between a stoma and a contact zone of a petal and tissue may be adjusted. 
     In some embodiments, the axial dimension of the device may be adjusted. For example, as described in  FIGS.  27 ,  28 A- 28 D,  29 A- 29 B,  30 ,  31 A- 31 B and  32 A- 32 B . 
     In some embodiments, one or more bolsters may be adjusted be mounted on a variable angle joint. For example, the bolster may passively adjust itself to balance pressure around the stoma. Alternatively or additionally, the bolster may be actively adjusted. For example, a variable angle joint may have a control mechanism. Optionally a user may set the angle of the bolster according the needs (for example due to the anatomy of the patient and/or the placement of the stoma). After the angle of the bolster has been set, the bolster may be tightened to retain it at the chosen angle. 
     In some embodiments the width and/or the stiffness of a bolster and/or an associated petal and/or a force of a bolster on the patient and/or around the stoma may be adjusted. For example, petals may be elastic and self adjust to the shape of the surface of the tissue around the stoma. Alternatively or additionally, there may be a mechanism to tighten or loosen a bolster and/or a petal thereof. For example a threaded element and/or a wedge may be used to change the angle at which a petal extends from a bolster. 
     In some embodiments a bolster may be adjusted in use to temporarily reduce pressure at a certain location (for example where there is swelling and/or sensitivity and/or infection and/or a sore). Alternatively or additionally, a device may be adjusted prior placement and/or during placement according to the particular characteristics of a patient that are known and/or have been measured. 
     In some embodiments, an inner tube is inserted into the outer tube, forming a channel between outside the patient and the lumen. In some embodiments, the inner tube extends through the stomach into the jejunum. In some embodiments, the inner tube during and/or after insertion, is connected to the external bolster. In some embodiments an opening of the tube (for example the outer opening) may be attached to, covered by and/or within the bolster (for example the external bolster). Alternatively or additionally a tube may extend through a bolster. For example the inner tube may extend outward through the external bolster. For example the inner tube may extend outward from the patient less than 1 cm and/or between 1 cm to 1 m and/or between 1 m to 5 m or further. 
     In some embodiments, insertion and/or positioning of parts of the device into the lumen and/or stoma is assisted by imaging e.g. endoscopic imaging, ultrasound imaging. In some embodiments, one or more portion of the device includes radiopaque material and/or radiopaque marker/s and imaging includes, e.g. X-ray and/or CT and/or MRI. 
     At  5018 , in some embodiments, the patient is fed, at discrete feeds or continuously by attaching a food reservoir to the ostomy device, such that, at  5020 , food flows from the reservoir into the patient through the inner tube. In some embodiments, a food pump controls dispensing of food from the food reservoir into the patient. 
     At  5022 , in some embodiments, various care protocols are performed by a caregiver and/or the patient e.g. periodically, for example, in some embodiments, the device is rotated (e.g. by rotating the outer bolster) periodically, for example to prevent encapsulation of the inner bolster into the lumen (e.g. stomach inner wall), for example, to change portions of tissue under pressure from the inner and/or outer bolster. For example, in some embodiments, an outer portion of the device is periodically cleaned. 
     In some embodiments, fit of the device to the patient anatomy is periodically checked and/or adjusted. 
     For example, in some embodiments, freedom of movement of the device in situ is manually checked, in order to ascertain what level of pressure the inner bolster is applying to the lumen inner wall. In some embodiments, points of contact of the outer bolster and/or tissue around and/or under the outer bolster and/or a level of elastic deflection of outer bolster is visually checked to ascertain pressure levels of the bolster/s on patient tissue (e.g. outer abdominal surface and/or stomach lining). 
     For example, in some embodiments, upon patient weight change and/or a change in level of tissue swelling and/or signs of physiologically unacceptable pressure between patient tissue and the device, a minimum axial separation between bolsters is adjusted (e.g. as described herein), for example, by a caregiver. 
     In some embodiments, the inner tube is flushed and/or massaged to prevent blockage. 
     At  5024 , in some embodiments, the inner tube is removed and the cleaned and/or replaced while the bolsters and outer tube remain in position within the patient. 
     At  5026 , for example, when an ostomy device is no longer required and/or when the ostomy device requires replacement, the inner bolster is dismantled by disassembling the inner bolster into a plurality of portions. In some embodiments, the dismantled portions of the internal bolster are free within the lumen (e.g. stomach), for example, then passing through the digestive system. Alternatively, in some embodiments, the disassembled portions are then removed from the lumen (e.g. by pulling through the stoma). 
     Alternatively, in some embodiments, the internal bolster is sufficiently flexible to be removed by pulling on the tube from outside the stomach. Alternatively, in some embodiments, the device is dismantled during an endoscopic procedure where, for example, the inner bolster is detached from the tube and, is optionally then removed through the esophagus or the inner bolster attached to the tube is removed through the esophagus. 
     At  5028 , in some embodiments, the outer tube and outer bolster are then removed. In some embodiments, the stoma then naturally closes. Alternatively, in some embodiments, the stoma is then surgically closed. Alternatively, in some embodiments, a new ostomy device is installed. 
     In some embodiments, the ostomy device (e.g. as described herein) is used for purposes other than PEG feeding. For example, jejunum feeding, collection of waste from the colon, connection of two internal lumens. 
       FIG.  51    is a photograph of a device inserted at an angle through simulated tissue in accordance with some embodiments of the current invention. Optionally the device includes an external bolster attached by variable angle joint to a tube. In some embodiments, a PEG device may include a variable angle joint, for example a ball joint. Optionally, the ball joint may join an outer bolster base  5110  and/or petals  5199   a ,  5199   b  and  5199   c  to a tube  5102 . Optionally petals  5199   a ,  5199   b  and/or  5199   c  contact a surface  5106  of tissue  5104 . For example, petals  5199   a ,  5199   b  and/or  5199   c  may prevent bolster  5100  and/or tube  5102  from being pulled into the stoma. Alternatively or additionally, one or more extensions may contact a surface  5106  of tissue  5104 . For example, the extension may prevent bolster  5100  and/or tube  5102  from being pulled into the stoma. For example an extension may have a dome shape. 
     In some embodiments, a variable angle joint may improve the fit of a bolster  5100  to an outer surface  5106  of a patient. For example, sometimes an opening, a stoma and/or a tube  5102  may pass through tissue  5104  at an acute angle  5151   a  to surface  5106 . The ball joint may allow adjustment of an angle  5151   b  between an axis  5153   b  of bolster  5100  and an axis  5153   a  of tube  5102 . Optionally rotation of the variable angle joint may at least partially compensate for the difference between angle  5151   b  and a line normal to surface  5106 . For example compensation make axis  5153   b  of bolster  5100  closer than axis  5153   a  of tube  5102  to a normal to surface  5106 . 
       FIGS.  52  and  53    are perspective and cross sectional views of a device with a pivoting external bolster inserted at an angle to an external body surface in accordance with some embodiments of the current invention. In some embodiments bolster base  5110  has the form of a skirt that rotates over a ball joint  5255  over a range of angles. 
     In some embodiments angle  5151   b  may be passively adjusted to equalize the force on petals  5199   a ,  5199   b  and  5199   c . For example, base  5110  may float freely on joint  5255 . Optionally, when there is an increased force on one of the petals  5199   a ,  5199   b  or  5199   c  the excess force will create a torque rotating bolster  5100  away from that side. The resulting rotation optionally balances the forces on the petals  5199   a ,  5199   b  and  5199   c . Optionally angle  5151   b  between bolster  5100  and axis  5153   a  may help compensate for short term changes in surface  5106 , for example swelling on one side of the stoma. Alternatively or additionally, there may be a biasing mechanism that biases the bolster to a certain position, for example coaxial to the tube. For example an elastic element for example a spring and/or an elastomeric element may bias the angle such that deflections from the biased angle require progressively more force for progressively larger deflections. 
     In some embodiments, friction between bolster base  5110  and joint  5255  may be chosen to allow movement to compensate for variations in angle  5151   a  of axis  5153   a  of tube  5102  and surface  5106  but to avoid shifting of tube  5102 . Optionally, friction between bolster base  5110  and joint  5255  may be low allowing compensation to short term movements for example due to movement of the patient and/or due to movement of internal organs of the patient. Alternatively or additionally, a variable angle joint may include an adjustment mechanism. For example, an adjustment mechanism may tighten the joint making it resist changing its angle once set. For example, the adjustment mechanism may include a tightening means such as a screw. For example the adjustment mechanism may limit the angular range of the bolster. 
       FIG.  54    is a block diagram of an adjustable bolster  5100  in accordance with an embodiment of the current invention. In some embodiments, one or more extensions  5499   a ,  5499   b  are attached to a bolster base  5410 . Base  5410  optionally swivels on a joint  5455 . Joint  5455  is optionally attached to a tube  5402 . 
     In some embodiments, when bolster  5400  is in use, tube  5402  passes through a stoma and/or an opening in tissue  5404 . Optionally extensions  5499   a ,  5499   b  contact a surface of tissue  5404  and/or prevent bolster  5400  from being pulled into the stoma and/or the opening. 
     In some embodiments, swiveling bolster  5400  may allow it to adjust to a surface of tissue  5404 . For example, if tube  5402  is at an angle to the surface of tissue  5404 , bolster  5400  may swivel so that a plane of extensions  5499   a ,  5499   b  is parallel to the surface. For example, bolster  5400  may swivel so that an axis of bolster  5400  is perpendicular to the surface of tissue  5404 . 
     Optionally an adjustor  5493  mediates the connection between bolster base  5410  and joint  5455 . For example adjuster  5493  may include a screw that when tightened increase a force of contact and/or a coefficient of friction between joint  5455  and base  5410 . Increasing friction may for example fix the position of base  5410  with respect to joint  5455  hindering further swiveling. Alternatively or additionally, adjuster  5493  may allow swiveling, but increase a resistance thereto. 
     In some embodiments, a tube  5402  may be flexible. For example, swiveling of bolster  5400  around joint  5455  may compensate for an angle between an outer axis of tube  5402  and a normal to the surface of tissue  5404 . Alternatively or additionally, tube  5402  may be rigid and/or have a right cylindrical form. 
     Measuring Tissue Placing Outer Tube 
       FIG.  55 A  is a flow chart illustration of a measuring the depth from a base site to a location inside a living organism in accordance with some embodiments of the current invention. For example the device may be used to measure a distance between two ends of a stoma and/or a port and/or a passageway into living tissue and/or a lumen of living organism. Optionally a marker (optionally including graduations) is inserted into the organism to the measurement location. For example, the marker may indicate a distance to a guide element. Optionally the guide element is placed at a base site. The marker may be positioned by viewing and/or sensing in the lumen. For example, placement of the marker may be without stressing the lumen tissue. The distance from the location in the organism to the base site is optionally measured by reading a graduation of the marker at the location inside the organism. For example, the method may be used to measure the length of a stoma and/or a port from an opening outside the lumen to an opening on the inner wall of the lumen. 
     In some embodiments, an instrument including the graduated marker and the guide may be supplied  5501 . For example the graduated marker may be positioned on a distal portion of a stylet. The stylet optionally includes a pointed distal end. For example the graduated marker may be located on the stylet proximal to the point. Optionally the guide may be located on the stylet proximal to the marker. For example, the guide may include a shoulder of the stylet and/or the graduations may indicate a distance between the marker and the shoulder of the stylet. Optionally, the marker may be inserted  5502  into the organism. For example, distal point of the stylet and/or the marker may be inserted into the organism in a vicinity of the measurement location for example by piercing of and/or insertion through tissue surrounding the location. 
     In some embodiments, the guide may be positioned  5504  at the base site. A graduation on the marker nearest to the location is optionally read  5506 , indicating the distance from the location to the guide and/or base site. For example, the stylet may be inserted until the shoulder is positioned  5504  at a skin insertion site including the base site. A graduation nearest the location to be measured inside the organism may be identified and/or read  5506  to indicate a distance between the internal location and the base site. 
     In some embodiments a single device may be used for forming and measuring a stoma. For example, the device may include an insertion needle and a graduated sleeve. The needle point may form the distal tip of the device. Proximal to the point graduations on the sleeve may indicate a distance to a guide connected to the sleeve proximal to the graduations. For example, the guide may include a shoulder. Optionally the needle is used to pierce tissue surrounding a lumen (for example the stomach and/or intestine). The needle and/or marker are optionally inserted into the lumen. Optionally piercing and inserting form a stoma between an insertion point on the skin and the lumen. In some embodiments, once the sleeve has entered the lumen, the needle point may be pulled back into the sleeve, for example to prevent the needle point from further puncturing the lumen. 
     In some embodiments, the sleeve is inserted until a guide of the device reaches an insertion point on an outer surface (e.g. skin) of the subject. For example, the guide may include a proximal shoulder of the device and/or the device may be fully inserted until the shoulder is adjacent to (e.g. flush to) the skin surface. Alternatively or additionally, a guide may include a second set of graduations (indicating, for example how far the sleeve has been inserted into the subject). The sleeve is optionally partially inserted into the subject until the second set of graduations is adjacent to the skin of the subject. 
     In some embodiments, the distal end of the sleeve protruding into the lumen may be viewed. For example, an viewing device may be supplied in the lumen (for example the imaging device may include a camera mounted on an endoscope). The viewing may optionally be from outside (e.g. through an opening during operation on the lumen). The viewing device may be used to identify and/or read a marking on the sleeve closest to the lumen wall. The marking may include graduation optionally indicates the length of the stoma from the skin surface to the inner wall of the lumen. 
     In some embodiments, the stoma created in the measuring process and/or the sleeve may be used for insertion of an ostomy device, for example as described hereinabove in  FIGS.  50 A- 50 B . For example, the graduated measurement sleeve may be used as a channel for inserting a drawstring into the lumen for drawing a pulling device and/or loop into the lumen (for example through a mouth and/or a trachea). For example, the ostomy device may be passed through and/or placed in the stoma created during the measuring. Optionally, a measurement of the length of the stoma, for example made as described in  FIGS.  55 A- 55 B , may be used to select a low profile ostomy device. For example, the first device inserted and/or anchored in the stoma (for example the first access port (e.g. PEG tube) inserted into the stoma) may be a low profile device. Optionally measuring the stoma and insertion of the initial port (e.g. PEG) may be accomplished in a single procedure. 
     In some embodiments, a stoma length may be measured without compressing the associated tissue. For example, the measurement of stoma length of uncompressed tissue may be used a safe length for a PEG. For example a PEG fitted to the safe length may fit snugly with no and/or minimal and/or negligible and/or small pressure on the tissue. 
     In some embodiments, a stoma length may be measured before inserting a PEG device. For example, based on the measurement, an initial PEG device placed during the procedure producing the stoma may be a low profile device. 
     Reference is now made to  FIG.  55 B  depicting a process for measuring the depth of the stomach lumen from the outer surface of the skin, according to some embodiments of the invention. 
     According to some exemplary embodiments, an endoscope is inserted through the esophagus into the stomach at  5530 . In some embodiments, the endoscope is connected to a camera for visualizing the inner surface of the stomach wall. In some embodiments, the endoscope is inserted to select a target site for creating a stoma at the stomach wall. 
     According to some exemplary embodiments, a measurement device having a needle is inserted through the outer surface of the stomach into the stomach lumen at  5534 . In some embodiments, the measurement device punctures the stomach wall at a stoma target site that was selected using the endoscope. Optionally, the insertion of the measurement device creates the stoma opening. In some embodiments, the measurement device is inserted until reaching a stopping point on the measurement device. In some embodiments, the stopping point is positioned outside of the body and optionally marks a measuring reference. 
     According to some exemplary embodiments, once the stopping point on the measurement device is in contact with the outer surface of the skin, the needle within the measurement device is retracted at  5536 . In some embodiments, retraction of the needle leaves an empty lumen within the measurement device. 
     According to some exemplary embodiments, the markings on the measurement device that are positioned within the stomach lumen are visualized at  5538 . In some embodiments, the markings are visualized from within the stomach lumen by the endoscope. Alternatively, the markings are visualized by from outside using an imaging technique, for example an x-ray imaging technique, an MRI or CT. In some embodiments, the markings are color coded markings, optionally with dividing stripes between adjacent markings to allow, for example better visualization. In some embodiments each of the color markings encodes for a different depth or distance from the outer surface of the stoma. Optionally, each of the color markings encodes for a different depth or distance from the stopping point of the measurement device. 
     According to some exemplary embodiments, based on the marking that is positioned in the closest proximity to the inner surface of the stomach wall, an ostomy device is selected at  5540 . In some embodiments, the length of the selected ostomy device matches the length of the marking, optionally the color coded marking that is visualized to be in the closest proximity to the inner surface of the stomach wall. In some embodiments, each color coded marking indicates a different length of an outer tube. 
     According to some exemplary embodiments, a pushing device is inserted into the stoma at  5542 . In some embodiments, the pushing device is a guiding element which is sized and shaped to allow, for example to guide at least part of the ostomy device from the stomach lumen to the outer surface of the body through the stoma. In some embodiments, a leading thread or a leading wire is inserted from the outside through the stoma and the lumen of the measurement device into the stomach lumen. In some embodiments, the endoscope is connected to the leading thread and pulls the leading thread out from the mouth. In some embodiments, a loop positioned at a pushing device end is connected to the leading thread. In some embodiments, the leading thread is connected to a loop of a dilator of a pushing device, for example dilator  5880  shown in  FIG.  58 A . In some embodiments, after the connection of the pushing device to the leading thread, the leading thread pulls the pushing device through the esophagus and through the stoma. In some embodiments, the dilator is pulled through the stoma, while the inner bolster is kept inside the stomach lumen. 
     According to some exemplary embodiments, the leading thread is inserted through the lumen of the measurement device into the stomach and is connected to a pushing device already placed in the stomach. Alternatively, the pushing device is held within the stomach by the endoscope.  FIGS.  56 A- 56 C  are perspective views of measurement sheaths and inserter needles in accordance with some embodiments of the current invention. In some embodiments a distal end of a measurement device forms a sharp tip  5601 . Optionally the tip is connected to a needle shank  5602 . For example, shank  5602  may pass through a sleeve  5605   a . The sleeve optionally includes a tapered distal section  5604 . Along the sleeve and/or needle, there may be a graduated section  5606   a . Proximal to graduated section  5606   a  there is an optional guide  5610   a.    
     In some embodiment pointed tip  5601  and/or shank  5601  are optionally hollow. Alternatively or additionally a pointed tip and/or shank may be solid. 
     In some embodiments, graduated section  5606   a  may include color coded bands. Optionally the bands may be one adjacent to another. Alternatively or additionally, there may be space between the bands. Alternatively or additionally other visible markers may be used such as lines and/or symbols and/or changes in the shape such as protrusions and/or etched portions and/or indentations. Active graduations may be supplied, for example visible and/or radio beacons may be used. Optionally a device may include multiple resolution graduations. For example low resolution color bands may be divided up by high resolution divisions for example lines. Multiple resolutions markings may allow for more precise measurements. Markers may include for example numbers and/or symbols. 
     In some embodiments a guide  5608   a  may include a shoulder. For example, at a time of measurement, sheath  5605   a  may be inserted through tissue into a lumen until the shoulder (e.g. guide  5608   a ) is flush with the skin of a user. Alternatively or additionally the proximal guide may include a graduated section. For example, the probe is inserted into tissue until a portion of the proximal graduated section is visible outside the organism and/or tissue being measured. The proximal graduation optionally will be read from outside the tissue to indicate what portion of the needle was passed into the tissue. Optionally, there may be a single internal marker (on the distal portion of the measurement device). The internal marker may be aligned with a location to be measured. For example, a viewing device (for example an endoscope) may be inserted into a lumen. The measurement device may be inserted through the wall of the lumen until the marker is seen through the endoscope flush with the wall of the lumen. With the marker located at the lumen wall the distance between the marker and the base site may be read from graduations on the proximal side of the measuring device. 
     In some embodiments a measurement device will be used to measure the length of a stoma for insertion of a PEG tube. For example, sharp tip  5601  and/or sleeve  5605   a  are inserted through abdominal skin and/or muscle and/or other tissue and/or through a stomach wall into a stomach cavity until a distal edge of guide  5608   a  is flush with the outer abdominal wall and/or part of graduated portion  5606   a  passes through the stomach wall into the stomach cavity. Optionally an imaging device in the stomach is used to identify the color band of graduated portion  5606   a  that is located at the edge of the inner wall of the stomach. For example, the length along sheath from guide  5608   a  to the color coded band may be the length of the stoma from the abdominal wall to the inner wall of the stomach. The needle may be removed from sheath  5605   a  and/or sheath  5605   a  may remain in the stoma for use in installing a PEG. For example a guidewire may be inserted through sheath  5605   a  into the stomach and/or pulled through the lumen to an opening (e.g. the mouth) where it may be connected to an insertion device (e.g. a dissector an obturator and/or a dilator) and/or a PEG tube which are optionally pulled into the stoma. Alternatively or additionally a marker may be on or in a needle. The marker may be visible through the sheath which is optionally transparent and/or translucent and/or made of a mesh through which the needle can be seen. The distance may be measured from the guide to the marker on the needle. In some embodiments, since the marker is position in the location through visual sighting and not by a force on the tissue, the tissue may be measured in an unstressed state. 
     Optionally in some embodiments measurement segments may be between 6 to 8 mm. For example, the length of the measurement segments may match the axial expandability of the PEG tube. For example for a PEG tube with a flexible bolster as described herein, the flexible bolster may adjust and/or compensate for changes of length of less than 10 mm. For a bolster with less ability to compensate, the graduations on the measurement tool (e.g. the measurement segments e.g. the color bands) may be smaller to get a more precise measurement. For example, the precision of the measurement may range between 30 to 50% of the axial compensation ability of the PEG and/or between 50 to 80% and/or between 80% to 100% and/or between 100% to 130% of the axial compensation ability of the PEG and/or bolsters. Alternatively or additionally a hollow needle may be used as a measuring device without a sheath. For example, bands may range between 0 and 1 mm long and/or between 1 to 4 mm long and/or between 4 to 8 mm long and/or between 8 to 10 mm and/or between 10 to 15 mm long. 
     In some embodiments a sheath handle  5610   a  is provided. For example, handle  5610   a  may be used for manipulation, insertion and/or extraction of sheath  5605   a . In some embodiments a needle handle  5612   a  is provided. For example, handle  5612   a  may be used for manipulation, insertion and/or extraction of needle tip  5601  and/or shank  5602 . 
       FIGS.  56 B- 56 C  illustrate an alternative embodiment of a measurement tool with a needle fully inserted and partially retracted respectively. For example the embodiment of  FIGS.  56 B- 56 C  may include an alternative graduation portion  5606   b  guide  5608   b  and/or sheath handle  5610   b  and/or needle handle  5612   b.    
     In some embodiments a measuring device, for example for a PEG stoma, may include a needle of 16G and ranging between 14 to 18G. Optionally sheath may be 13G and/or range between 11 to 15G. Alternatively, a needle may be wider and thinner depending of the size of the lumen and the thickness and resistance of its walls for example the needle and sheath may differ for measuring different organs and/or lumens and/or the needle may be smaller for children than for adults. For example the needle may range between 10 to 13G and/or 19 to 22G and/or 22 to 28G. The sheath may range between 1 to 3 G less than the needle. Optionally for a PEG stoma a needle and/or sheath may range between 80 to 100 mm in length and/or between 30 to 80 mm and/or between 100 to 130 mm. 
     In some embodiments, an endoscope is used to see a marker from inside the living organism. For example in  FIG.  56 B  an endoscope  5619  is used to see that a marker is just protruding through in inside wall of a lumen. The distance between guide  5608   b  and the graduation is the length of the stoma formed through tissue  5620 . 
     According to some exemplary embodiments, as shown in  FIG.  56 C  each measurement segment of measuring device  5603 , for example measurements segments  5632  and  5634  have a different distinctive color. In some embodiments, the distinctive color allows, for example to clearly visualize the measurement segment color using a visualization device placed in the stomach. Alternatively, each measurement segment has a distinctive pattern and/or shape and/or texture, for example to allow differentiation between the measurement segments. In some embodiments, a dividing zone  5636  is positioned between the measurement segments to allow, for example a better separation between adjacent segments. In some embodiments, the dividing zone is a gap between adjacent measurement segments. Alternatively the dividing zone has a visibly distinctive pattern and/or shape and/or color to indicate a separation region between the adjacent measurement segments. 
     In some embodiments, the width of each measurement segment is between 2 millimeters to 12 millimeters, for example between 2-6 millimeters or between 5-8 millimeters. 
     In some embodiments, the measuring device  5603 , in inserted through the stoma until measuring point  5630  is attached to the outer surface of the skin. 
     In some embodiments, visualizing the measurement segments, allows to match an ostomy device with a length that matches the length indicated by the measurement segment. 
     In some embodiments, as explained above the, having wide measurement segments allows, for example to match ostomy device with a length that matches a range of measured lengths between the inner surface of the stomach lumen and the outer surface of the skin and not a specific length. In some embodiments, this allows for example to fix the ostomy device between the stomach lumen and the outer surface of the skin with a partial movement range to prevent stretching of the tissue or application of tension forces on the ostomy device after fixation. 
     Details of Flexible Resistant Outer Bolster 
       FIGS.  57 A- 57 B  are schematic views of elastic distances in accordance with some embodiments of the current invention. In some embodiments elastic distances are sized and shaped to provide even pressure between a bolster and tissue of a subject over significant axial and/or rotational displacements. Optionally, an elastic element may have a form that distributes stresses evenly along the element. For example, the distance may have the shape of a petal. The distancer is optionally curved. For example the distance may be concave towards a tissue interface and/or concave away from the tissue interface. 
     In some embodiments, three independent spacers may interact with tissue independently at contact interfaces distributed radially around a bolster. The elastic elements optionally leave a large portion of the area around the bolster open to allow air circulation. Alternatively or additionally the bolster may tilt optionally providing compensation for irregular swelling and/or twisting movements and the like. Alternatively or additionally there may be more or fewer than three spacers. For example in some cases a single elastic element may contact the tissue in locations distributed around the tube. Alternatively or additionally a rigid or flexible spacer may be connected to a flexible central bolster (for example the central bolster may be tiltable and/or move axially and/or it may be mounted to an elastic member such as a spring. Optionally the flexible central bolster and/or extender may compensate for tilting of the tube in respect to the tissue, regular or irregular swelling of the tissue and/or axial movement of the tube with respect to the tissue. 
     In some cases, movements of a person having a port opening to an internal tissue or lumen (e.g. a PEG) cause the position of the port to move with respect to the skin. Alternatively or additionally changes in the tissue (for example swelling) may cause displacements and tilting between the tissue of a subject and a PEG and/or a bolster. In some embodiments, an elastic spacer is designed to compensate for displacements and/or provide even interactive forces between the bolster and the skin. The compensation is optionally adjusted according to the shape, thickness and/or material properties of the flexible element. Optionally, the elastic element is shaped and sized to allow airflow around the stoma and/or to space the interface between the skin and the elastic element radially away from the stoma. Examples of elastic spacer elements in accordance with some embodiments are supplied for example by petals and/or extensions as described herein (for example in  FIGS.  18 A- 18 C,  28 A- 28 D,  29 A- 29 B,  30 ,  31 A- 31 B,  51 ,  52 ,  53 ,  54 ,  57 A and  57 B ). 
       FIGS.  57 A- 57 B  are schematic illustrations of a tube  5723  (e.g. a PEG tube) passing through tissue  5720  of a user and having an external bolster  5721  including elastic distancing elements  5722   a  and  5722   b  in accordance with an embodiment of the current invention. Optionally, elastic elements  5722   a ,  5722   b  are curved. For example, the curvature may distribute stresses evenly along the element. For example stresses may be caused by displacements of a tissue interface  5726   a ,  5726   b  with respect to bolster  5721  and/or tube  5723 . 
     In some embodiments, elastic elements  5722   a  and/or  5722   b  have a significant portion  5724   a  and/or  5724   b  that is aligned to the axis of tube  5723 . For example, an aligned portion may be oriented at an angle ranging between 0 to 10 degrees and/or between 10 to 30 degrees and/or 30 to 60 degrees to the axis of tube (e.g. tube  5723 ) at a connection (e.g. connection  5728   a  or  5728   b ) between the tube and the element. For example, an aligned portion may include between 10 to 30% and/or between 30% to 60% and/or between 60% to 100% of the elastic element. Optionally, axial displacements and/or tilting between tissue  5720  and tube  5723  may be absorbed as axial stress on aligned portion  5724   a  or  5724   b.    
     In some embodiments, an elastic element (for example element  5722   a ) may be concave away from tissue  5720 . Alternatively or additionally an elastic element (for example element  5722   b ) may be concave towards tissue  5720 . Alternatively or additionally a elastic element may be wavy and/or angled for example with some sections concave upwards and/or downward and/or undefined concavity. 
     In some embodiments, a surface of flexible element (e.g. element  5722   a  or  5722   b ) may make a non-right angle with an axis of a tube (e.g.  5721 ) at a connection (for example connection  5728   a  or  5728   b ). For example, the angle between the flexible element and the axis of the tube at the connection may range between 0 to 20 degrees and/or between 20 to 45 degrees and/or between 45 to 70 degrees and/or between 70 to 80 degrees. For example the angle between the flexible element and a mean outer surface of tissue  5720  at the insertion location may range between 10 to 20 degrees and/or between 20 to 45 degrees and/or between 45 to 70 degrees and/or between 70 to 90 degrees. 
     In some embodiments, a flexible element may be curved. Optionally, a curved element may distribute stress and/or strain more evenly than a straight and/or horizontal element (for example similarly to an arch that may distribute stress more evenly than a horizontal lintel). For example a path between two points along a curved element may be longer than a straight line path between the points. For example, a distance along element  5722   a  between connection  5728   a  and interface  5726   a  is longer than a straight line between connection  5728   a  and interface  5726   a . For example, a distance along element  5722   b  between connection  5728   b  and interface  5726   b  is longer than a straight line between connection  5728   b  and interface  5726   b . For example, the path along a flexible element between the interface and a connector to a tube and/or a bolster may range between 10% to 15% and/or between 15% to 25% and/or between 25% to 50% and/or between 50% to 100% and/or greater than 100% longer than a straight line path between the connection and the interface. In some embodiments, distributing the stress along a longer element may allow an element to compensate for larger displacements (for example like a coil spring). Distributing the stress may allow the elastic element to compensate for larger displacements without buckling. 
     In some embodiments a flexible element may have an even thickness. For example an elastic element may be long and slender and/or flat and thin. Alternatively or additionally, the flexible element may be thickened a certain locations. For example, the element may become thicker where there is higher strain. For example, the elastic element may be thicker at a joints and/or a bend. Optionally, the elastic element may be thicker near the connection between the elastic element and the tube (for example element  5722   a  may be thicker near connection  5728   a  and/or element  5722   b  may be thicker near connection  5728   b ). Optionally an elastic element may become thinner as it spreads radially away from the tube. 
     In some embodiments an elastic element (e.g. element  5722   a  and/or  5722   b ) may be made of silicon. For example an elastic element thickness (for example the maximum thickness, minimum thickness and/or mean thickness) may range between 1 to 3 mm and/or between 0 to 1 mm and/or between 3 to 6 mm and/or between 6 to 10 mm. For example, an element having a stiff skeleton (for example a skeleton of metal optionally including spring steel and/or nitinol) may be thinner for example a silicon element may fit towards the middle of the spectrum for example a foam element may be towards the thick end of the spectrum and/or thicker. 
     In some embodiments a significant portion of the surface of tissue in a circular area around tube between the tube and an interface area with the tissue (for example in a circular area around tube  5723  between tube  5723  and interface area  5726   a  and/or  5726   b ) may be exposed to air and/or may not be covered by spacers. For example, the area exposed and/or uncovered area may range between 5 to 10% of the area of the circular region and or between 10 to 20% and/or between 20 to 40% and/or between 40 to 70%. 
       FIGS.  58 A- 58 B  are perspective views of a pushing device in accordance with some embodiments of the current invention. For example a dilator  5880  is connected to an ostomy device  5800  by a connector, for example a screw thread  5881 . Optionally screw thread  5881  attaches to a proximal portion of device  5800 . No rigid parts (for example no part of dilator is inserted into the middle and distal end of tube  4612 . Tube  4612  and/or the distal portion of device  5800  are optionally flexible making them more easily inserted through the mouth, trachea etc. to the stomach or intestines. The less of dilator  5880  is inside tube  4612 , the more flexible is tube  4612  and the easier it may be to insert tube  4612  into the lumen. For example when dilator  5880  is connected to device  5800 , dilator  5880  may be inserted through less than 1/10 of tube  4612  and/or between 1/10 to ⅕ and/or between ⅕ to ½ and/or between ½ to ⅗. Optionally thread  5881  on dilator  5880  is an external thread which connects to an internal thread on device  5800 . 
     A Disassembly Tool 
       FIGS.  59 A- 59 C  are perspective views of a disassembly tool  5968  and socket in accordance with some embodiments of the current invention. The form of tool  5968  is optionally a wrench head  5969  on a long rod. The teeth of wrench head  5969  are optionally inclined (for example like a ratchet) such that wrench head can be used to turn socket  5970  in one direction only. For example, this facilitates disassembly, but avoids erroneously tightening the inner bolster making it harder to remove. Socket  5970  is fit on an inner lip and/or ledge of an ostomy device. The inner lip is small enough to avoid blocking flow and large enough to ensure good grip. Optionally the ledge may not completely surround the lumen of the ostomy device thereby allowing good grip for disassembly but also allowing an inner tube to pass by the lip while still contacting the inner walls of the ostomy device lumen at least in some places. 
     An Anti Rotational Bolster Connector 
       FIG.  60    is a perspective view of an anti rotational connector  6090  for an outer bolster to a tube in accordance with some embodiments of the current invention. For example the connector has an internal screw thread  6091  (for example for connecting to a dilator during insertion tool, an interference element (e.g. a ledge  6092 ) for connecting to a plastic snap connector on the outer bolster and/or a self aligning beveled non-slip head (for example a beveled hex head  6093  for preventing rotation of the bolster with respect to the tube. 
     Exemplary Ostomy Device with a Flared Tube 
     Reference is now made to  FIGS.  61 A and  61 B  depicting a simplified isometric view of an ostomy device having a flared outer tube, according to some embodiments of the invention. 
     According to some exemplary embodiments, an ostomy device, for example ostomy device  1800  comprises flared outer tube  1852  with a larger diameter at the distal end  1854 , placed inside the stomach. In some embodiments, the flared outer tube positioned at least partially within the body allows, for example to minimize the possibility of the flared tube to be pulled outside from the body by having a tube ending inside the stomach lumen that is wider than the stoma. In some embodiments, the diameter of the tube ending within the stomach is at least 4% larger than stoma diameter, for example 5%, 10%, 15% larger. 
     Exemplary Inner Bolster of an Ostomy Device 
     Reference is now made to  FIGS.  62 A- 62 C  depicting an internal bolster with at least partly rigid shaft, according to some embodiments of the invention. 
     According to some exemplary embodiments, internal bolster  6208  comprises petals  6254  that are placed in contact with an internal bolster shaft  6266 , optionally by cap  6252 . In some embodiments, the internal bolster shaft  6266  is a rigid shaft. In some embodiments, the internal bolster shaft  6266  hardness level is at least 40 shore A, for example 50 shore A, 60 shore A or 70 shore A. In some embodiments, a partly rigid internal bolster shaft allows, for example to push the internal bolster out from the body with minimal damage to the body tissues. 
     According to some exemplary embodiments, when attached to internal bolster shaft  6266 , petals  6254  are spaced apart from each other. In some embodiments, the spacing between adjacent petals allows, for example each petal to apply minimal or no pressure on adjacent petals when the petals are in a collapsed and/or in a relaxed state. In some embodiments, each petal of petals  6254  comprises an at least partly rigid section  6268  at the attachment point of the petal to the internal bolster shaft. In some embodiments, the rigidity of section  6268  is at least 5% rigidity, for example 10%, 15%, 20%, 25%, 30%, 40% rigidity. In some embodiments, the rigidity of section  6268  allows to limit the bending of petals  6254 , for example to ensure that the internal bolster and petals will not be permanently collapsed when the internal bolster is pushed through the esophagus. 
     According to some exemplary embodiments, rib  6265  is positioned between each adjacent petals of petals  6254 , when they are connected to the internal bolster  6208 . In some embodiments, the rib  6265  is shaped and sized to at least partially reduce application of forces, for example friction forces or torque forces applied by the petals on cap  6252 , for example when the petals bend or twist. 
     According to some exemplary embodiments, each petal of petals  6254  comprises at least a partially rigid section  6269 . In some embodiments, the section  6269  is connected to the external bolster  6208  between grooves in cap  6252  and grooves in connecting section  6209  of the internal bolster. In some embodiments, when cap  6252  is released, each petal of petals  6254  are release from the connecting section  6209  and the internal bolster  6208 . 
     Exemplary Inner Tube Portion 
     Reference is now made to  FIGS.  63 A- 63 D  depicting an inner tube portion of an ostomy device, according to some embodiments of the invention. 
     According to some exemplary embodiments, an inner tube portion, for example inner tube portion  6316  comprises an inner tube upper segment  6321  connected to the proximal section  6330  of an inner tube  6314 . In some embodiments, a ring  6324  is connected to the inner tube cap  6322 . In some embodiments, ring  6324  comprises buttons  6332 , on the circumference of ring  6324 . Optionally, the buttons  6332  are extending out from the circumference of ring  6324 . In some embodiments the buttons  6332  are elastic buttons or springy buttons. In some embodiments, when the buttons are bend or pressed, ring  6324  is twisted and the inner tube portion is deflected from the outer tube of the ostomy device. In some embodiments, the buttons  6332  are shaped and sized to be placed within gaps  6326  in the circumference of the inner tube upper segment  6321 . In some embodiments, an inner tube cap  6322 , having an opening  6334  is placed on top of the inner tube section. 
     In some embodiments, a valve, for example a duckbill valve  6320  is positioned within ring  6324 . In some embodiments, duckbill valve  6320  is configured to allow food to be inserted into the inner tube  6314  and into the stomach lumen, and prevents food to leak outside from the inner tube. In some embodiments, the duckbill valve is positioned between the inner tube of a low-profile ostomy device and an external feeding tube that can be attached and detached from the low-profile ostomy device. In some embodiments, a low-profile ostomy device is an ostomy device that protrudes 10 centimeters at most from the outer surface of the skin, for example 2, 4, 6 centimeters. 
     In some embodiments, an outer tube of an ostomy device comprises a valve, for example a duckbill valve. In some embodiments, the duckbill valve of the outer tube prevents food to leak out from the outer tube, for example to prevent leakage of food out from the stomach when inner tube is not in place. 
     Exemplary External Bolster 
     Reference is now made to  FIGS.  64 A- 64 E , depicting an external bolster of an ostomy device, according to some embodiments of the invention. 
     According to some exemplary embodiments, external bolster  6450  is placed inside an external petals ring  6452  which comprises external petals  6499  around the circumference of the rigid ring. In some embodiments, external bolster  6450  comprises at least one protruding section  6458  extending out from the circumference of the external bolster. In some embodiments, protruding section  6458  of the external bolster  6450  have an outer surface, shaped and sized to increase friction between the external bolster  6450  and external petals ring  6452 . In some embodiments, increasing the friction between protruding sections  6458  and the external petals ring  6452  allows for example, the rotation of the external bolster and the ostomy device when rotating the petals ring  6452 . In some embodiments, the friction between protruding sections  6458  and the external petals ring  6452  prevents, for example a relative rotation of the external petals ring  6452  in relation to the external bolster and/or the ostomy device. 
     In some embodiments, a cap  6454  is connected to the rigid ring  6452  via an elastic strap  6456 . Optionally cap  6454  is shaped to fit and close opening  6334  shown in  FIG.  63 D  when an external feeding tube is not connected. 
     According to some exemplary embodiments, external bolster  6450  comprises openings  6460  at the top circumference. In some embodiments, openings  6460  are shaped and sized to allow, for example the attachment and locking of elastic buttons  6332  of the inner tube portion  6316  shown in  FIG.  63 C . In some embodiments, the position of openings  6460  allows for example, to direct the insertion of the elastic buttons  6332 , optionally to a desired position. In some embodiments, each of the openings  6460  have a different geometrical shape that match at least one specific elastic button of elastic buttons  6332 , to allow for example a specific orientation connection between the elastic buttons  6332  and openings  6460 . 
     According to some exemplary embodiments, for example as shown in  FIG.  64 E , the inner circumference of the external bolster has a geometrical shape that allow, for example to prevent the rotation of the outer tube connected to the external bolster. In some embodiments, the inner circumference  6462  of the external bolster  6450  is shaped as a polygon, for example as a hexagon. In some embodiments, the inner circumference of the external bolster has a matching geometrical shape to the anti-rotation connector of the outer tube, for example the anti-rotation connector  6090 . In some embodiments, when connecting the external bolster to the anti-rotation connector, a snap connector of the external bolster, for example snap connector  1802  shown in  FIG.  61 B  snaps underneath ledge  6092 , shown in  FIGS.  61 B and  60   . The interconnection between snap connector  1802  and ledge  6092  prevents the release of the external bolster from the outer tube. 
     In some exemplary embodiments of the invention, the anti-rotation connector includes an inclined portion which is also shaped, to match the geometry of the external bolster inner circumference  6462 , so as to orientationally guide the bolster to be aligned with the interconnection. Optionally, the matching geometries are polygonal, optionally with rotational symmetry. 
     Exemplary High-Profile Ostomy Device 
     Reference is now made to  FIGS.  65 A and  65 B , depicting a high-profile ostomy device, according to some embodiments of the invention. In some embodiments a high-profile ostomy device is an ostomy device that protrudes at least 10 centimeters from the outer surface of the body, for example 20 centimeters, 30 centimeters, or intermediate or greater protrusions. In some embodiments, a high-profile ostomy device is an ostomy device where the connector to the feeding element is located on the distal of a tube protruding out of the ostomy device or the external bolster. 
     According to some exemplary embodiments, a feeding tube is connected to an ostomy device  6510 . In some embodiments, the feeding tube is connected to ostomy device  6510  by an irreversible locking mechanism. In some embodiments, to disconnect the feeding tube  6512  from the ostomy device  6510 , elastic sections of a snap-fit locking mechanism between the inner tube portion and the external bolster are pressed and the feeding tube  6512  is released together with the inner tube portion  6520  from the ostomy device  6510 . 
     According to some exemplary embodiments, the connection between an external feeding tube to the ostomy device is weaker than the connection of the ostomy device to the body. In some embodiments, the connection of the elastic buttons  6332  of the inner tube portion to the external bolster of the ostomy device is weaker than the connection between the feeding tube and the inner tube portion. In some embodiments, the weaker connection between the inner tube portion and the external bolster acts for example, as a safety mechanism to allow the disconnection of the feeding tube and the inner tube portion before the ostomy device is pulled out from the ostomy opening in the abdomen. In some embodiments, the connector or the locking mechanism of the outer tube and the internal and/or external bolsters connects the outer tube to the bolster with a greater pull-out resistance force compared to the connector or the locking mechanism between the inner tube portion and the ostomy device. 
     Exemplary Kit for Direct Stomach Feeding 
     According to some exemplary embodiments, a kit for direct stomach feeding comprises an ostomy device and an external feeding tube. In some embodiments, the ostomy device comprises a tube and an internal and/or external bolsters for fixing the tube between a stomach lumen and the outer surface of the skin. In some embodiments, the kit comprises an inner tube, configured to be place within the tube. In some embodiments, the external feeding tube is connected to the external bolster or to the outer tube or to the inner tube. 
     Exemplary Device for Small Intestine Feeding or Stomach Decompression 
     Reference is now made to  FIGS.  65 C- 65 G  depicting an ostomy device with an elongated inner tube for small intestine feeding and/or for stomach decompression, according to some embodiments of the invention. 
     According to some exemplary embodiments, ostomy device comprises an inner tube portion  6532  having an elongated inner tube  6534  and an external tube portion  6536 . In some embodiments, the inner tube portion  6532  is pushed through the outer tube  6533 , until the inner tube portion  6532  extends out from the outer tube  6533 , for example as shown in  FIG.  65 D . In some embodiments, the inner tube portion is pushed until an inner tube cap  6536  is locked within an external bolster  6538 , for example as shown in  FIG.  65 E . In some embodiments, the length of the elongated inner tube is at least 5 centimeters, for example 5, 10, 15, 30, centimeters. 
     According to some exemplary embodiments, the inner tube  6534  of the ostomy device  6530  is shaped and sized to extend from stomach  6539  into the small intestine. In some embodiments, the inner tube  6534  is placed within the small intestine, with the inner tube end  6537  is positioned in the jejunum  6542  or in the duodenum  6540 . In some embodiments, placing the end of the inner tube within the small intestine allows, for example feeding directly into the small intestine, optionally bypassing the stomach. 
     According to some exemplary embodiments, the inner tube  6534  of the ostomy device, is positioned with the inner tube end  6537  inside the stomach. In some embodiments, the inner tube end  6537  is positioned above stomach content level  6546 , for example as shown in  FIG.  65 G . In some embodiments, placing the inner tube end  6537  above the stomach content level allows, for example to decompress the stomach optionally by allowing gas to exit from the body through the ostomy device. 
     Exemplary Process of Stomach Content Aspiration 
     Reference is now made to  FIG.  66 A  depicting a process of stomach content aspiration, according to some embodiments of the invention. 
     According to some exemplary embodiments, a subject is eating at  6630 . In some embodiments, after the subject finishes eating, the external end of an ostomy device is opened at  6632 . In some embodiments, the external end of the ostomy device is opened during eating. In some embodiments, the external tube of an ostomy device is opened at  6632 . In some embodiments, the external tube is opened after a pre-determined time from the eating. In some embodiments, the pre-determined time is adjusted according to the composition of food that the subject ate and/or according to nutritional parameters of the food. Optionally, the pre-determined time is adjusted according to the amount of food the subject ate. 
     According to some exemplary embodiments, a motor is connected to a grinder of the inner tube at  6634 . In some embodiments, the motor activates the grinder, for example to grind the stomach content. In some embodiments, the motor activates the grinder for a pre-determined time period. In some embodiments, the grinding time period is adjusted according to the amount of food and/or according to the stomach content composition. Optionally, the grinding time is adjusted according to the time passed from the finishing of the eating at  6630 . In some embodiments, the motor pumps out the stomach content. 
     According to some exemplary embodiments, a pump is connected to the inner tube at  6636 , for example to allow pumping out the stomach content. 
     According to some exemplary embodiments, the stomach content is drained at  6638 . In some embodiments, the stomach content is drained through the inner tube. Optionally the stomach content is drained through a draining tube connected to the inner tube. In some embodiments, the stomach content is drained into a waste reservoir connected to the draining tube. In some embodiments, the stomach content is drained until the desired amount and/or weight of content is drained out from the body. 
     According to some exemplary embodiments, the inner tube is replaced at  6640 . In some embodiments, the inner tube is replaced, for example if food at least partly blocks the inner tube lumen. 
     Exemplary Stomach Content Aspiration Device 
     Reference is now made to  FIG.  66 B , depicting a stomach content draining device, according to some embodiments of the invention. 
     According to some exemplary embodiments, a stomach content draining device  6602  comprises an outer tube  6605  inserted through body wall  6604  into stomach  6603 , and an inner tube  6606  positioned within the outer tube  6605 . In some embodiments, the inner tube  6606  comprises a filter  6608 , for example a basket connected to the distal end of the inner tube  6606  that is placed inside the stomach  6603 . In some embodiments, the filter is at least partially permeable to food. 
     According to some exemplary embodiments, inner tube  6606  is at least 5% more rigid compared to the outer tube  6605 , for example 10%, 20%, 30%, 50% more rigid. In some embodiments, inserting a rigid inner tube into a flexible outer tube stretches the outer tube. 
     According to some exemplary embodiments, the outer tube  6605  comprises an inner stomach valve  6642 . In some embodiments, the inner stomach valve comprises a flat valve configured to prevent food from entry into the outer tube  6605  if inner tube  6606  is not present. In some embodiments, when inner tube  6606  is pushed through outer tube  6605 , inner tube  6606  opens the valve towards the stomach lumen. 
     According to some exemplary embodiments, a grinder  6610  is positioned within the inner tube  6606 . In some embodiments, upon activation the grinder grinds the content of the stomach and/or the content of the stomach that is found within the inner tube  6606 . In some embodiments, the grinder  6610  is partly positioned outside of the inner tube  6606 , for example to grind the content of the stomach. In some embodiments, the grinder part which extends into the stomach lumen is placed within filter  6608 . Optionally, filter  6608  prevents direct contact of grinder  6610  with the stomach inner wall. In some embodiments, the grinder  6610  is a spiral shaft, optionally with sharp leading edges, for example to allow slicing of food within the inner tube. 
     According to some exemplary embodiments, the outer tube  6605  is connected to an internal bolster  6607  placed within the stomach  6603  and to an external bolster  6612  placed outside of the body. 
     According to some exemplary embodiments, inner tube  6606  is connected to an external connector  6614 . In some embodiments, the external connector  6614  is configured to lock the inner tube  6606  within the outer tube  6605 . In some embodiments, the external connector  6614  comprises a motor connector  6619 . In some embodiments, the motor connector  6619  is coupled to the grinder  6610 , for example to allow the rotation of the grinder  6610 . In some embodiments, a motor  6616 , for example an electric motor is connected through a motor adaptor  6618  to the motor connector  6619 . In some embodiments, upon activation motor  6616  rotates the grinder  6610  optionally by rotating motor adaptor  6618  and/or motor connector  6619 . In some embodiments, turning grinder  6610 , for example by motor  6616  moves food out from the stomach. 
     According to some exemplary embodiments, a draining tube  6620  is connected to the inner tube, optionally through external connector  6614 . In some embodiments, the stomach content is drained through the draining tube  6620  into waste reservoir  6622 . Optionally a pump  6624 , for example a peristaltic pump is connected to draining tube  6620 . In some embodiments, the pump  6624  actively pumps the stomach content through the inner tube and the draining tube into waste reservoir  6622 . In some embodiments, pump  6624  rotates grinder  6610 . 
     According to some exemplary embodiments, flushing fluid  6628  is passed into the inner tube  6606 , for example when parts of the stomach content are stuck within the inner tube. In some embodiments, the flushing fluid  6628  is passed through flushing tube  6626 . Alternatively, flushing fluid is passed through draining tube  6620 . In some embodiments, flushing fluid  6628  comprises enzymes and/or digestive chemicals, for example to allow digestion of food within the stomach and/or within the inner tube. 
     According to some exemplary embodiments, flushing tube  6626  and/or draining tube  6620  are connected to the inner tube  6606  through motor connector  6619  which allows, for example co-centric connection between motor connector  6619  and motor adaptor  6618 . Alternatively, motor adaptor  6618  is connected to motor connector  6619  from an upper or a lower side while flushing tube  6626  and/or draining tube  6620  are connected directly to the center of tube  6606   
     According to some exemplary embodiments, grinder  6610  is placed within an inner tube, for example inner tube  6314 ,  1714  or  1814 . In some embodiments, the inner tube is placed within an outer tube, for example outer tube  1812 . In some embodiments, the outer tube is connected to an internal bolster of an ostomy device placed within the stomach, for example inner bolster  1808  and to an external bolster, for example external bolster  3110 , or  5100 . 
     Exemplary Stomach Content Draining Device within the Body 
     Reference is now made to  FIG.  66 C  depicting a stomach content draining device within the body, according to some embodiments. 
     According to some exemplary embodiments, a draining device  6650  is inserted into the body wall  6604  into a stomach  6603 . In some embodiments, the draining device  6650  comprises a tube  6652  with a grinder  6658  positioned within the tube. In some embodiments, a filter, for example basket  6654  is connected to the distal end of the tube  6652 , and is positioned within the stomach  6603 . In some embodiments, an internal bolster  6656  is connected to tube  6652  at the distal end of the tube  6652  within stomach  6603 . Additionally, an external bolster  6655  is connected to tube  6652  at the proximal end outside of the body. In some embodiments, the internal bolster  6656  prevents pushing tube  6652  outside of the body. In some embodiments, the external bolster  6655  stabilizes the tube  6652  when the body moves and/or prevents the internalization of tube  6652  through the abdominal opening. 
     According to some exemplary embodiments, tube  6652  is placed within an outer tube. In some embodiments, the internal bolster  6656  and/or the external bolster  6655  are connected to the outer tube. 
     Exemplary Inner Tube with a Grinder 
     Reference is now made to  FIGS.  67 A- 67 D , depicting an inner tube and a grinder of a stomach content draining device, according to some embodiments of the invention. 
     According to some exemplary embodiments, inner tube  6704  comprising a distal end  6716  configured to be placed within a stomach and a proximal end  6720 , configured to be placed outside of the body. In some embodiments, a filter, for example elastic basket  6706  is connected to the distal end  6716  of the inner tube  6704 . In some embodiments, basket  6706  is configured to be in a collapsed state, for example when basket  6706  is moved through the outer tube into the stomach, and in a relaxed state when basket  6706  is pushed out from the inner tube  6704 . In some embodiments, the basket comprises voids or openings that allow the basket, for example to collapse. Alternatively or additionally, the basket is made from an elastic material or an elastomer. 
     According to some exemplary embodiments, basket  6706  comprises is made from wires placed in a distance from one another, or from a mesh of wires. Optionally, the wires are elastic, for example to allow the collapse of the basket  6706 . In some embodiments, the maximal distance between two adjacent wires, for example wires  6707  and  6709  determine the size of food particles that can enter into the inner tube  6704 . Alternatively, the maximal size of the pores within the mesh of wires determine the size of the food that can enter the inner tube. 
     According to some exemplary embodiments, an external bolster, for example external bolster  6712  is connected to the proximal end  6720  of the inner tube  6704 . Alternatively or additionally an inner tube cap  6710  is connected to proximal end  6720  of the inner tube  6704 . 
     General 
     As used herein the term “about” refers to ±20% 
     The terms “comprises”, “comprising”, “includes”, “including”, “having” and their conjugates mean “including but not limited to”. 
     The term “consisting of” means “including and limited to”. 
     The term “consisting essentially of” means that the composition, method or structure may include additional ingredients, steps and/or parts, but only if the additional ingredients, steps and/or parts do not materially alter the basic and novel characteristics of the claimed composition, method or structure. 
     As used herein, the singular form “a”, “an” and “the” include plural refers unless the context clearly dictates otherwise. For example, the term “a compound” or “at least one compound” may include a plurality of compounds, including mixtures thereof. 
     Throughout this application, various embodiments of this invention may be presented in a range format. It should be understood that the description in range format is merely for convenience and brevity and should not be construed as an inflexible limitation on the scope of the invention. Accordingly, the description of a range should be considered to have specifically disclosed all the possible subranges as well as individual numerical values within that range. For example, description of a range such as from 1 to 6 should be considered to have specifically disclosed subranges such as from 1 to 3, from 1 to 4, from 1 to 5, from 2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numbers within that range, for example, 1, 2, 3, 4, 5, and 6. This applies regardless of the breadth of the range. 
     Whenever a numerical range is indicated herein, it is meant to include any cited numeral (fractional or integral) within the indicated range. The phrases “ranging/ranges between” a first indicate number and a second indicate number and “ranging/ranges from” a first indicate number “to” a second indicate number are used herein interchangeably and are meant to include the first and second indicated numbers and all the fractional and integral numerals therebetween. 
     As used herein the term “method” refers to manners, means, techniques and procedures for accomplishing a given task including, but not limited to, those manners, means, techniques and procedures either known to, or readily developed from known manners, means, techniques and procedures by practitioners of the chemical, pharmacological, biological, biochemical and medical arts. 
     As used herein, the term “treating” includes abrogating, substantially inhibiting, slowing or reversing the progression of a condition, substantially ameliorating clinical or aesthetical symptoms of a condition or substantially preventing the appearance of clinical or aesthetical symptoms of a condition. 
     It is appreciated that certain features of the invention, which are, for clarity, described in the context of separate embodiments, may also be provided in combination in a single embodiment. Conversely, various features of the invention, which are, for brevity, described in the context of a single embodiment, may also be provided separately or in any suitable subcombination or as suitable in any other described embodiment of the invention. Certain features described in the context of various embodiments are not to be considered essential features of those embodiments, unless the embodiment is inoperative without those elements. 
     Although the invention has been described in conjunction with specific embodiments thereof, it is evident that many alternatives, modifications and variations will be apparent to those skilled in the art. Accordingly, it is intended to embrace all such alternatives, modifications and variations that fall within the spirit and broad scope of the appended claims. 
     All publications, patents and patent applications mentioned in this specification are herein incorporated in their entirety by reference into the specification, to the same extent as if each individual publication, patent or patent application was specifically and individually indicated to be incorporated herein by reference. In addition, citation or identification of any reference in this application shall not be construed as an admission that such reference is available as prior art to the present invention. To the extent that section headings are used, they should not be construed as necessarily limiting. In addition, any priority document(s) of this application is/are hereby incorporated herein by reference in its/their entirety.