Magnetic compression anastomosis for biliary obstruction: review and experience at Tokyo Medical University Hospital

Abstract

Background Magnetic compression anastomosis (MCA) is a revolutionary, minimally invasive method of performing choledochoenterostomy or choledochocholedochostomy without using surgical techniques in patients with biliary stricture or obstruction. Herein, we describe a case series of MCA for severe biliary stricture or obstruction, which could not be treated with conventional therapies. Patients and methods Two patients with biliary obstruction were treated using MCA for choledochocholedochostomy and choledochoenterostomy at Tokyo Medical University Hospital and Tokyo Medical University Hachioji Medical Center. Endoscopically, a samarium-cobalt (Sm-Co) rare-earth magnet was placed at the superior site of obstruction through the percutaneous transhepatic biliary drainage route and another Sm-Co magnet was placed at the inferior site of obstruction. A comprehensive computeraided literature search for MCA was performed up to September 2009 by using MEDLINE and EMBASE. Results MCA techniques enabled complete anastomosis in both cases without procedure-related complications. Conclusions The MCA technique is a revolutionary method of performing choledochocholedochostomy and choledochoenterostomy interventionally in patients with biliary obstruction, for whom the conventional endoscopic procedure is not available, or in candidates who are deemed unsuitable for surgery.

Biliary-duodenal anastomosis using magnetic compression following massive resection of small intestine due to strangulated ileus after living donor liver transplantation: a case report

“…Procedure-related complications are seldom observed, and the results of anastomotic patency are uneventful compared with conventional surgery [5]. Because MCA is an interventional procedure, it can be performed on elderly patients, those with poor general condition or who have history of multiple laparotomy.…”

“…There is also a risk of inflammation of the anastomosis caused by foreign bodies, such as stitches or clips [4]. However, magnetic compression anastomosis (MCA) is a less invasive and safer procedure than choledochoenterostomy or choledochocholedochostomy for a biliary stricture or obstruction, with a low rate of complications and re-stenosis [5]. This procedure is also used for biliary stricture after liver transplantation or palliation of obstructive jaundice for malignancies [4, 6].…”

Magnets for therapy in the GI tract: a systematic review

“…Encouraging evidence of safety and efficacy in the animal model 12 is contrasted with adverse events that have been reported in other settings. 13 Magnet-assisted biliary anastomosis is well-reported in Japan and Korea, [15][16][17][18][19][20][21][22][23] although the magnets used appear to be commercial devices rather than customized for clinical use. Magnet delivery in the biliary setting is typically through the combination of a dilated percutaneous drainage fistula and endoscopic delivery via the ampulla following enlargement by endoscopic sphincterectomy.…”

Magnetic compression gastrostomy in the rat

“…Magnetic compression anastomosis (MCA) has been reported previously for gastrointestinal, biliary, urinary, and vascular anastomosis [3][4][5][6][7][8][9][10][11][12][13][14].…”