Gastroenterostomy by using magnets on porcine models

Introduction: Malignancies around the duodenum (e.g.: pancreatic cancer, bile duct cancer) often cause gastric outlet obstruction. Palliation is mostly possible on surgical way, which associates high stress and risk for the patients in poor general condition caused by malnutrition and the malignant disease itself. Gastroenteral anastomoses created by magnets may provide an alternative treatment for these patients. Earlier the technical execution of gastrojejunostomy by using magnets was imitated successfully on biosynthetic model, which was composed of intestinal tract of slaughtered swine.

Materials and method: The biological effects and complications of anastomosis made by rare-earth (NdFeB) magnets were examined in vivo on domestic pigs. The procedures were performed under intravenous general anaesthetization (cetamine, fentanyl) and intubation. Guide wires introduced into the duodenum and the stomach in the course of upper panendoscopy and covered rare-earth magnets were guided to the duodenojejunal flexura and into the stomach. The attachment of the magnets was performed by pushing them down from the wires with a probe under fluoroscopy guidance. During observation the behavior and the appetite of the pigs followed with attention to detect symptoms of the occasional perforation. After two weeks the magnets were removed on gastroscopic way.

Results: No abnormality referred to any complication detected during the examination. In the course of control endoscopy, the gastrojejunal anastomosis was get to the visual field, the afferent and the efferent intestinal loop was visible. The anastomosis evolved securely.

Discussion: On the videos of the experiments the simplicity of technical execution is well demonstrated. The rate of the stricture on the duodenum limits the size of the lower magnet and in this way the size of the anastomosis as well. Therefore further experiments are kept going with different size and shape of magnets.