New minimal invasive intervention: Flexible endoscopic creation of magnetic compression anastomosis

Introduction: The palliative surgical treatment of gastric outlet obstruction caused by inoperable malignant (pancreatic-, bile duct-, distal stomach cancer) or benign diseases (pyloric stenosis, chronic pancreatitis) is creation of surgical gastro-jejunal anastomosis (GEA) to by-pass the stenotic duodenum. Beside traditional gastro-jejunostomy performed through a laparotomy there are minimal invasive techniques as well, just as laparoscopic GEA or implantation of self-expandable metal stents. Since the laparoscopic technique performed in narcosis, this procedure is stressful as well for the usually bad conditioned patients; and the occlusion and migration of metal stents are common complications.

Method: At 1st Department of Surgery, Semmelweis University after practice of creation magnetic anastomosis on biosynthetic model the procedure was performed on a living porcine model as well. Magnets were inserted per orally to the jejunum and the stomach, assisted by a flexible endoscope and two guide wires. Positioning and attachment of the magnets were followed by fluoroscopy. During control endoscopy performed on the 14. day after procedure, magnets were removed and the gastro-jejunal anastomosis was examined.

Results: This technique is easy to perform, the gastro-jejunal anastomosis developed without any complications. Since the procedure causes minimal strain for the patient, this new method could become an alternative of the existing minimal invasive techniques.