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DOI: 10.1055/a-1682-6815
Endoscopic magnet-assisted gastrojejunostomy to treat symptoms caused by a deformed pylorus
A 42-year-old woman presented with a 5-year history of abdominal distension, abdominal pain, and emesis, which became worse after she began eating a little more. Gastroduodenal barium examination detected a deformed pylorus ([Fig. 1 a]). Subsequently, a gastroduodenoscopy was performed, which revealed that the outlet of her stomach lay on the lesser curvature side of the gastric angulus, with a blind end at the antrum ([Fig. 1 b]). We therefore suggested to the patient that she undergo surgery; however, she declined to undergo such treatment, preferring instead an endoscopic method to treat her problems. In the end, we decided to attempt, with the patient’s informed consent, an endoscopic magnet-assisted gastrojejunostomy ([Video 1]).
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Video 1 Video showing a deformed pylorus identified in a 42-year-old woman with a history of abdominal distension, abdominal pain, and emesis; the procedure of endoscopic magnet-assisted gastrojejunostomy; and the subsequent dilation and stenting of the fistula to leave an unobstructed channel.
Qualität:
Firstly, two ring-shaped magnets (16-mm diameter) with attached fixing strings were placed in succession into her jejunum and stomach ([Fig. 2 a, b]). After several attempts to adjust their position under fluoroscopic guidance, the two magnets attracted perfectly and were then stabilized by the string ([Fig. 2 c, d]). After 1 week with the magnets in place, a superficial ulcer developed under the compression of the magnets ([Fig. 2 e]). We extracted the magnets after another 2 weeks ([Fig. 2 f]), leaving behind a stenotic fistula. We then used a dilation balloon to enlarge the fistula ([Fig. 3 a, b]) and put in a 16 × 20-mm lumen-apposing metal stent ([Fig. 3 c]). A subsequent endoscopy and barium examination showed that this manually built channel was unobstructed ([Fig. 3 d–f]), with no leakage of barium. During 1 month of follow-up, the patient gained relief of her symptoms, without any complications of the procedure.
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With advancements of technology, endoscopic methods, such as magnets, natural orifice transluminal endoscopic surgery (NOTES), and endoscopic ultrasound (EUS)-guided techniques, are able to create a gastrointestinal anastomosis without the requirement for surgery [1]. Moreover, the creation of magnet-assisted gastroenteric anastomoses has been demonstrated to be feasible and safe for malignant gastric outlet obstruction [2]. Our experience indicates that this method may also result in good outcomes for patients with benign anatomic abnormalities.
Endoscopy_UCTN_Code_TTT_1AO_2AN
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Competing interests
The authors declare that they have no conflict of interest.
* Joint first authors
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References
- 1 Marrache MK, Itani MI, Farha J. et al. Endoscopic gastrointestinal anastomosis: a review of established techniques. Gastrointest Endosc 2021; 93: 34-46
- 2 van Hooft JE, Vleggaar FP, Le Moine O. et al. Endoscopic magnetic gastroenteric anastomosis for palliation of malignant gastric outlet obstruction: a prospective multicenter study. Gastrointest Endosc 2010; 72: 530-535
Corresponding author
Publikationsverlauf
Artikel online veröffentlicht:
15. November 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
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References
- 1 Marrache MK, Itani MI, Farha J. et al. Endoscopic gastrointestinal anastomosis: a review of established techniques. Gastrointest Endosc 2021; 93: 34-46
- 2 van Hooft JE, Vleggaar FP, Le Moine O. et al. Endoscopic magnetic gastroenteric anastomosis for palliation of malignant gastric outlet obstruction: a prospective multicenter study. Gastrointest Endosc 2010; 72: 530-535
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