Magnetic cholecysto-duodenal anastomosis

Abstract

Introduction

There is a growing interest in minimally invasive endoscopic gallbladder drainage therapies. Unlike stenting, a technology based on magnetic compression could theoretically produce a durable drainage anastomosis without residual foreign material. This study aimed to evaluate the safety and technical feasibility of a cholecysto-duodenal magnetic compression anastomosis.

Material and methods

We performed a survival study of two Yorkshire pigs. Duodenal magnets were deployed endoscopically; reciprocal gallbladder magnets were placed laparoscopically, and the magnets were coupled. Pigs underwent serial endoscopy documenting magnet expulsion and evolution of cholecysto-duodenal anastomosis creation. Necropsies and histological evaluation were performed. Primary endpoints were technical success and safety. Secondary endpoints included anastomosis integrity, patency, and histologic characteristics.

Results

Magnets were successfully delivered and coupled. Patent, leak-free anastomoses formed by day 4. Magnets were expelled by day 10. All anastomoses were widely patent at one month (mean diameter 15 mm). Necropsy showed the absence of adhesions affecting the anastomosis. Histology showed complete re-epithelialization without inflammation or foreign body reaction.

Conclusions

Magnetic cholecysto-duodenal anastomosis for gallbladder drainage appears safe and feasible in the animal model. The anastomoses are patent, leak-free, and without inflammation from the presence of foreign material. Technical modifications for magnet delivery under endoscopic ultrasound (EUS) guidance are currently underway.

Keywords:

• Magnetic anastomosis
• cholecysto-duodenal anastomosis
• endoscopic gallbladder drainage
• incisionless anastomosis system
• IAS
• compression anastomosis
• SAMSEN

Declaration of interest

Marvin Ryou, MD, is a consultant to GI Windows, Inc. David B. Lautz, MD FACS is a consultant to GI Windows, Inc. Christopher C. Thompson, MD, FASGE, FACG is a consultant to GI Windows, Inc.