WIRE AND MAGNET SEPTOTOME, A NEW METHOD FOR ENDOSCOPIC LEAK-FREE SECTION OF SEPTA IN THE GI TRACT: PRELIMINARY RESULT OF A PILOT ANIMAL STUDY

Aims:

Treatment of symptomatic mid- or distal- esophageal diverticulum is challenging. The rationale of the endoscopic treatment is its marsupialisation into the esophagus and/or treatment of underlying motility disorders. Section of the septum carries the risk of bleeding and perforation, the latter being potentially prevented by the use of magnets or sutures endoscopically performed at the bottom of the diverticulum.

Methods:

We developed a device made of two round shape magnets of 19 mm of diameter, linked by a self-retractable surgical wire of up to 15 cm. The magnets are implanted level with the bottom of the diverticulum on both sides of the septum, while the wire turns around the septum (figure 1). The self retractable wire induces a progressive ischemia, leading to a necrosis of the tissue and its progressive section.

Results:

We created surgically an artificial septum in the a pig stomach. Two weeks later, the magnets linked with the retractable wire were implanted. The following clinical evolution of the pig was uneventful. Seven days after implantation, an endoscopy confirmed that the progressive retraction of the wire had induced a nearly complete cut of the created septum by pressure necrosis induced by the magnets. The tissue was then explanted. The total length of the septum cut by the wire and the magnets is 25 mm long with no leakage at the bottom of the septum (see figure 2).

Conclusions:

This proof of concept animal testing shows that a new endoscopic device made of magnets linked with a retractable wire may allow tissue apposition and section by pressure necrosis using a single instrument placed over a single session. Besides esophageal diverticula, it might also find application in the creation of anastomosis.