Our first experiences with endoscopic gastroentric anastomosis using magnets

Background: Many malignancies (especially pancreatic cancer) can cause gastric outlet obstruction. Surgical gastrointestinal bypass need narcosis and associate high stress and risk for patients with poor general conditions. Endoscopic insertion of self-expandable metal stent is less invasive, but often causes complications like migration, occlusion, and malignant overgrowth. In the last years some studies examined a new minimal invasive technique which using magnets to create gastroenteric anastomosis.

Material and Method: Our study examined the technical executable of endoscopic gastroenteric anastomosis using magnets (EGAM). A biosynthetic model was developed to imitate the upper digestive tract. The model combined synthetic materials with biogenic specimens taken from slaughtered domestic pig. The procedure was performed with endoscopic and fluoroscopic guidance. To increase the X-ray absorption and to make contrast difference the model was put in the physiological saline. Two coated rare-earth magnets (Br: 1200Gauss, D: 10mm) with central hole were inserted by guide wire and duodenal probe into the model. The first magnet was pushed into the first jejunal loop; the second one was placed in the stomach. The gastric magnet was maneuvered using endoscope. When magnets reached good position, they were pushed down from the guide wires to let them mate.

Result: The biosynthetic model was usable to training endoscopy without sacrificed animals. The magnets were mated across gastric and jejunal walls successfully. The pressure between the magnets needs to sterile inflammation which will make adhesion between the bowels, and will develop the anastomosis after 7–10 days.

Conclusion: The technique could be made with standard upper endoscope and instruments. EGAM may be potentially useful for managing gastric outlet obstruction.