SELF-FORMING MAGNETS FOR CREATION OF ESOPHAGO-JEJUNAL COMPRESSION ANASTOMOSIS
Marvin Ryou, Christopher C. Thompson, Jiping Wang*
Gastroenterology, Brigham & Women's Hospital / Harvard Medical School, Boston, MA
Background:
Performing an esophagojejunostomy is technically difficult given the anatomic location regardless of using staplers or handsewn techniques. Anastomotic complications include leaks, stricture and bleeding which could lead to significant morbidity. A less invasive, reliable and easy to perform method for creating esophagojejunostomy would be desirable. We present a preclinical study assessing the creation of esophagojejunal anastomosis using self-forming magnets (SFM) that can be delivered through an endoscope or a laparoscopic delivery tool (<5 mm diameter) to ultimately produce a large-diameter, implant-free anastomosis.
Methods:
Esophagojejunal anastomosis creation was performed in 5 swine (35-40 kg) survived 14 days. Under general anesthesia, laparotomy was performed. A linear stapler was used to transect the distal esophagus. Total gastrectomy was performed. The esophageal SFM was delivered through an upper scope and formed in the distal esophagus; the jejunal SFM was delivered through an enterotomy using a laparoscopic device. The SFM pair were manually coupled. An immediate conduit was created through the coupled SFM pair using Bovie electrocautery. All animals underwent surveillance endoscopy and contrast study under fluoroscopy at Day 14 immediately prior to euthanasia to assess the anastomosis.
Results:
Esophagojejunal anastomosis creation was successfully performed in 5/5 animals (100%). SFM were successfully delivered, formed, and coupled in all cases (100%). 5/5 (100%) animals recovered and thrived following surgery.. Endoscopy and contrast study demonstrated a widely patent, leak-free anastomosis at Day 14. The anastomosis had fully re-epithelialized and was barely perceptible on high definition endoscopic visualization. Necropsy revealed no abscesses. Histologic examination of the anastomoses showed minimal to absent inflammation due to absence of foreign material (unlike conventional sutures and staples).
Conclusions:
This preclinical series suggests a large caliber, leak-free esophagojejunal anastomosis can be safely created using self-forming magnets delivered laparoscopically and/or endoscopically. Coupled magnets are spontaneously expelled following anastomosis formation. The anastomosis is widely patent and natural appearing due to lack of foreign material. The use of self-forming magnets may allow for technically easier and more reproducible esophagojejunal anastomosis creation with potentially a reduction in leaks and strictures.
Image 1: Endoscopic images of esophageal SFM being deployed to form a large octagon. After coupling with jejunal SFM, an immediate conduit is created using electrocautery. Double contrast study confirms creation of an immediate, leak-free esophagojejunostomy.
Image 2: External view of coupled magnets. 2 week necropsy shows fully fused, leak free esopahgojejunostomy and in the interim coupled magnets have been naturally expelled.
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