3479 Non-invasive gastrointestinal anastomosis with magnet rings.

Abstract

Patients with inoperable GI cancers and strictures or stenoses often require intestinal bypass. These patients usually have advanced disease and are poor surgical candidates. In addition, surgical intervention often result in substantial mortality and morbidity as well as hospitalization and recovery time. Non-invasive methods of performing GI anastomosis may help improve their outcome and quality of life. We present cases to illustrate the use of magnet compression anastomosis. METHODS: Discshaped magnets of 1.5 cm in diameter and 0.7 cm thick are used. Two magnets are placed within the GI tract, one magnet each in the respective portion of the GI tract to be anastomosed. The magnets are placed orally, rectally, or endoscopically and are then maneuvered into the desired locations either endoscopically or percutaneously with an external magnet. Once the magnets are in place, the magnetic force attracting the two magnets then serve to compress the walls of the two respective gastrointestinal tracts together. Over the course of one to four weeks, an anastomosis is formed between the two adjoining segments of the gastrointestinal tract. CASES: Both cases 1 and 2 are patients with advanced antral gastric cancer with multiple metastases, who were not surgical candidates but who were unable to eat because of marked gastric outlet obstruction. One magnet was placed in the stomach and the other magnet was placed in the third portion of the duodenum. Promptly after magnet placement, the two magnets could be seen fluoroscopically compressing the stomach wall and the duodenal wall between them. After two weeks, the anastomoses were formed and the magnet pair passed spontaneously in the stool.Well-functioning anastomoses were confirmed by X ray. Case 3: This is a patient with sigmoid colon cancer with colon stricture. An anastomosis between ascending colon and distal sigmoid would provide bypass of the stricture. The 2 magnets were placed orally and endoscopically at ascending and distal colon. Ten days after, the anastomosis was completed and the two magnets passed spontaneously in the stool. The anastomosis functioned very well and the patient has had no obstructive symptoms for 6 months. CONCLUSION: Magnet compression anastomosis does not require surgical intervention or anesthesia, and still forms a well functioning anastomosis for bypassing neoplastic strictures and stenoses. It may become an additional clinical tool for providing palliative relief of gastrointestinal strictures and stenoses in patients with irreversible end-stage disease. Patients with inoperable GI cancers and strictures or stenoses often require intestinal bypass. These patients usually have advanced disease and are poor surgical candidates. In addition, surgical intervention often result in substantial mortality and morbidity as well as hospitalization and recovery time. Non-invasive methods of performing GI anastomosis may help improve their outcome and quality of life. We present cases to illustrate the use of magnet compression anastomosis. METHODS: Discshaped magnets of 1.5 cm in diameter and 0.7 cm thick are used. Two magnets are placed within the GI tract, one magnet each in the respective portion of the GI tract to be anastomosed. The magnets are placed orally, rectally, or endoscopically and are then maneuvered into the desired locations either endoscopically or percutaneously with an external magnet. Once the magnets are in place, the magnetic force attracting the two magnets then serve to compress the walls of the two respective gastrointestinal tracts together. Over the course of one to four weeks, an anastomosis is formed between the two adjoining segments of the gastrointestinal tract. CASES: Both cases 1 and 2 are patients with advanced antral gastric cancer with multiple metastases, who were not surgical candidates but who were unable to eat because of marked gastric outlet obstruction. One magnet was placed in the stomach and the other magnet was placed in the third portion of the duodenum. Promptly after magnet placement, the two magnets could be seen fluoroscopically compressing the stomach wall and the duodenal wall between them. After two weeks, the anastomoses were formed and the magnet pair passed spontaneously in the stool.Well-functioning anastomoses were confirmed by X ray. Case 3: This is a patient with sigmoid colon cancer with colon stricture. An anastomosis between ascending colon and distal sigmoid would provide bypass of the stricture. The 2 magnets were placed orally and endoscopically at ascending and distal colon. Ten days after, the anastomosis was completed and the two magnets passed spontaneously in the stool. The anastomosis functioned very well and the patient has had no obstructive symptoms for 6 months. CONCLUSION: Magnet compression anastomosis does not require surgical intervention or anesthesia, and still forms a well functioning anastomosis for bypassing neoplastic strictures and stenoses. It may become an additional clinical tool for providing palliative relief of gastrointestinal strictures and stenoses in patients with irreversible end-stage disease.