Side-to-side magnetic duodeno-ileostomy in adults with severe obesity with or without type 2 diabetes: early outcomes with prior or concurrent sleeve gastrectomy

First-in-Human Linear Magnetic Jejuno-Ileal Bipartition: Preliminary Results with Incisionless, Sutureless, Swallowable Technique

BACKGROUND

Minimally invasive surgery may be further advanced with the novel biofragmentable magnetic anastomosis compression system. Two magnets may be swallowed, or placed by flexible endoscopy, in a side-to-side magnetic jejuno-ileostomy (MagJI) bipartition for weight and type 2 diabetes (T2D) reduction. MagJI markedly reduces the major complications of enterotomy, stapling/suturing, and retained foreign materials.

METHODS

This was a prospective first-in-human investigation of feasibility, safety, and preliminary efficacy in adults with body mass index (BMI, kg/m2) ≥ 30.0- ≤ 40.0. After serial introduction via swallowing or endoscopy, linear magnets were laparoscopically guided to the distal ileum and proximal jejunum where they were aligned. Magnets fused over 7-21 days forming jejuno-ileostomy.

PRIMARY ENDPOINTS

feasibility and severe adverse event (SAEs) incidence (Clavien-Dindo grade); secondary endpoints: weight, T2D reduction.

RESULTS

Between 3-1 - 2024 and 6-30 - 2024, nine patients (mean BMI 37.3 ± 1.1) with T2D (all on T2D medications; mean HbA1C 7.1 ± 0.2%, glucose 144.8 ± 14.3 mg/dL) underwent MagJI. Mean procedure time: both magnets swallowed, 86.7 ± 6.3 min; one magnet swallowed with second delivered endoscopically, 113.3 ± 17.0 min. Ninety-day feasibility confirmed in 100.0%: 0.0% bleeding, leakage, infection, mortality. Most AEs grade I-II; no SAEs. At 6-month radiologic confirmation, all anastomoses were patent. Excess weight loss 17.5 ± 2.8 kg; mean BMI reduction 2.2 ± 0.3, HbA1C 6.1 ± 0.1% (p < 0.01), glucose 115.5 ± 6.5 mg/dL (p = 0.19); 83.0% dropped below 6.5% HbA1C and had markedly reduced anti-T2D medications.

CONCLUSIONS

The swallowable, biofragmentable magnetic anastomosis system appeared to be feasible and safe in achieving incisionless, sutureless jejuno-ileostomy. The first-in-human MagJI procedure may offer minimally complicated anastomosis creation and moderate MBS weight loss and T2D reduction.

First-in-human side-to-side linear magnetic compression gastroileostomy: feasibility and early outcomes in adults with obesity

BACKGROUND

Conventional surgical stapling/suturing requires tissue fixation with retained potentially inflammatory materials. A novel minimally invasive magnetic compression anastomosis system that requires no fixation, enterotomy closure, or permanent implant seems to mitigate major complications associated with stapling/suturing. As an option for revision of clinically suboptimal sleeve gastrectomy (SG), the technical feasibility, safety, and preliminary efficacy of magnetic gastroileostomy bipartition (MagGI procedure) were evaluated in a first-in-human case series.

METHODS

In this prospective single-center study, adults with a body mass index (BMI) of ≥30.0 to ≤50.0 kg/m2 who were candidates for SG revision underwent the MagGI procedure. A distal magnet was delivered endoscopically with laparoscopic assistance to the ileum. A proximal magnet was positioned endoscopically in the gastric antrum. The magnets were aligned to gradually fuse, forming a gastroileal bipartition. The primary safety endpoint was minimal incidence of device- and procedure-related severe adverse events (SAEs) (Clavien-Dindo [CD] classification). The primary efficacy endpoint was technical feasibility. The secondary endpoints were reduction of weight and metabolic parameters.

RESULTS

Between November 27, 2023, and May 27, 2024, 7 patients (mean BMI of 38.8 ± 0.9 kg/m2) underwent revisional MagGI. Feasibility was demonstrated, and patent gastroileal anastomoses were confirmed in 100.0% of cases, with no device-related events and 1 SAE with a CD III mild rating. There was no anastomotic leakage, bleeding, obstruction, infection, or stricture. Total weight loss and excess weight loss were 18.9% ± 3.9% and 52.4% ± 11.0%, respectively. A BMI reduction of 7.4 kg/m2 was observed (P <.05). Mild nutritional concerns were treated.

CONCLUSION

At the 6-month interim evaluation, the MagGI procedure was performed to revise clinically suboptimal SG. In addition, the procedure was technically straightforward, incurred no major complications, and renewed clinically meaningful weight loss in a small cohort.

Comparative study of cylindrical vs circular ring magnets for colonic anastomosis in rats

BACKGROUND

Magnetic compression anastomosis (MCA) offers a simple and reliable technique for inducing anastomoses at any point along the digestive tract. Evidence regarding whether the design of the MCA device influences the anastomosis effect is lacking.

AIM

To investigate any difference in the side-to-side colonic anastomosis effect achieved with cylindrical vs circular ring magnets.

METHODS

We designed cylindrical and circular ring magnets suitable for side-to-side colonic anastomosis in rats. Thirty Sprague-Dawley rats were randomly divided into a cylindrical group, circular ring group, and cylindrical–circular ring group (n = 10/group). Side-to-side colonic anastomosis was completed by transanal insertion of the magnets without incision of the colon. Operation time, perioperative complications, and magnet discharge time were recorded. Rats were euthanized 4 weeks post-operatively, and anastomotic specimens were obtained. The burst pressure and anastomotic diameter were measured sequentially, and anastomosis formation was observed by naked eye. Histological results were observed by light microscopy.

RESULTS

In all 30 rats, side-to-side colonic anastomosis was completed, for an operation success rate of 100%. No postoperative complications of bleeding and intestinal obstruction occurred, and the postoperative survival rate were 100%. The operation time, magnet discharge time, anastomotic bursting pressure, and anastomotic diameter did not differ significantly among the three designs (P > 0.05). Healing was similar across the groups, with gross specimens showing good anastomotic healing and good mucosal continuity observed on histological analysis.

CONCLUSION

This study found no significant difference in the establishment of rat side-to-side colonic anastomosis with the use of cylindrical vs circular ring magnets.

Magnetic compression anastomosis gastrojejunostomy: feasibility and efficacy of a novel device in a swine model

BACKGROUND

Means of addressing technical challenges in forming gastrojejunostomy (GJ) anastomoses and maintaining their patency are sought.

OBJECTIVES

Evaluation of preclinical feasibility and healing efficacy of a novel linear magnetic compression anastomosis (MCA) device to form a patent GJ versus sutured jejunal enterotomy (JE) sites in swine.

SETTING

Single-center veterinary testing facility.

METHODS

Feasibility of 3 prototype sizes (4, 6, and 8 cm) of a metal MCA device (MCAD) to form a patent GJ was evaluated over 6 weeks. A distal magnet was laparoscopically inserted in the jejunum, a proximal magnet was placed gastroscopically in the stomach; magnets were aligned to gradually form an anastomosis, self-detached, and be expelled. At necropsy, MCAs were assessed for patency and compared with JE tissues to evaluate wound healing.

RESULTS

MCADs aligned at the GJ location without complications. In 5/6 MCAD pairs, dislodgement occurred between 7 and 26 days; expulsion 13-31 days; 1 MCAD pair was retained in the stomach. At necropsy, all pigs were healthy, gaining a mean 15.0 kg. Anastomoses were not adequately patent in 2/4 pigs receiving the 4-cm or 6-cm MCADs because their linear length was too small. But, anastomoses of both pigs receiving the 8-cm MCADs maintained full patency. Minimal inflammation and fibrosis were seen in MCA specimens versus sutured enterotomies.

CONCLUSIONS

A novel linear MCA device was feasible and effectively created a patent GJ anastomosis in swine with minimal inflammation and fibrosis. The MCAD may be appropriate for clinical evaluation.

Magnetic single-anastomosis side-to-side duodeno-ileostomy for revision of sleeve gastrectomy in adults with severe obesity: 1-year outcomes

INTRODUCTION

Uncomplicated surgical approaches that minimize anastomotic complications while improving revisional metabolic/bariatric surgical (MBS) outcomes are needed.

METHODS

This prospective single-center study assessed the feasibility, safety, and efficacy of the novel linear magnetic anastomosis system (LMAS [3 cm]) in performing a side-to-side duodeno-ileostomy (MagDI) bipartition to revise clinically suboptimal primary sleeve gastrectomy (SG). Patients with severe obesity with/without type 2 diabetes (T2D) with suboptimal weight loss, regain, and/or T2D recurrence post SG underwent revisional MagDI. A distal and proximal magnet were delivered endoscopically to the ileum and duodenum and aligned via laparoscopic assistance. Gradual magnet fusion formed a DI bipartition.

PRIMARY ENDPOINTS

technical feasibility, safety (Clavien-Dindo [CD] severe adverse event classification) at 1 year. Secondary endpoints: MBS weight and T2D reduction.

RESULTS

July 29, 2022-March 28, 2023, 24 patients (95.8% female, mean age 44.9 ± 1.5 years, and body mass index [BMI] 39.4 ± 1.3 kg/m2) underwent MagDI. Feasibility was attained via correct magnet placement (mean operative time 63.5 ± 3.3 min), patent anastomoses created, and magnet passage per anus in 100.0% of patients. There were 4 CD-III mild or moderate severe AEs, 0.0% associated with the LMAS or MagDI: 0.0% anastomotic leakage, obstruction, bleeding, infection, reintervention, or death. Mean BMI reduction was 2.1 kg/m2 (p < 0.05); total weight loss 5.3%, excess weight loss 16.4%; and the patient with T2D improved.

CONCLUSION

The single-anastomosis MagDI procedure using the novel 3-cm LMAS to revise clinically suboptimal SG was technically straightforward, incurred no major complications, mitigated weight regain, and renewed clinically meaningful weight loss.

CLINICALTRIALS

GOV IDENTIFIER

NCT05322122.