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Ünal E, Esen Ü, Uysal A, Çiftçi TT, Akinci D, Parlak E. Combined endoscopic-percutaneous approach for magnetic compression anastomosis in post-transplant anastomotic biliary strictures. Eur Radiol 2025:10.1007/s00330-025-11634-w. [PMID: 40287869 DOI: 10.1007/s00330-025-11634-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Revised: 03/09/2025] [Accepted: 04/01/2025] [Indexed: 04/29/2025]
Abstract
OBJECTIVES To investigate long-term outcomes of combined endoscopic-percutaneous methods for endoscopically unmanageable anastomotic biliary strictures in living donor liver recipients. MATERIALS AND METHODS This retrospective single-center study included 144 patients referred for biliary stricture between November 2017 and May 2023. Eighty-eight patients (leak = 8, non-anastomotic stricture = 3, treatment refused = 12, successful ERCP = 65) were excluded. Patients initially underwent percutaneous biliary drainage. Patients for whom percutaneous intervention was successful in traversing stricture were followed up with fully-covered self-expandable metallic stents and/or plastic catheter stents. However, in case of failure, magnetic compression anastomosis (MCA) was performed. RESULTS A total of 56 patients (mean age, 59 years ±11; 35 men) comprised the study group. Percutaneous intervention was successful in traversing the stricture in 26/56 patients. Among the remaining 30 patients, 26 were eligible for MCA, which was performed successfully in 24 patients (92%). The mean duration from magnet placement to internalization was 7.71 ± 2.77 days (95% CI: 6.54-8.88). Altogether, in 47 patients (24 of whom underwent MCA), percutaneous drains were removed following biliary stenting. The mean follow-up was 1082.5 ± 668.2 days (95% CI: 907.49-1257.51). In 19 patients (40%), recurrent stricture was evident at ERCP during a median follow-up of 90 (IQR: 60-210) days following stent removal. The recurrent stricture rate following MCA (n = 6/24) was significantly lower compared to patients in whom MCA was not performed (n = 13/23; p = 0.026). Overall, stent type had no significant effect on patency (p = 0.189). CONCLUSION Percutaneous biliary procedures are essential for endoscopically unmanageable post-transplant anastomotic biliary strictures. MCA seems to provide higher patency rates even in patients with total biliary occlusion. KEY POINTS Question What steps can be taken when endoscopy fails in the treatment of post-transplant anastomotic biliary strictures? Findings Percutaneous biliary access and magnetic compression anastomosis can be applied to increase graft survival in the setting of endoscopically unmanageable post-transplant biliary strictures. Clinical relevance Impassable biliary obstructions are unfortunate complications and not uncommon in liver transplant recipients. Magnetic compression anastomosis is an alternative minimally invasive method of treatment for complete biliary occlusions.
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Affiliation(s)
- Emre Ünal
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, 06100, Turkey.
| | - Ümran Esen
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, 06100, Turkey
| | - Aycan Uysal
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, 06100, Turkey
| | - Türkmen Turan Çiftçi
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, 06100, Turkey
| | - Devrim Akinci
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, 06100, Turkey
| | - Erkan Parlak
- Department of Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara, 06100, Turkey
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Ünal E, Çiftçi TT, Akinci D, Parlak E. Magnets in action: role of interventional radiologists in magnetic compression anastomosis procedures. Insights Imaging 2024; 15:128. [PMID: 38816640 PMCID: PMC11139847 DOI: 10.1186/s13244-024-01705-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/08/2024] [Indexed: 06/01/2024] Open
Abstract
Obstructions encountered in biliary, gastrointestinal, and urinary tracts are increasing in number due to successful percutaneous and endoscopic organ-saving procedures. Although functional recovery is established to an extent, failure of traversing an obstruction may end up necessitating invasive surgical procedures. Multidisciplinary collaboration may traverse the limitations of each individual approach, therefore creating the perfect intervention for the patient. Magnetic compression anastomosis is a minimally invasive procedure that can provide a great outcome in select cases with biliary, gastrointestinal, or urinary tract obstructions. CRITICAL RELEVANCE STATEMENT: In this article, various applications of magnetic compression anastomosis are reviewed with illustrative cases of esophageal, biliary, colonic, and urinary obstructions that cannot be traversed with a wire. This method will expand the spectrum of interventions performed in the IR unit. KEY POINTS: Magnets can enable wire access beyond an impassable obstruction. Magnets can create anatomical and non-anatomical anastomosis at an occlusion. Magnetic compression anastomosis is a minimally invasive procedure that can provide great outcomes.
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Affiliation(s)
- Emre Ünal
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Türkmen Turan Çiftçi
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Devrim Akinci
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Erkan Parlak
- Department of Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Zhang M, Li Y, Pan M, Xu S, Gai J, Zhang H, An Y, Shi A, Lyu Y, Yan X. Creation of gastroenteric anastomosis through natural orifice in rats by magnetic compression technique. Surg Endosc 2022; 36:8170-8177. [PMID: 35501603 DOI: 10.1007/s00464-022-09257-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/08/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Being one of the core techniques of magnetic surgery, magnetic compression technique (MCT) has been used for digestive tract anastomosis reconstruction in experimental studies. This study verified the feasibility of gastroenteric anastomosis through natural orifice using MCT in rats. METHODS The parent and daughter magnets were designed and manufactured for oral and anal insertion in 20 Sprague-Dawley rats. After anesthesia, the parent magnet was inserted into the colon spleen area through the anus, and the daughter magnet was inserted into the stomach through the mouth. Then the two magnets were positioned to attract each other and bind together. The position of the two magnets was monitored using X-ray. The time required for the formation of the anastomosis and expulsion of the magnets were recorded. 2 weeks later, the animal was sacrificed and the anastomotic specimen was obtained which was observed under naked eye and microscope. RESULTS The gastroenteric anastomosis was successfully performed via natural orifices in 18 out of 20 rats. The mean time to construct the anastomosis was 3.78 ± 0.88 min. X-ray examination showed that the magnets were in the appropriate position in 17 rats. The magnets were excreted in 9.47 ± 1.62 days after surgery. The gross and microscopic examination of the specimen showed that the anastomoses were patent and the mucosa at the anastomotic was smooth. The mean bursting pressure of the anastomosis was 136.94 ± 6.79 mmHg. CONCLUSION It is feasible to perform gastroenteric anastomosis through natural orifices by MCT.
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Affiliation(s)
- Miaomiao Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China.,National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Yixing Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Min Pan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Shuqin Xu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China.,National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Jingci Gai
- Qide College, Xi'an Jiaotong University, No. 76 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Hanzhi Zhang
- Qide College, Xi'an Jiaotong University, No. 76 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Yingfeng An
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China.,National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China.,Shaanxi Provincial Centre for Disease Control and Prevention, No. 3 Jiandong Street, Xi'an, 710054, Shaanxi, People's Republic of China
| | - Aihua Shi
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Yi Lyu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China. .,National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China.
| | - Xiaopeng Yan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China. .,National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China.
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Lumen reconstruction with magnetic compression anastomosis technique in a patient with complete esophageal stricture. Acta Gastroenterol Belg 2022; 85:393-395. [DOI: 10.51821/85.2.8436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Complete esophageal obstruction (CEO) is a rare condition of which treatment options are challenging. Surgery is the main treatment with high morbidity and mortality rates. Magnetic compression anastomosis (MCA) is a novel technique developed to restore lumen patency in gastrointestinal and biliary tracts. However, MCA experience is limited in respect of esophageal strictures.
Case Report: We present a 26-year-old patient having CEO. Magnets are inserted endoscopically to both sides of the obstructed area via oral and retrograde (through the gastrostomy tract) route. On day 8, magnets stuck together and were removed endoscopically through the oral route. Subsequently, sessions of balloon dilatations and triamcinolone injection were performed. The patient’s complaint of aphagia resolved after the treatment process.
Conclusion: In conclusion, MCA is an alternative technique that can be used to restore lumen patency in esophageal strictures and also avoids complications of surgical interventions.
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Expert consensus on treating esophageal stenosis in children by magnetic recanalization. Chin Med J (Engl) 2022; 135:796-798. [PMID: 35671180 PMCID: PMC9276091 DOI: 10.1097/cm9.0000000000001957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Chen H, Ma T, Wang Y, Zhu HY, Feng Z, Wu RQ, Lv Y, Dong DH. Fedora-type magnetic compression anastomosis device for intestinal anastomosis. World J Gastroenterol 2020; 26:6614-6625. [PMID: 33268950 PMCID: PMC7673965 DOI: 10.3748/wjg.v26.i42.6614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 08/29/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although previous studies have confirmed the feasibility of magnetic compression anastomosis (MCA), there is still a risk of long-term anastomotic stenosis. For traditional MCA devices, a large device is associated with great pressure, and eventually increased leakage. AIM To develop a novel MCA device to simultaneously meet the requirements of pressure and size. METHODS Traditional nummular MCA devices of all possible sizes were used to conduct ileac anastomosis in rats. The mean (± SD) circumference of the ileum was 13.34 ± 0.12 mm. Based on short- and long-term follow-up results, we determined the appropriate pressure range and minimum size. Thereafter, we introduced a novel "fedora-type" MCA device, which entailed the use of a nummular magnet with a larger sheet metal. RESULTS With traditional MCA devices, the anastomoses experienced stenosis and even closure during the long-term follow-up when the anastomat was smaller than Φ5 mm. However, the risk of leakage increased when it was larger than Φ4 mm. On comparison of the different designs, it was found that the "fedora-type" MCA device should be composed of a Φ4-mm nummular magnet with a Φ6-mm sheet metal. CONCLUSION The diameter of the MCA device should be greater than 120% of the enteric diameter. The novel "fedora-type" MCA device controls the pressure and optimizes the size.
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Affiliation(s)
- Huan Chen
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Tao Ma
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Yue Wang
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Hao-Yang Zhu
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Zhe Feng
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Rong-Qian Wu
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Yi Lv
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Ding-Hui Dong
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
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