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Surgical Endoscopy

, Volume 30, Issue 10, pp 4533–4538 | Cite as

Minimally invasive entero-enteral dual-path bypass using self-assembling magnets

  • Marvin Ryou
  • Hiroyuki Aihara
  • Christopher C. Thompson
Article

Abstract

Background

A minimally invasive method of entero-enteral bypass may be desirable for treatment of obstruction, obesity, or metabolic syndrome. We have developed a technology based on miniature self-assembling magnets which create large-caliber anastomoses (incisionless anastomosis system or IAS). The aim of this study was to assess (a) procedural characteristics of IAS deployment and (b) long-term integrity and patency of the resulting jejuno-ileal dual-path bypass.

Methods

Endoscopic jejuno-ileal bypass creation using IAS magnets was performed in 8 Yorkshire pigs survived 3 months. Procedure: The jejunal magnet was endoscopically deployed. However, the ileal magnet required surgical delivery given restraints of porcine anatomy. A 5-mm enterotomy was created through which the ileal magnet was inserted using a modified laparoscopic delivery tool. Magnets were manually coupled. Pigs underwent serial endoscopies for anastomosis assessment. Three-month necropsies were performed, followed by pressure testing of anastomoses and histological analysis.

Results

Jejuno-ileal bypass creation using self-assembling IAS magnets was successful in all 8 pigs (100 %). Patent, leak-free bypasses formed in all animals by day 10. All IAS magnets were expelled by day 12. Anastomoses were widely patent at 3 months, with mean maximal diameter of 30 mm. At necropsy, adhesions were minimal. Pressure testing confirmed superior integrity of anastomotic tissue. Histology showed full epithelialization across the anastomosis with no evidence of submucosal fibrosis or inflammation.

Conclusions

Entero-enteral bypass using self-assembling IAS magnets is safe and technically feasible in the porcine model. IAS magnets can be rapidly delivered endoscopically or through a modified laparoscopic device. Expulsion of fused magnets avoids retention of prosthetic material. Anastomoses are widely patent and fully re-epithelialized. Three-month pressure testing reveals anastomotic tissue to be as robust as native tissue, while necropsy and histology suggests minimal/absent tissue inflammation. In human anatomy, a fully endoscopic jejuno-ileal bypass using IAS magnets may be feasible.

Keywords

Incisionless anastomosis system (IAS) Anastomosis Magnetic anastomosis Compression anastomosis Surgical anastomosis Side-to-side anastomosis Dual-path bypass Self-assembling magnets for endoscopy SAMSEN Endoscopic bypass Endoscopic anastomosis Intestinal anastomosis 

Notes

Acknowledgments

The incisionless anastomosis system was developed with the support of the Center for Integration of Medicine and Innovative Technologies (CIMIT; Boston, MA).

Compliance with ethical standards

Disclosures

Marvin Ryou, MD: equity interest, GI Windows. Hiroyuki Aihara, MD, Ph.D.: No conflict of interest. Christopher C. Thompson, MD, MHES: equity interest, GI Windows.

References

  1. 1.
    Ly J, O’Grady G, Mittal A, Plank L, Windsor JA (2010) A systematic review of methods to palliate malignant gastric outlet obstruction. Surg Endosc 24:290–297CrossRefPubMedGoogle Scholar
  2. 2.
    Gentileschi P, Kini S, Catarci M, Gagner M (2002) Evidence-based medicine: open and laparoscopic bariatric surgery. Surg Endosc 16:736–744CrossRefPubMedGoogle Scholar
  3. 3.
    Duan J, Tan C, Xu H et al (2015) Side-to-side jejunoileal bypass induces better glucose-lowering effect than end-to-side jejunoileal bypass on nonobese diabetic rats. Obes Surg 25:1458–1467CrossRefPubMedGoogle Scholar
  4. 4.
    Himpens JM (2004) The gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass. Semin Laparosc Surg 11:171–177PubMedGoogle Scholar
  5. 5.
    Kantsevoy SV, Jagannath SB, Niiyama H et al (2005) Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc 62:287–292CrossRefPubMedGoogle Scholar
  6. 6.
    Bergstrom M, Ikeda K, Swain P, Park P (2006) Transgastric anastomosis by using flexible endoscopy in a porcine model (with video). Gastrointest Endosc 63:307–312CrossRefPubMedGoogle Scholar
  7. 7.
    Chiu PW, Wai Ng EK, Teoh AY et al (2010) Transgastric endoluminal gastrojejunostomy: technical development from bench to animal study (with video). Gastrointest Endosc 71:390–393CrossRefPubMedGoogle Scholar
  8. 8.
    Shang E, Hasenberg T, Magdeburg R, Keese M, Post S, Weiner R (2009) First experiences with a circular stapled gastrojejunostomy by a new transorally introducible stapler system in laparoscopic Roux-en-Y gastric bypass. Obes Surg 19:230–236CrossRefPubMedGoogle Scholar
  9. 9.
    Swain CP, Mills TN (1991) Anastomosis at flexible endoscopy: an experimental study of compression button gastrojejunostomy. Gastrointest Endosc 37:626–631CrossRefGoogle Scholar
  10. 10.
    Villaverde A, Cope C, Chopita N et al (2004) Long term follow-up of endoscopic gastroenteric anastomoses with magnets (EGAM) [abstract]. Gastrointest Endosc 59:AB92CrossRefGoogle Scholar
  11. 11.
    Fritscher-Ravens A, Mosse CA, Mukherjee D et al (2003) Transluminal endosurgery: single lumen access anastomotic device for flexible endoscopy. Gastrointest Endosc 58:585–591CrossRefPubMedGoogle Scholar
  12. 12.
    Jamshidi R, Stephenson JT, Clay JG et al (2009) Magnamosis: magnetic compression anastomosis with comparison to suture and staple techniques. J Pediatr Surg 44:222–228CrossRefPubMedGoogle Scholar
  13. 13.
    Pichakron KO, Jelin EB, Hirose S et al (2011) Magnamosis II: magnetic compression anastomosis for minimally invasive gastrojejunostomy and jejunojejunostomy. J Am Coll Surg 212:42–49CrossRefPubMedGoogle Scholar
  14. 14.
    Gonzales KD, Douglas G, Pichakron KO et al (2012) Magnamosis III: delivery of a magnetic compression anastomosis device using minimally invasive endoscopic techniques. Pediatr Surg 47:1291–1295CrossRefGoogle Scholar
  15. 15.
    Wall J, Diana M, Leroy J et al (2013) Magnamosis IV: magnetic compression anastomosis for minimally invasive colorectal surgery. Endoscopy 45:643–648CrossRefPubMedGoogle Scholar
  16. 16.
    Diana M, Wall J, Perretta S et al (2011) Totally endoscopic magnetic enteral bypass by external guided rendezvous technique. Surg Innov 18:317–320CrossRefPubMedGoogle Scholar
  17. 17.
    Chopita N, Vaillaverde A, Cope C et al (2005) Endoscopic gastroenteric anastomosis using magnets. Endoscopy 37:313–317CrossRefPubMedGoogle Scholar
  18. 18.
    Cope C (1995) Creation of compression gastroenterostomy by means of the oral, percutaneous, or surgical introduction of magnets: feasibility study in swine. J Vasc Interv Radiol 6:539–545CrossRefPubMedGoogle Scholar
  19. 19.
    Cope C, Ginsberg GG (2001) Long-term patency of experimental magnetic compression gastroenteric anastomoses achieved with covered stents. Gastrointest Endosc 53:780–784CrossRefPubMedGoogle Scholar
  20. 20.
    Ryou M, Cantillon-Murphy P, Azagury D et al (2011) Smart self-assembling magnets for endoscopy (SAMSEN) for transoral endoscopic creation of immediate gastrojejunostomy (with video). Gastrointest Endosc 73:353–359CrossRefPubMedGoogle Scholar
  21. 21.
    Ryou M, Agoston AT, Thompson CC (2015) Endoscopic intestinal bypass creation by using self-assembling magnets in a porcine model. Gastrointest Endosc. doi: 10.1016/j.gie.2015.10.023
  22. 22.
    Romagnuolo J, Morris J, Palesch S et al (2010) Natural orifice transluminal endoscopic surgery versus laparoscopic surgery for inadvertent colon injury repair: feasibility, risk of abdominal adhesions, and peritoneal contamination in a porcine survival model. Gastrointest Endosc 71:817–823CrossRefPubMedGoogle Scholar
  23. 23.
    Ryou M, Fong DG, Pai RD et al (2008) Transluminal closure for NOTES: an ex vivo study comparing leak pressures of various gastrostomy and colotomy closure modalities. Endoscopy 40:432–436CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Marvin Ryou
    • 1
  • Hiroyuki Aihara
    • 1
  • Christopher C. Thompson
    • 1
  1. 1.Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA

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