Magnetic compression anastomosis in gastrointestinal and biliary disease: Techniques and clinical applications

Figure 1 Flow diagram of study selection. The diagram summarises the identification, screening, exclusion, and inclusion of studies used in the narrative review and evidence tables. ¹Selected case reports were included in the descriptive discussion when they were innovative or of historical significance. PICO: Patient population, intervention, comparison, and outcome.

Figure 2 Magnetic compression anastomosis for biliary stricture. A: Post-operative or post-transplant biliary stricture; B: Delivery of Proximal and distal magnet via percutaneous transhepatic catheter and endoscopy; C: Magnet approximated and stricture being negotiated by wire; D: Once neo-fistula formed and wire negotiated, stent is placed to maintain the patency of the fistula.

Figure 3 Representative access routes for magnetic compression anastomosis in gastrointestinal and biliary disease. A: Bilioenteric anastomotic stricture approached through transhepatic and enteroscopic routes; B: Esophageal anastomotic stricture approached through oral endoscopy and gastrostomy access; C: Colorectal stricture approached through colonoscopic and distal luminal access. PEG: Percutaneous endoscopic gastrostomy.

Figure 4 Magnetic compression anastomosis for postcholecystectomy bile duct injury stricture. A: Percutaneous transhepatic cholangiogram showing complete cut off of common bile duct; B: Parent magnet being deployed by percutaneous trans hepatic route; C: Daughter magnet being delivered via endoscopic retrograde cholangiographic route; D: Both the magnet were kept in place by stents; E: After 10 days, magnets approximated and wire negotiated into intrahepatic biliary radicle via neo fistula; F: Cholangiogram demonstrating resolution of stricture and neo fistula.

Figure 5 Magnet migration and failed magnetic compression anastomosis. A: Percutaneous cholangiogram showing complete cut of the bile duct; B: Both parent and daughter magnets deployed, however, the distance between them is long (4 cm); C: Serial radiograph showed no anastomosis formation; D: Distal magnet was retrieved endoscopically; however, cholangioscopic retrieval of the magnet failed, and the patient underwent surgery.