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

Table 1 Comparison of surgical, endoscopic, and magnetic compression approaches

Parameter	Surgical repair	Endoscopic/stenting	MCA
Invasiveness	High (open/laparoscopic)	Low-moderate (endoscopic)	Low-moderate (minimally invasive)
Immediate success rate	High (but not 100%)	Variable (depends on anatomy)	High (in selected cases)
Need for re-intervention	Moderate (strictures can recur)	High (stents need exchange, recurrent strictures)	Moderate (requires dilation and stenting post-MCA)
Technical difficulty	High (surgery/anastomosis)	Moderate (ERCP/PTBD)	High (new technique, device handling)
Patient risk	High (operative risk)	Low-moderate (infection, pancreatitis)	Low (mostly sedation/endoscopy risks)
Evidence base	Strong	Strong (RCTs, meta-analyses)	Weak (case series, early reports)

MCA: Magnetic compression anastomosis; ERCP: Endoscopic retrograde cholangiopancreatography; PTBD: Percutaneous transhepatic biliary drainage; RCTs: Randomized controlled trial.

Table 2 Summary of clinical studies evaluating magnetic compression anastomosis for biliary conditions

Ref.	Country	Design and patients	Indication	Main outcome	Adverse events and limitations
Jang et al[35], 2011	South Korea	Retrospective observational study; n = 12	Biliary anastomotic strictures after living donor liver transplantation	Successful recanalization of biliary anastomotic stricture after LDLT. Clinical success: 9/12 (75%); technical success: 10/12 (83.3%)	Mild cholangitis (n = 1); recurrence of anastomotic stricture (n = 1)
Jang et al[36], 2014	South Korea	Retrospective case series; n = 7	Recanalization of refractory benign biliary strictures	Successful recanalization of completely obstructed benign biliary strictures. Clinical success: 5/7 (71.4%); technical success: 5/7 (71.4%)	No MCA-related complications or restenosis reported
Ersoz et al[37], 2016	Turkey	Pilot study/case series; n = 6	Disconnected bile duct after living-donor liver transplantation	Biliary recanalization after magnetic compression anastomosis. Clinical success: 6/6 (100%); technical success: 6/6 (100%)	No procedure-related adverse events reported
Jang et al[2], 2017	South Korea	Single-center retrospective cohort study; n = 39	Completely obstructed benign biliary strictures	Successful recanalization and long-term patency of the biliary tract. Clinical success: 33/39 (84.6%); technical success: 35/39 (89.7%)	Mild cholangitis (n = 1); restenosis (n = 1); partial restenosis (n = 1)
Parlak et al[21], 2017	Turkey	Prospective case series; n = 9	Complete biliary obstruction after liver transplantation	Recanalization of complete duct-to-duct biliary anastomosis obstruction. Clinical success: 7/9 (77.8%); technical success: 7/9 (77.8%)	No procedure-related adverse events
Li et al[10], 2020	China	Prospective single-center clinical study; n = 9	Benign biliary strictures	Successful recanalization of benign biliary stricture with sustained duct patency. Clinical success: 9/9 (100%); technical success: 9/9 (100%)	Mild cholangitis (n = 1); biliary bleeding from PTBD tract (n = 1)
Ödemiş et al[12], 2022	Turkey	Retrospective case series; n = 19	Completely obstructed benign biliary strictures	Recanalization of completely obstructed benign biliary strictures with restoration of bile flow. Clinical success: 12/19 (63.2%); technical success: 19/21 procedures (90.5%)	Magnet entrapment (n = 3); magnet migration (n = 2); cholangitis (n = 1)
Chavan et al[38], 2024	India	Case series; n = 3	Post-cholecystectomy benign biliary stricture recanalization	Bile duct recanalization confirmed by cholangiography after magnet removal. Clinical success: 3/3 (100%); technical success: 3/3 (100%)	None reported
Jang et al[39], 2024	South Korea	Retrospective cohort study; n = 10	Complete biliary obstruction after cholecystectomy	Recanalization of complete biliary obstruction with creation of a fistulous tract. Clinical success: 8/10 (80%); technical success: 10/10 (100%)	No procedure-related adverse events; 2 patients developed stricture recurrence treated with repeat FCSEMS
Ünal et al[40], 2025	Turkey	Retrospective single-center cohort study; n = 26	Post-transplant biliary strictures (combined endoscopic-percutaneous approach)	Successful recanalization of completely obstructed post-transplant biliary anastomotic strictures with long-term patency. Clinical success: 24/26 (92.3%); technical success: 24/26 (92.3%)	Recurrent biliary stricture during follow-up (n = 6); no major procedure-related complications reported

FCSEMS: Fully covered self-expandable metal stent; LDLT: Living donor liver transplantation; MCA: Magnetic compression anastomosis; PTBD: Percutaneous transhepatic biliary drainage.

Table 3 Summary of clinical studies evaluating magnetic compression anastomosis for biliary-enteric conditions

Ref.	Country	Design and patients	Indication	Main outcome	Adverse events and limitations
Liu et al[41], 2018	China	Prospective clinical trial; n = 41	Biliojejunostomy	Successful formation of bilioenteric anastomosis with long-term patency. Clinical success: 39/41 (95.1%); technical success: 41/41 (100%)	Cholangitis before magnet expulsion (n = 3); biliary anastomotic stricture requiring reoperation (n = 2)
Liu et al[42], 2019	China	Prospective case series; n = 5	Laparoscopic magnetic compression biliojejunostomy for obstructive jaundice	Formation of patent biliojejunostomy with successful internal biliary drainage. Clinical success: 5/5 (100%); technical success: 5/5 (100%)	Wound infection (n = 1); no anastomotic leak or stricture
Liu et al[43], 2019	China	Prospective case series; n = 4	Biliojejunostomy and pancreaticojejunostomy during Whipple’s procedure	Formation of functional biliojejunostomy and pancreaticojejunostomy after pancreaticoduodenectomy. Clinical success: 3/4 (75%); technical success: 4/4 (100%)	Cholangitis (n = 1); pancreatic fistula (n = 1); biliary anastomotic stricture at 11 months (n = 1)
Li et al[44], 2021	China	Retrospective case series; n = 7	Magnetic compression anastomosis during laparoscopic pancreatoduodenectomy for choledochojejunostomy and pancreatojejunostomy	Formation and postoperative function of magnetic biliojejunostomy and pancreaticojejunostomy after laparoscopic pancreatoduodenectomy. Clinical success: 7/7 (100%); technical success: 7/7 (100%)	Pancreatic fistula (n = 2); intra-abdominal infection (n = 2); delayed gastric emptying (n = 2); intra-abdominal bleeding (n = 1); no biliary or pancreatic anastomotic leak
Li et al[45], 2021	China	Prospective clinical study; n = 23	Cholangiojejunostomy	Restoration of biliary drainage through magnetic compression cholangiojejunostomy. Clinical success: 22/23 (95.7%); technical success: 23/23 (100%)	Bile leakage (n = 1); postoperative complications (Clavien-Dindo I-IIIa) in 10 patients; cholangitis during follow-up (n = 3); anastomotic stricture (n = 1)
Avaliani et al[46], 2009	Russia	Prospective clinical series; n = 34	Palliation of malignant obstructive jaundice	Creation of biliary-enteric fistula for internal biliary drainage in malignant obstructive jaundice. Clinical success: 29/34 (85.3%); technical success: 34/34 (100%)	Temporary occlusion of bypass due to food debris (n = 2); tumor ingrowth requiring surgical revision (n = 3); reflux cholangitis (n = 2)

Table 4 Summary of clinical studies evaluating magnetic compression anastomosis for esophageal conditions

Ref.	Country	Design and patients	Indication	Main outcome	Adverse events and limitations
Zaritzky et al[47], 2009	Argentina	Prospective; n = 5	Esophageal atresia	Successful formation of an esophageal anastomosis. Clinical success: 100%; technical success: 80%	Restenosis in 80% requiring dilatation and Fever in one patient
Slater et al[50], 2019	United States	Multicenter retrospective case series; n = 13	Long-gap esophageal atresia	Establishment of esophageal continuity and long-term preservation of native esophagus. Clinical success: 12/13 (92.3%); technical success: 13/13 (100%)	Esophageal stricture requiring dilation in all patients (mean 9.8 dilations); stent placement (n = 6); surgery for refractory stricture (n = 2); perforation after dilation (n = 1)
Shieh et al[51], 2022	United States	Retrospective case series; n = 3	Long-gap esophageal atresia	Establishment of esophageal continuity and long-term. Clinical success: 0/3 (0%); technical success: 3/3 (100%)	Failure of anastomosis in 2 patients; magnet erosion into lung requiring surgery (n = 1); severe anastomotic stricture after repeat magnamosis (n = 1)
Conforti et al[52], 2023	Italy	Case series; n = 5	Long-gap esophageal atresia	Restoration of esophageal continuity. Clinical success: 5/5 (100%); technical success: 5/5 (100%)	Anastomotic stenosis requiring dilation (5/5); esophageal perforation after dilation (n = 1)
Lee et al[53], 2024	Germany, United States	First-in-human case series; n = 10	Esophageal magnetic compression anastomosis using the connect-EA device for esophageal atresia repair	Restoration of esophageal continuity and tolerance of oral feeding. Clinical success: 7/10 (70%); technical success: 9/10 (90%)	Bronchoesophageal fistula (n = 1); esophageal perforation after balloon dilation (n = 2)

EA: Esophageal atresia.

Table 5 Summary of clinical studies evaluating magnetic compression anastomosis for intestinal and colorectal conditions

Ref.	Country	Design and patients	Indication	Main outcome	Adverse events and limitations
Graves et al[13], 2017	United States	Prospective single-center first-in-human pilot study; n = 5	Small bowel anastomosis during open reconstructive surgery	Formation of functional small bowel anastomosis without leak, bleeding, or stricture. Clinical success: 5/5 (100%); technical success: 5/5 (100%)	No anastomosis-related complications; unrelated complications included aspiration pneumonia, internal hernia, Clostridium difficile infection, and superficial surgical site infection
Kamada et al[63], 2021	Japan	Retrospective single-center case series; n = 14	Gastrointestinal obstruction (without general anesthesia)	Creation of functional gastrointestinal anastomosis to relieve obstruction. Clinical success: 11/14 (78.6%); technical success: 14/14 (100%)	Restenosis (n = 2); anastomotic perforation due to balloon dilation (n = 1)
Gagner et al[64], 2023	Georgia	Prospective first-in-human observational study; n = 5	Side-to-side magnetic compression duodeno-ileostomy with sleeve gastrectomy for obesity and type 2 diabetes	Successful creation of patent duodeno-ileal anastomosis with magnet expulsion without reintervention. Clinical success: 5/5 (100%); technical success: 5/5 (100%)	No device-related adverse events; mild abdominal wound pain (n = 3), mucosal tear during endoscopy (n = 1), intra-abdominal hematoma (n = 1), ileal serosal tear (n = 1)
Gagner et al[65], 2023	Belgium, Spain, Georgia	Prospective multicenter observational study; n = 24	Side-to-side magnetic duodeno-ileostomy with sleeve gastrectomy for obesity and type 2 diabetes	Successful magnet placement with formation of patent duodeno-ileal anastomosis and spontaneous magnet expulsion. Clinical success: 24/24 (100%); technical success: 24/24 (100%)	3 procedure-related serious adverse events; no device-related adverse events, no anastomotic leak, bleeding, obstruction, infection, or mortality
Cadière et al[66], 2024	Belgium	Prospective observational study; n = 10	Side-to-side duodeno-ileal bipartition with sleeve gastrectomy	Patent duodeno-ileal anastomosis confirmed endoscopically at 1 year. Clinical success: 9/9 evaluated (100%); technical success: 10/10 (100%)	Serosal tears (n = 2), sleeve leak (n = 1), dehydration (n = 3), internal hernia (n = 1); no device-related AEs
Gagner et al[22], 2025	Canada, Belgium, Spain, Georgia	Prospective multicenter study; n = 43	Side-to-side magnetic duodeno-ileostomy with or without sleeve gastrectomy for severe obesity	Successful magnet positioning, formation of patent duodeno-ileal anastomosis, and spontaneous magnet passage. Clinical success: 43/43 (100%); technical success: 43/43 (100%)	No device-related adverse events, leaks, bleeding, obstruction, infection, or death
Gagner et al[67], 2024	Belgium	Prospective single-center study; n = 24	Revisional side-to-side magnetic duodeno-ileostomy after sleeve gastrectomy for severe obesity	Formation of patent duodeno-ileal anastomosis with spontaneous magnet expulsion and no need for reintervention. Clinical success: 24/24 (100%); technical success: 24/24 (100%)	8 SAEs (Clavien-Dindo II-III) but none related to device or procedure; no leak, bleeding, obstruction, infection, or death
Gagner et al[68], 2024	Belgium	Prospective single-center first-in-human study; n = 7	Gastroileostomy for revision of sleeve gastrectomy	Successful placement and alignment of magnets with patent gastroileal anastomosis and spontaneous magnet expulsion. Clinical success: 7/7 (100%); technical success: 7/7 (100%)	3 serious adverse events (Clavien-Dindo III anal fissure/hemorrhoids in 1 patient); no device-related adverse events, leaks, bleeding, obstruction, infection, or death
Gagner et al[69], 2025	Czech Republic	Prospective first-in-human observational study; n = 9	Jejuno-ileostomy bipartition for obesity and type 2 diabetes	Successful magnet alignment and formation of patent jejuno-ileal anastomosis with spontaneous magnet expulsion. Clinical success: 9/9 (100%); technical success: 9/9 (100%)	No severe adverse events; minor events included influenza after discharge and transient hypoglycemia after magnet expulsion
Bhandari et al[70], 2026	India, Chile	Prospective multicenter study; n = 14	Jejuno-jejunal anastomosis in Roux-en-Y gastric bypass	Freedom from anastomotic adverse events within 30 days. Clinical success: 14/14 (100%); technical success: 14/14 (100%)	Procedure-related AEs: Bleeding, dysphagia, pulmonary embolism, diabetic ketoacidosis (n = 4); no device-related AEs
Machytka et al[57], 2017	Czech Republic	Prospective single center study; n = 10	Partial jejunal diversion	Total weight loss. Clinical success: 100%; technical success: 100%	No Serious, trocar-related gastric injury in one patient

AE: Adverse event; SAE: Serious adverse event.