1
|
Liu SQ, Lv Y, Luo RX. Endoscopic magnetic compression stricturoplasty for congenital esophageal stenosis: A case report. World J Clin Cases 2022; 10:12313-12318. [PMID: 36483808 PMCID: PMC9724527 DOI: 10.12998/wjcc.v10.i33.12313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/24/2022] [Accepted: 10/17/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Congenital esophageal stenosis (CES) is a rare malformation of the digestive tract. Endoscopic dilation and thoracotomy have been the main treatments for CES. However, there is no well-defined management protocol. Magnetic compression stricturoplasty (MCS) has been used in refractory esophageal stricture in children after esophageal atresia.
CASE SUMMARY We describe the first case of MCS for CES in one female child patient. The child (aged 3 years and 1 mo) was admitted due to frequent vomiting and choking after eating complementary food since 7 mo old. Esophagography and gastroendoscopy showed that there was stenosis in the lower esophagus, suggesting a diagnosis of CES. The patient did not receive any treatment for esophageal stricture including surgery or endoscopic dilation procedures before MCS. MCS procedure was smoothly conducted without complications. At 24 mo after MCS, durable esophageal patency without dysphagia was achieved.
CONCLUSION MCS may serve as an alternative and efficient method for patients with CES.
Collapse
Affiliation(s)
- Shi-Qi Liu
- Department of Nursing, The Medical College, Xijing University, Xi’an 710123, Shaanxi Province, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Rui-Xue Luo
- The Corrosion & Protection Research Lab, Northwest Institute for Nonferrous Metal Research, Xi’an 710016, Shaanxi Province, China
| |
Collapse
|
2
|
Ödemiş B, Başpınar B, Tola M, Torun S. Magnetic Compression Anastomosis Is a Good Treatment Option for Patients with Completely Obstructed Benign Biliary Strictures: A Case Series Study. Dig Dis Sci 2022; 67:4906-4918. [PMID: 35050430 DOI: 10.1007/s10620-022-07381-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Completely obstructed benign biliary strictures (BBS) is a difficult-to-treat condition. Surgery is the main treatment modality with high morbidity and mortality. Recently, the magnetic compression anastomosis (MCA) technique was employed in such cases with low complication rates. AIMS To evaluate the effectiveness of the MCA in completely obstructed BBS. METHODS 21 MCA procedures were performed in 19 patients with completely obstructed BBS. All patients had percutaneous biliary access. Magnets were located to the proximal side of the obstruction via percutaneous biliary sheath and the distal side endoscopically. The procedure was terminated as the magnets attracted. Either self-expandable fully covered metallic stent and/or a growing number of plastic stents were introduced after recanalization was achieved. RESULT A total number of 19 patients with completely obstructed BBS resulting from cholecystectomy or liver transplant underwent 21 MCA procedures. Among those, 19 (90.5%) interventions were successful. The median stricture length that had been measured after magnet attraction was 4 mm (range 1-10 mm). The median magnet coupling time in successful cases was 9 days (range 4-27 days). No correlation was found between magnet coupling time and stricture length (p = 0.27). Complications were observed in 6 (cholangitis:1, magnet migration:2, magnet entrapment:3) of 19 successful MCA procedures. Fifteen of the 19 successful procedures had at least a period of stent-free follow-up. Recurrence of stenosis occurred in 7 procedures, of which 4 remained stent-free with retreatment. Eventually, 12 procedures had stent-free last status. CONCLUSIONS MCA is an effective and safe treatment option in completely obstructed BBS. Further studies are required for procedural standardization.
Collapse
Affiliation(s)
- Bülent Ödemiş
- Department of Gastroenterology and Hepatology, Ankara City Hospital, Bilkent Avenue Çankaya, 06800, Ankara, Turkey.
| | - Batuhan Başpınar
- Department of Gastroenterology and Hepatology, Ankara City Hospital, Bilkent Avenue Çankaya, 06800, Ankara, Turkey
| | - Muharrem Tola
- Department of Radiology, Division of Interventional Radiology, Ankara City Hospital, Bilkent Avenue Çankaya, 06800, Ankara, Turkey
| | - Serkan Torun
- Faculty of Medicine, Department of Gastroenterology, Düzce University, Konuralp Campus, Beçiyörükler District, 81010, Merkez, Düzce, Turkey
| |
Collapse
|
3
|
Li X, Zhang H, Zhang M, Niu S, Zhang F. Development of a Magnetic Kissing Guidewire and Animal Experiment: a Preliminary Study. J Cardiovasc Transl Res 2020; 14:589-594. [PMID: 32152796 DOI: 10.1007/s12265-020-09980-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/26/2020] [Indexed: 11/28/2022]
Abstract
Endovascular therapy has been the first option for many vascular diseases. Due to the increasing development of endovascular devices and techniques in recent decades, endovascular procedures could be applied in treating those cases with complex anatomy. Two or three vascular access routes are required to establish through-and-through access in endovascular therapy for arterial occlusive disease and complex aortic aneurysm. Guidewire snaring with a snare kit is essential but sometimes time-consuming in the establishment of through-and-through access. To simplify the procedure, we design the magnetic kissing guidewire (MKG) with a magnetic tip that attracts each other to establish a guidewire route that meets the needs of clinical practice. We conducted the in vitro test to evaluate its magnetic force and the in vivo test to assess its performance in the arteries of twelve sheep. The results revealed that this novel guidewire significantly simplified the establishment of through-and-through access.
Collapse
Affiliation(s)
- Xiangtao Li
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, 10 Tieyi Rd, Haidian District, Beijing, 100038, China
| | - Huan Zhang
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, 10 Tieyi Rd, Haidian District, Beijing, 100038, China
| | - Mingyi Zhang
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuai Niu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Fuxian Zhang
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, 10 Tieyi Rd, Haidian District, Beijing, 100038, China.
| |
Collapse
|
4
|
Ahmad J. Metal, magnet or transplant: options in primary sclerosing cholangitis with stricture. Hepatol Int 2018; 12:510-519. [PMID: 30430358 DOI: 10.1007/s12072-018-9906-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/20/2018] [Indexed: 02/06/2023]
Abstract
Primary sclerosing cholangitis (PSC) is a chronic inflammatory disease of the biliary tree of unknown etiology leading to stricturing and dilation. There is currently no effective medical therapy for PSC and liver transplantation (LT) remains the ultimate treatment for severe disease defined as repeated episodes of cholangitis, decompensated biliary cirrhosis or in exceptional cases, cholangiocarcinoma (CCA). Patients often present with a "dominant" stricture and the therapeutic endoscopist plays an important role in management to improve biliary patency using a variety of techniques that involve sampling, balloon dilation and temporary stenting. Newer modalities such as self-expanding metal stents or magnetic compression anastomosis that have been used in other diseases may have a role to play in PSC but should remain investigational. Liver transplantation for PSC is curative in most cases but the optimal timing remains unclear. The lifetime risk of CCA is 10-15% in PSC patients and LT is often not possible at the time of diagnosis. Multiple studies have tried to identify risk factors and to diagnose CCA at an early stage when surgical resection may be possible or LT can be performed. However, deceased donor organs for LT remain in short supply throughout the world so even identifying PSC patients with CCA at an early stage may not be beneficial unless a live donor organ is available.
Collapse
Affiliation(s)
- Jawad Ahmad
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
| |
Collapse
|
5
|
Kubo M, Wada H, Eguchi H, Gotoh K, Iwagami Y, Yamada D, Akita H, Asaoka T, Noda T, Kobayashi S, Nakamura M, Ono Y, Osuga K, Yamanouchi E, Doki Y, Mori M. Magnetic compression anastomosis for the complete dehiscence of hepaticojejunostomy in a patient after living-donor liver transplantation. Surg Case Rep 2018; 4:95. [PMID: 30112678 PMCID: PMC6093822 DOI: 10.1186/s40792-018-0504-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/07/2018] [Indexed: 12/14/2022] Open
Abstract
Background Magnetic compression anastomosis (MCA) is a minimally invasive method of anastomosis that does not involve a surgical procedure in patients with stricture, obstruction, or dehiscence of anastomosis after surgery. We experienced a case of complete dehiscence of bilioenteric anastomosis that was successfully treated by MCA. Case presentation A 55-year-old woman received ABO-incompatible right-lobe living-donor liver transplantation with hepaticojejunostomy for the right anterior duct (RAD) and right posterior duct (RPD). Nineteen days after the operation, bilious and bloody discharge was detected from the abdominal drain. We performed an emergency operation and found that the anastomosis was completely dehiscent. We placed bile drainage catheters into the stumps of the RAD and RPD. She repeatedly experienced cholangitis after the surgery, so we added percutaneous transhepatic cholangial drainage (PTCD) tubes. We decided to treat the complete dehiscence of anastomosis by MCA. One year after the liver transplantation, we performed MCA for the RAD. The bilioenteric fistula was completed 21 days after MCA, and the magnets were retrieved by double-balloon endoscopy. Two months later, MCA for the RPD was also performed by the same procedure. The bilioenteric fistula was not completely established, so we performed double-balloon endoscopy and pulled the magnets down 47 days after MCA for the RAD. The internal/external bile drainage tubes were then left in place to maintain the bilioenteric fistula. Twelve months after MCA for the RAD and 19 months after MCA for the RPD, we removed the tubes without any complications. Conclusion Magnetic compression anastomosis for stricture, obstruction, or dehiscence of the anastomosis after living-donor liver transplantation was an effective and safe procedure.
Collapse
Affiliation(s)
- Masahiko Kubo
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| | - Hiroshi Wada
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan.
| | - Kunihito Gotoh
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| | - Yoshifumi Iwagami
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| | - Daisaku Yamada
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| | - Hirofumi Akita
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| | - Tadafumi Asaoka
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| | - Takehiro Noda
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| | - Shogo Kobayashi
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| | - Masahisa Nakamura
- Department of Diagnostic and Interventional Radiology, Graduated School of Medicine, Osaka University, Suita city, Osaka prefecture, Japan
| | - Yusuke Ono
- Department of Diagnostic and Interventional Radiology, Graduated School of Medicine, Osaka University, Suita city, Osaka prefecture, Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology, Graduated School of Medicine, Osaka University, Suita city, Osaka prefecture, Japan
| | - Eigoro Yamanouchi
- Department of Radiology, International University of Health and Welfare Hospital, Nasushiobara city, Tochigi prefecture, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| |
Collapse
|
6
|
Nakaseko Y, Shiba H, Yamanouchi E, Takano Y, Sakamoto T, Imazu H, Ashida H, Yanaga K. Successful Treatment of Stricture of Duct-to-Duct Biliary Anastomosis After Living-Donor Liver Transplantation of the Left Lobe: A Case Report. Transplant Proc 2018; 49:1644-1648. [PMID: 28838456 DOI: 10.1016/j.transproceed.2017.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 06/16/2017] [Indexed: 01/18/2023]
Abstract
Biliary complications, such as stricture or obstruction, after living-donor liver transplantation (LDLT) remain major problems to be solved. Magnetic compression anastomosis (MCA) is a minimally invasive method of biliary anastomosis without surgery in patients with biliary stricture or obstruction. A 66-year-old woman had undergone LDLT for end-stage liver disease for primary biliary cholangitis 20 months previously at another hospital. Computerized tomography showed dilation of the intrahepatic bile duct (B2). Because B2 was invisible with the use of endoscopic retrograde cholangiopancreatography, percutaneous transhepatic biliary drainage (PTBD) was performed for treatment of cholangitis. The rendezvous technique failed because a guidewire could not pass through the biliary stricture. Therefore, we decided to perform MCA. A parent magnet was endoscopically placed distally in the common bile duct of the stricture, and a daughter magnet attached to a guidewire was inserted proximally through the fistula tract of the PTBD. Both magnets were positioned across the stricture, and the 2 magnets were pulled to each other by magnetic power, to sandwich the stricture. By 14 days after MCA, a fistula between B2 and the common bile duct was created. At 28 days after MCA, the magnets were removed distally and a 16-French tube was placed across the fistula. At 7 months after MCA, that tube was removed. In conclusion, when a conventional endoscopic or percutaneous approach including the rendezvous technique fails, MCA is a good technique for biliary stricture after LDLT.
Collapse
MESH Headings
- Aged
- Anastomosis, Surgical/adverse effects
- Anastomosis, Surgical/methods
- Bile Ducts/diagnostic imaging
- Bile Ducts/pathology
- Bile Ducts/surgery
- Bile Ducts, Intrahepatic/diagnostic imaging
- Bile Ducts, Intrahepatic/surgery
- Biliary Tract Surgical Procedures/adverse effects
- Biliary Tract Surgical Procedures/methods
- Cholangiopancreatography, Endoscopic Retrograde/methods
- Cholangitis/etiology
- Cholangitis/pathology
- Cholangitis/surgery
- Constriction, Pathologic/etiology
- Constriction, Pathologic/surgery
- Drainage/adverse effects
- Drainage/methods
- End Stage Liver Disease/etiology
- End Stage Liver Disease/surgery
- Female
- Humans
- Liver Cirrhosis, Biliary/complications
- Liver Cirrhosis, Biliary/surgery
- Liver Transplantation/adverse effects
- Liver Transplantation/methods
- Living Donors
- Magnetics
- Postoperative Complications/etiology
- Postoperative Complications/pathology
- Postoperative Complications/surgery
- Tomography, X-Ray Computed
Collapse
Affiliation(s)
- Y Nakaseko
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan.
| | - H Shiba
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - E Yamanouchi
- Department of Radiology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Y Takano
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - T Sakamoto
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - H Imazu
- Department of Endoscopy, Jikei University School of Medicine, Tokyo, Japan
| | - H Ashida
- Department of Radiology, Jikei University School of Medicine, Tokyo, Japan
| | - K Yanaga
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|