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Zhang G, Liang Z, Zhao G, Zhang S. Endoscopic application of magnetic compression anastomosis: a review. J Gastroenterol Hepatol 2024; 39:1256-1266. [PMID: 38638082 DOI: 10.1111/jgh.16574] [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: 12/29/2023] [Revised: 03/03/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
Magnetic compression anastomosis (MCA) is a new method that provides sutureless passage construction for tubular organs. Due to the high recurrence rate of conventional endoscopic treatment and the high morbidity and mortality of surgical procedures, the MCA technique shows promise. The aim of this review is to comprehensively examine the literature related to the use of MCA in different gastrointestinal diseases over the past few years, categorizing them according to the anastomotic site and describing in detail the various methods of magnet delivery and the clinical outcomes of MCA. MCA is an innovative technique, and its use represents an advancement in the field of minimally invasive interventions. Comparison studies have shown that the anastomosis formed by MCA is comparable to or better than surgical sutures in terms of general appearance and histology. Although most of the current research has involved animal studies or studies with small populations, the safety and feasibility of MCA have been preliminarily demonstrated. Large prospective studies involving populations are still needed to guarantee the security of MCA. For technologies that have been initially used in clinical settings, effective measures should also be implemented to identify, even prevent, complications. Furthermore, specific commercial magnets must be created and optimized in this emerging area.
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Affiliation(s)
- Guo Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng Liang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guiping Zhao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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2
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Zhang M, Ma J, Shi A, Gong R, Zhao X, Zhong Q, Shen L, Lyu Y, Yan X. Effect of tissue tension on magnetic compression anastomosis of digestive tract. Sci Rep 2024; 14:14265. [PMID: 38902360 PMCID: PMC11190232 DOI: 10.1038/s41598-024-65160-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/17/2024] [Indexed: 06/22/2024] Open
Abstract
With the increasing application of magnetic compression anastomosis (MCA) in gastrointestinal anastomosis, we identified an interesting phenomenon that an anastomosis is more prone to stenosis after endoscopic gastrointestinal MCA. We hypothesized that the increase in tissue tension during endoscopic procedures is the cause of anastomotic stenosis. In this study, we investigated the effect of tissue tension on gastroduodenal bypass MCA in Sprague-Dawley (SD) rats. Twenty SD rats were divided into the study group (high-tension group, n = 10) and control group (no tension group, n = 10), wherein the rats underwent complete gastroduodenal bypass magnetic anastomosis under high tension and no tension of the digestive tract, respectively. Anastomotic specimens were obtained 4 weeks after the operation, and anastomotic diameters of the two groups were observed and measured. The histological difference was observed by hematoxylin & eosin and Masson staining. The operation was successfully completed in all rats, and all survived until 4 weeks postoperatively. Anastomotic measurements revealed that the anastomosis diameter was significantly smaller in the study group than in the control group, and there were three cases of severe anastomotic stenosis. Histological observation showed that the amount of collagen fibers in the anastomosis was greater in the study group than in the control group. The results suggest that the high-tension state of the digestive tract is an important factor leading to anastomotic stenosis, and thus, we put forward the Yan-Zhang's Tissue Tension Theory of MCA to explain this phenomenon.
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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, China
- Shaanxi Provincial Key Laboratory of Magnetic Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
- National and Local Joint Engineering Research Center of Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Jia Ma
- Department of Surgical Oncology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Aihua Shi
- National and Local Joint Engineering Research Center of Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Ruimin Gong
- Zonglian College, Xi'an Jiaotong University, Xi'an, China
| | - Xuhe Zhao
- Zonglian College, Xi'an Jiaotong University, Xi'an, China
| | - Qiuye Zhong
- Zonglian College, Xi'an Jiaotong University, Xi'an, China
| | - Linxin Shen
- Zonglian College, Xi'an Jiaotong University, Xi'an, 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, China.
- Shaanxi Provincial Key Laboratory of Magnetic Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, China.
- National and Local Joint Engineering Research Center of Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, 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, China.
- Shaanxi Provincial Key Laboratory of Magnetic Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, China.
- National and Local Joint Engineering Research Center of Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, China.
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3
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Pérez-Bertólez S, Godoy-Lenz J. Primary repair of esophageal atresia Gross type C via thoracoscopic magnetic compression anastomosis: Is it the best option? World J Gastrointest Surg 2024; 16:1474-1481. [PMID: 38817291 PMCID: PMC11135306 DOI: 10.4240/wjgs.v16.i5.1474] [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: 01/09/2024] [Revised: 04/03/2024] [Accepted: 04/25/2024] [Indexed: 05/23/2024] Open
Abstract
Magnetic compression anastomosis is a promising treatment option for patients with complex esophageal atresia; but, at the present time, should not be the first therapeutic option in those cases where the surgeon can perform a primary anastomosis of the two ends of the esophagus with acceptable tension.
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Affiliation(s)
- Sonia Pérez-Bertólez
- Department of Pediatric Surgery, Sant Joan de Deu Hospital, University of Barcelona, Barcelona 08950, Spain
| | - Jorge Godoy-Lenz
- Department of Pediatric Surgery, Clínica Alemana of Santiago, Santiago 7650568, Chile
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Lee WG, Evans LL, Chen CS, Fuchs JR, Zamora IJ, Bruzoni M, Harrison MR, Muensterer OJ. Lessons Learned From the First-In-Human Compassionate Use of Connect-EA™ in Ten Patients With Esophageal Atresia. J Pediatr Surg 2024; 59:437-444. [PMID: 37838619 DOI: 10.1016/j.jpedsurg.2023.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Delayed primary repair of esophageal atresia in patients with high-risk physiologic and anatomic comorbidities remains a daunting challenge with an increased risk for peri-operative morbidity and mortality via conventional repair. The Connect-EA device facilitates the endoscopic creation of a secure esophageal anastomosis. This follow-up study reports our long-term outcomes with the novel esophageal magnetic compression anastomosis (EMCA) Connect-EA device for EA repair, as well as lessons learned from the ten first-in-human cases. We propose an algorithm to maximize the advantages of the device for EA repair. METHODS Under compassionate use approval, from June 2019 to December 2022, ten patients with prohibitive surgical or medical risk factors underwent attempted EMCA with this device. All patients underwent prior gastrostomy, tracheoesophageal fistula ligation (if necessary), and demonstrated pouch apposition prior to EMCA. RESULTS Successful device deployment and EMCA formation were achieved in nine patients (90%). Mean time to anastomosis formation was 8 days (range 5-14) and the device was retrieved endoscopically in five (56%) cases. At median follow-up of 22 months (range 4-45), seven patients (78%) are tolerating oral nutrition. Balloon dilations (median 4, range 1-11) were performed either prophylactically for radiographic asymptomatic anastomotic narrowing (n = 7, 78%) or to treat clinically-significant anastomotic narrowing (n = 2, 22%) with no ongoing dilations at 3-month follow up post-repair. CONCLUSION EMCA with the Connect-EA device is a safe and feasible minimally-invasive alterative for EA repair in high-risk surgical patients. Promising post-operative outcomes warrant further Phase I investigation. LEVEL OF EVIDENCE IV, Case series of novel operative technique without comparison group.
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Affiliation(s)
- William G Lee
- Department of Pediatric Surgery, University of California San Francisco, 550 16th Street Box 0570, San Francisco, CA 94143, USA
| | - Lauren L Evans
- Department of Pediatric Surgery, University of California San Francisco, 550 16th Street Box 0570, San Francisco, CA 94143, USA
| | - Caressa S Chen
- Department of Pediatric Surgery, University of California San Francisco, 550 16th Street Box 0570, San Francisco, CA 94143, USA
| | - Julie R Fuchs
- Division of Pediatric Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA 94304, USA
| | - Irving J Zamora
- Department of Pediatric Surgery, Monroe Carell Jr Children's Hospital at Vanderbilt, 2200 Children's Way 7th Floor, Nashville, TN 37232, USA
| | - Matias Bruzoni
- Division of Pediatric Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA 94304, USA
| | - Michael R Harrison
- Department of Pediatric Surgery, University of California San Francisco, 550 16th Street Box 0570, San Francisco, CA 94143, USA
| | - Oliver J Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, LMU Munich, Lindwurmstrasse 4, 80337, Munich, Germany.
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Liang NE, Lin S, Slater BJ, Bruzoni M. Use of magnets in pediatric surgery. Semin Pediatr Surg 2024; 33:151381. [PMID: 38194748 DOI: 10.1016/j.sempedsurg.2024.151381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Since the 1970s, magnets have been progressively harnessed for use in minimally invasive treatment of pediatric surgical disease. In particular, multiple magnetic devices have been developed for treating esophageal atresia, pectus excavatum and scoliosis. These devices, which can be placed via small incisions or under endoscopic or fluoroscopic guidance, provide the added benefit of sparing patients multiple large, invasive procedures, and allowing for gradual correction of congenital anomalies over days to months, depending on the disease. In the following text, we detail the current landscape of magnetic devices used by pediatric surgeons, illustrate their use through clinical cases, and review the available body of literature with respect their outcomes and complications.
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Affiliation(s)
- Norah E Liang
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB-425, Boston, MA 02138, USA.
| | - Saunders Lin
- Department of Surgery, Division of Pediatric Surgery, University of Chicago School of Medicine, Chicago, IL, USA
| | - Bethany J Slater
- Department of Surgery, Division of Pediatric Surgery, University of Chicago School of Medicine, Chicago, IL, USA
| | - Matias Bruzoni
- Texas Children's Hospital Austin, Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine, Austin, TX, USA
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Krishnan N, Pakkasjärvi N, Kainth D, Danielson J, Verma A, Yadav DK, Goel P, Anand S. Role of Magnetic Compression Anastomosis in Long-Gap Esophageal Atresia: A Systematic Review. J Laparoendosc Adv Surg Tech A 2023; 33:1223-1230. [PMID: 37603306 DOI: 10.1089/lap.2023.0295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Abstract
Background: Magnetic compression anastomosis (MCA) is an alternative technique for patients with long-gap esophageal atresia (EA). It allows for preservation of the native esophagus. We aimed to systematically summarize the current literature on MCA in EA. Methods: Studies where neonates with EA were treated with MCA devices were included, while studies on esophageal stenosis were excluded. All clinical studies, including comparative studies, case series, and case reports, were eligible for inclusion. Methodological quality assessment was performed using a validated tool. Results: Twelve studies with a total of 42 patients were included in this review. There was a wide variation among these studies with regard to the time of initiation of MCA (1 day to 7 months), procedure time (13-320 minutes), and magnet characteristics (strength, size, and shape of the magnets used). The time to achieve anastomosis ranged from 1 to 12 days. Stricture at the anastomotic site was reported in almost all the patients, which required multiple endoscopic dilatations (median no. of dilatations/patient = 9.8). Stent placement for refractory stricture was required in 9 (21%) patients, and surgery for stricture was required in 6 (14%) patients. Long-term outcomes included esophageal dysmotility (n = 3) and recurrent pulmonary infections (n = 3) were reported in only four studies. Conclusion: As per the findings of this review, neonates with long-gap EA undergoing MCA would invariably require multiple sittings of endoscopic dilatations (median no. of dilatations/patient = 9.8). Also, there is a wide variation among the included studies in terms of the procedure of MCA. Future studies with a standardized procedure for achieving MCA are needed to determine additional outcomes in this fragile patient population.
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Affiliation(s)
- Nellai Krishnan
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Niklas Pakkasjärvi
- Department of Pediatric Surgery, Turku University Hospital, Turku, Finland
- Department of Pediatric Surgery, University Children's Hospital, Uppsala, Sweden
| | - Deepika Kainth
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Johan Danielson
- Department of Pediatric Surgery, University Children's Hospital, Uppsala, Sweden
| | - Ajay Verma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Devendra Kumar Yadav
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Prabudh Goel
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sachit Anand
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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7
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Lee WG, Evans LL, Johnson SM, Woo RK. The Evolving Use of Magnets in Surgery: Biomedical Considerations and a Review of Their Current Applications. Bioengineering (Basel) 2023; 10:bioengineering10040442. [PMID: 37106629 PMCID: PMC10136001 DOI: 10.3390/bioengineering10040442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
The novel use of magnetic force to optimize modern surgical techniques originated in the 1970s. Since then, magnets have been utilized as an adjunct or alternative to a wide array of existing surgical procedures, ranging from gastrointestinal to vascular surgery. As the use of magnets in surgery continues to grow, the body of knowledge on magnetic surgical devices from preclinical development to clinical implementation has expanded significantly; however, the current magnetic surgical devices can be organized based on their core function: serving as a guidance system, creating a new connection, recreating a physiologic function, or utilization of an internal–external paired magnet system. The purpose of this article is to discuss the biomedical considerations during magnetic device development and review the current surgical applications of magnetic devices.
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Affiliation(s)
- William G. Lee
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Lauren L. Evans
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Sidney M. Johnson
- Department of Surgery, University of Hawaii, Honolulu, HI 96822, USA
| | - Russell K. Woo
- Department of Surgery, University of Hawaii, Honolulu, HI 96822, USA
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Conforti A, Pellegrino C, Valfré L, Iacusso C, Schingo PMS, Capolupo I, Sgro' S, Rasmussen L, Bagolan P. Magnamosis for long gap esophageal atresia: Minimally invasive "fatal attraction". J Pediatr Surg 2023; 58:405-411. [PMID: 36150933 DOI: 10.1016/j.jpedsurg.2022.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 07/01/2022] [Accepted: 08/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aim of study is to report our preliminary experience with magnetic anastomosis (magnamosis) treating long-gap esophageal atresia (LGEA), the most challenging condition of esophageal atresia continuum. Magnamosis has been reported in 20 patients worldwide as an innovative and marginally invasive option. METHODS Prospective evaluation of all LGEA patients treated with magnamosis was performed (study registration number: 2535/2021). Main outcomes considered were demographic and surgical features, postoperative complications and feeding within 6-month of follow-up. RESULTS Between June 2020 and January 2021, 5 LGEA patients (Type A, Gross classification) were treated. Median preoperative gap was 5 vertebral bodies. Magnetic bullets were placed at an average age of 81 days of life, leading to successful magnamosis in all cases: 4 infants had primary magnetic repair (one after thoracoscopic mobilization of the pouches), 1 patient had a delayed magnamosis after Foker's procedure. Esophageal anastomosis was achieved after an average of 8 days. No anastomotic leak was found. All patients developed anastomotic stenosis at 6-month follow-up, requiring a mean of 6 dilations each. Full oral feeding was achieved in 3 patients, while 2 were still on oral-gastrostomy feeding. One patient experienced small esophageal perforation after dilation (3 months after magnamosis), distal to the anastomotic stricture and subsequently developed oral aversion. CONCLUSIONS Our preliminary results suggest magnamosis a safe and effective minimally invasive option in patients with LGEA. Absence of postoperative esophageal leaks may represent a major advantage of magnamosis over conventional surgery, although possible high rate of esophageal stenosis should be further evaluated. LEVELS OF EVIDENCE IV (Case series with no comparison group).
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Affiliation(s)
- Andrea Conforti
- Medical and Surgical Dept of the Fetus, Newborn and Infant, Bambino Gesù Children's Hospital IRCCS, , 4, Piazza S. Onofrio, 00165, Rome, Italy.
| | - Chiara Pellegrino
- Medical and Surgical Dept of the Fetus, Newborn and Infant, Bambino Gesù Children's Hospital IRCCS, , 4, Piazza S. Onofrio, 00165, Rome, Italy
| | - Laura Valfré
- Medical and Surgical Dept of the Fetus, Newborn and Infant, Bambino Gesù Children's Hospital IRCCS, , 4, Piazza S. Onofrio, 00165, Rome, Italy
| | - Chiara Iacusso
- Medical and Surgical Dept of the Fetus, Newborn and Infant, Bambino Gesù Children's Hospital IRCCS, , 4, Piazza S. Onofrio, 00165, Rome, Italy
| | | | - Irma Capolupo
- Medical and Surgical Dept of the Fetus, Newborn and Infant, Bambino Gesù Children's Hospital IRCCS, , 4, Piazza S. Onofrio, 00165, Rome, Italy
| | - Stefania Sgro'
- Department of Anesthesia and Critical Care, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lars Rasmussen
- Department of Pediatric Surgery, Odense University hospital, Odense, Denmark
| | - Pietro Bagolan
- Medical and Surgical Dept of the Fetus, Newborn and Infant, Bambino Gesù Children's Hospital IRCCS, , 4, Piazza S. Onofrio, 00165, Rome, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Italy
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Evans LL, Chen CS, Muensterer OJ, Sahlabadi M, Lovvorn HN, Novotny NM, Upperman JS, Martinez JA, Bruzoni M, Dunn JCY, Harrison MR, Fuchs JR, Zamora IJ. The novel application of an emerging device for salvage of primary repair in high-risk complex esophageal atresia. J Pediatr Surg 2022; 57:810-818. [PMID: 35760639 DOI: 10.1016/j.jpedsurg.2022.05.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/17/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Preservation of native esophagus is a tenet of esophageal atresia (EA) repair. However, techniques for delayed primary anastomosis are severely limited for surgically and medically complex patients at high-risk for operative repair. We report our initial experience with the novel application of the Connect-EA, an esophageal magnetic compression anastomosis device, for salvage of primary repair in 2 high-risk complex EA patients. Compassionate use was approved by the FDA and treating institutions. OPERATIVE TECHNIQUE Two approaches using the Connect-EA are described - a totally endoscopic approach and a novel hybrid operative approach. To our knowledge, this is the first successful use of a hybrid operative approach with an esophageal magnetic compression device. OUTCOMES Salvage of delayed primary anastomosis was successful in both patients. The totally endoscopic approach significantly reduced operative time and avoided repeat high-risk operation. The hybrid operative approach salvaged delayed primary anastomosis and avoided cervical esophagostomy. CONCLUSION The Connect-EA is a novel intervention to achieve delayed primary esophageal repair in complex EA patients with high-risk tissue characteristics and multi-system comorbidities that limit operative repair. We propose a clinical algorithm for use of the totally endoscopic approach and hybrid operative approach for use of the Connect-EA in high-risk complex EA patients.
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Affiliation(s)
- Lauren L Evans
- Department of Pediatric Surgery, University of California San Francisco, 550 16th Street Box 0570, San Francisco, CA 94143 USA
| | - Caressa S Chen
- Department of Pediatric Surgery, University of California San Francisco, 550 16th Street Box 0570, San Francisco, CA 94143 USA
| | - Oliver J Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, LMU Munich, Lindwurmstrasse 4, 80337 Munich, Germany
| | - Mohammad Sahlabadi
- Department of Pediatric Surgery, University of California San Francisco, 550 16th Street Box 0570, San Francisco, CA 94143 USA
| | - Harold N Lovvorn
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way 7th Floor, Nashville TN 37212 USA
| | - Nathan M Novotny
- Section of Pediatric Surgery, Beaumont Children's, 3535W. 13 Mile Road, Royal Oak, MI 48073 USA
| | - Jeffrey S Upperman
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way 7th Floor, Nashville TN 37212 USA
| | - J Andres Martinez
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, 2200 Children's Way, Nashville TN 37232 USA
| | - Matias Bruzoni
- Division of Pediatric Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA 94304 USA
| | - James C Y Dunn
- Division of Pediatric Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA 94304 USA
| | - Michael R Harrison
- Department of Pediatric Surgery, University of California San Francisco, 550 16th Street Box 0570, San Francisco, CA 94143 USA
| | - Julie R Fuchs
- Division of Pediatric Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA 94304 USA
| | - Irving J Zamora
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way 7th Floor, Nashville TN 37212 USA.
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10
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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.
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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
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11
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Xu XH, Lv Y, Liu SQ, Cui XH, Suo RY. Esophageal magnetic compression anastomosis in dogs. World J Gastroenterol 2022; 28:5313-5323. [PMID: 36185631 PMCID: PMC9521523 DOI: 10.3748/wjg.v28.i36.5313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/11/2022] [Accepted: 09/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Magnetic compression anastomosis (MCA) is a novel suture-free reconstruction of the digestive tract. It has been used in gastrointestinal anastomosis, jejunal anastomosis, cholangioenteric anastomosis and so on. The traditional operative outcomes of congenital esophageal atresia and benign esophageal stricture are poor, and there are too many complications postoperatively. AIM To test MCA technology to reconstruct the esophagus in dogs, prior to studying the feasibility and safety of MCA in humans. METHODS Thirty-six dogs were randomized into either the study or control group (n = 18 per group). The dogs in the study group were subjected to end-to-end esophageal anastomosis with the magnetic compression device, while those in the control group underwent hand-sewn anastomosis with 4-0 absorbable multifilament Vicryl. We used interrupted single-layer inverting sutures. The anastomosis time, gross appearance, weight and pathology of the anastomosis were evaluated at one month, three months and six months postoperatively. RESULTS The anastomosis time of the MCA group was shorter than that of the hand-sewn group (7.5 ± 1.0 min vs 12.5 ± 1.8 min, P < 0.01). In the MCA group, X-ray examination was performed every day to locate the magnetic device in the esophagus before the magnetic device fell off from the esophagus. In the hand-sewn group, dogs did not undergo X-ray examination. One month after the surgeries, the mean weight of the dogs in the hand-sewn group had decreased more than that of the dogs in the MCA group (11.63 ± 0.71 kg vs 12.73 ± 0.80 kg, P < 0.05). At 3 mo and 6 mo after the operation, the dogs' weights were similar between the two groups (13.75 ± 0.84 kg vs 14.03 ± 0.82 kg, 14.93 ± 0.80 kg vs 15.44 ± 0.47 kg). The number of inflammatory cells in MCA group was lower than that in hand-sewn group on 1 mo after operation. CONCLUSION MCA is an effective and safe method for esophageal reconstruction. The anastomosis time of the MCA group was less than that of the hand-sewn group. This study shows that MCA technology may be applied to human esophageal reconstruction, provided these favorable results are confirmed by more publications.
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Affiliation(s)
- Xiang-Hua Xu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Shi-Qi Liu
- Department of Pediatric Surgery, Xi’an Children’s Hospital, Xi’an 710003, Shaanxi Province, China
| | - Xiao-Hai Cui
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Rui-Yang Suo
- Zonglian College, Xi’an Jiaotong University Health Science Center, Xi’an 710061, Shaanxi Province, China
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12
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Magnetic Compression Technique for Esophageal Anastomosis in Rats. J Surg Res 2022; 276:283-290. [DOI: 10.1016/j.jss.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 02/17/2022] [Accepted: 03/09/2022] [Indexed: 11/21/2022]
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13
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Holler AS, König TT, Chen C, Harrison MR, Muensterer OJ. Esophageal Magnetic Compression Anastomosis in Esophageal Atresia Repair: A PRISMA-Compliant Systematic Review and Comparison with a Novel Approach. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9081113. [PMID: 35892616 PMCID: PMC9394416 DOI: 10.3390/children9081113] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/12/2022] [Accepted: 07/22/2022] [Indexed: 12/29/2022]
Abstract
The use of magnet compression to endoscopically create an esophageal anastomosis is an intriguing approach to esophageal atresia repair, but published cases with an existing available device have demonstrated mixed success. One major shortcoming has been the formation of subsequent severe, recalcitrant strictures after primary repair. To address the limitations of the existing device, we recently introduced and reported success with specially designed bi-radial magnets that exhibit a novel geometry and unique tissue compression profile. The aim of this study is to compare the outcomes using our novel device (novel group, NG) with those of previous reports which utilized the historical device (historic group, HG) in a PRISMA-compliant systematic review. Seven studies were eligible for further analysis. Additionally, one of our previously unreported cases was included in the analysis. Esophageal pouch approximation prior to primary repair was performed more frequently in the NG than in the HG (100% NG vs. 21% HG; p = 0.003). There was no difference in the overall postoperative appearance of postoperative stricture (95% HG vs. 100% NG; p = 0.64). The number of postoperative dilatations trended lower in the NG (mean 4.25 NG vs. 9.5 HG; p = 0.051). In summary, magnetic compression anastomosis adds a new promising treatment option for patients with complex esophageal atresia. Prior approximation of pouches and a novel magnet design have the potential to lower the rate of stricture formation.
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Affiliation(s)
- Anne-Sophie Holler
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, 55131 Mainz, Germany;
- Correspondence: ; Tel.: +49-894-4005-3101
| | - Tatjana Tamara König
- Department of Pediatric Surgery, Universitätsmedizin, Johannes-Gutenberg University, 55131 Mainz, Germany;
| | - Caressa Chen
- Department of Surgery and Bioengineering & Therapeutic Sciences, University of California, San Francisco, CA 94102, USA;
| | - Michael R. Harrison
- Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco, CA 94102, USA;
| | - Oliver J. Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, 55131 Mainz, Germany;
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14
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Gomes GF, Noda RW, Lima TMDC, Carboni da Silva E, Kashiwagui LY, Nakadomari TS, Anghinoni M. Endoscopic Treatment of a Total Ileorectal Anastomosis Stenosis using Magnets. Endoscopy 2022; 54:E300-E301. [PMID: 34215002 DOI: 10.1055/a-1524-0868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
| | | | | | | | | | | | - Marciano Anghinoni
- Oncologic Surgery Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil
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15
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Campos S, Arvanitakis M, Rio-Tinto R, Deviere J. Forward-viewing EUS-guided esophageal repermeabilization. Endosc Int Open 2022; 10:E707-E711. [PMID: 35571480 PMCID: PMC9106437 DOI: 10.1055/a-1781-6098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sara Campos
- Gastroenterology Department, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasmus University Hospital – Université Libre de Bruxelles, Brussels, Belgium
| | - Ricardo Rio-Tinto
- Gastroenterology Department, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Jacques Deviere
- Gastroenterology Department, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal,Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasmus University Hospital – Université Libre de Bruxelles, Brussels, Belgium
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16
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Liu S, Fang Y, Lv Y, Zhao J, Luo R, Luo R, Cheng J, Yang H, Zhang A, Shen Y, Jiang N. Magnetic compression stricturoplasty in patients with severe stricture after simultaneous esophageal atresia and duodenal obstruction repair: A case report. Exp Ther Med 2022; 23:93. [PMID: 34976135 PMCID: PMC8674971 DOI: 10.3892/etm.2021.11016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 10/07/2021] [Indexed: 01/27/2023] Open
Abstract
Combined esophageal atresia (EA), tracheoesophageal fistula (TEF) and duodenal obstruction result in various challenges in management, and a well-defined management protocol is still lacking. Esophageal stricture is the most common complication after EA repair. The use of magnetic compression alimentary tract anastomosis has been reported in children. By searching the literature, the present study reports the first case of simultaneous repair (EA repair followed by duodenal obstruction repair) and magnetic compression stricturoplasty for refractory esophageal stricture after EA repair in two male neonates. One of the neonates received delayed treatment of duodenal obstruction, and the other successfully underwent a simultaneous emergency operation of these combined anomalies. These two infants developed refractory strictures despite multiple endoscopic dilatation procedures during the postoperative follow-up period. Magnetic compression stricturoplasty procedures were successfully performed under fluoroscopic and endoscopic guidance without any leakage or complication. At the follow-up 10-months after stricturoplasty, the two patients achieved durable esophageal patency in the absence of dysphagia. Combination of early chest and abdominal X-ray detection is recommended to avoid a delayed diagnosis and treatment, as well as the synchronous operation for EA/TEF repair and duodenoduodenostomy in a single surgery for combined EA/TEF and duodenal obstructions. Therefore, magnetic compression stricturoplasty is a feasible and efficient method for establishing early patency of the esophagus in patients with refractory EA stricture.
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Affiliation(s)
- Shiqi Liu
- Department of Nursing, Medical College, Xijing University, Xi'an, Shaanxi 710123, P.R. China
| | - Ying Fang
- Department of Digestive Diseases, Xi'an Children's Hospital, Xi'an, Shaanxi 710003, P.R. China
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Jingru Zhao
- Department of Pediatrics, Northwest Women's and Children's Hospital, Xi'an, Shaanxi 710061, P.R. China
| | - Ruixue Luo
- Corrosion and Protection Research Lab (CPRL), Northwest Institute for Nonferrous Metal Research, Xi'an, Shaanxi 710016, P.R. China
| | - Ruogu Luo
- Department of Pediatrics, Northwest Women's and Children's Hospital, Xi'an, Shaanxi 710061, P.R. China
| | - Jun Cheng
- Pediatric Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi 710061, P.R. China
| | - Hongbin Yang
- Department of Digestive Diseases, Xi'an Children's Hospital, Xi'an, Shaanxi 710003, P.R. China
| | - Anpeng Zhang
- Department of Pediatrics, Northwest Women's and Children's Hospital, Xi'an, Shaanxi 710061, P.R. China
| | - Yingchun Shen
- Pediatric Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi 710061, P.R. China
| | - Na Jiang
- Department of Anesthesia, Northwest Women's and Children's Hospital, Xi'an, Shaanxi 710061, P.R. China
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17
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Muensterer OJ, Evans LL, Sterlin A, Sahlabadi M, Aribindi V, Lindner A, König T, Harrison MR. Novel Device for Endoluminal Esophageal Atresia Repair: First-in-Human Experience. Pediatrics 2021; 148:peds.2020-049627. [PMID: 34615695 DOI: 10.1542/peds.2020-049627] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 12/22/2022] Open
Abstract
Thoracoscopic esophageal atresia (EA) repair affords many benefits to the patient; however, intracorporeal suturing of the anastomosis is technically challenging. Esophageal magnetic compression anastomosis (EMCA) is a compelling option for endoluminal EA repair, but available EMCA devices have prohibitive rates of recalcitrant stricture. Connect-EA is a new endoluminal EMCA device system that employs 2 magnetic anchors with a unique mating geometry designed to reliably create a robust anastomosis and decrease rates of leak and stricture. We describe our first-in-human experience with this novel endoluminal device for staged EA repair in 3 patients (Gross type A, B, and C) at high risk for conventional surgical repair. First, the esophageal pouches were approximated thoracoscopically. After acute tension subsided, the device anchors were endoscopically placed in the esophageal pouches and mated. Anchors were spontaneously excreted in 2 cases. Endoscopic repositioning and retrieval of the anchors were required in 1 patient because of narrowed esophageal anatomy. There were no perioperative complications. Patients were managed for 14 to 18 months. The strictures that developed in the patients were membranous and responded well to dilation alone, resolving after 4 to 5 outpatient dilations. Gastrostomies were closed between 6 and 11 months and all patients are tolerating full oral nutrition. Early experience with this new endoluminal EMCA device system is highly favorable. The device offers considerable benefit over conventional handsewn esophageal anastomosis and anastomotic outcomes are superior to available EMCA devices.
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Affiliation(s)
- Oliver J Muensterer
- Department of Pediatric Surgery, Johannes Gutenberg University Mainz, Mainz, Germany .,Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Lauren L Evans
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Alexander Sterlin
- Department of Pediatric Surgery, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mohammad Sahlabadi
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Vamsi Aribindi
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Andreas Lindner
- Department of Pediatric Surgery, Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Tatjana König
- Department of Pediatric Surgery, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michael R Harrison
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
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18
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de Campos ST, Rio-Tinto R, Fidalgo P, Bispo M, Marques S, Devière J. Endoscopic Reconstruction of an Oral Feeding Route Using a Rendezvous Approach. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 29:420-425. [PMID: 36545189 PMCID: PMC9761350 DOI: 10.1159/000518913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/22/2021] [Indexed: 12/24/2022]
Abstract
Background The approach to esophageal obstruction or discontinuity remains challenging and often involves complex reconstructive surgeries. The rendezvous endoscopic technique might be interesting in cases of complete esophageal obstruction. Case Presentation Herein we describe a successful case of endoscopic recanalization of the esophageal lumen in a patient with a long-standing esophageal discontinuity resulting from several surgeries and chemoradiation for a squamous cell carcinoma of the hypopharynx, ending in a major cervical amputation, construction of a neopharynx, and definitive surgical closure of the superior esophagus with a PEG placement. With a rendezvous technique (peroral and through the gastrostomy) and under radiographic guidance, puncture from the neopharynx into the distal esophagus was performed, followed by balloon dilation and covered metal stent placement in order to reconstruct a neoesophagus. Five weeks later, the stent was removed (using a stent-in-stent technique). No complications occurred. The patient has been able to eat soft food and is being kept under regular endoscopic surveillance to control/treat a luminal stenosis of the neoesophagus. Conclusions This case report illustrates a successful endoscopic treatment of post-surgical complete esophageal obstruction. This approach should be considered in the therapeutic armamentarium of these difficult clinical settings.
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Affiliation(s)
- Sara Teles de Campos
- Department of Gastroenterology, Digestive Oncology Unit, Champalimaud Foundation, Lisbon, Portugal,*Sara Teles de Campos,
| | - Ricardo Rio-Tinto
- Department of Gastroenterology, Digestive Oncology Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Paulo Fidalgo
- Department of Gastroenterology, Digestive Oncology Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Miguel Bispo
- Department of Gastroenterology, Digestive Oncology Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Susana Marques
- Department of Gastroenterology, Digestive Oncology Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Jacques Devière
- Department of Gastroenterology, Digestive Oncology Unit, Champalimaud Foundation, Lisbon, Portugal,Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasmus University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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19
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Huberland F, Rio-Tinto R, Cauche N, Dugardeyn S, Delattre C, Sandersen C, Rocq L, van Ouytsel P, Delchambre A, Devière J, Blero D. Magnets and a self-retractable wire for endoscopic septotomies: from concept to first-in-human use. Endoscopy 2021; 54:574-579. [PMID: 34282579 PMCID: PMC9132732 DOI: 10.1055/a-1554-0976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND A medical device that allows simple and safe performance of an endoscopic septotomy could have several applications in the gastrointestinal (GI) tract. We have developed such a device by combining two magnets and a self-retractable wire to perform a progressive septotomy by compression of the tissues. We describe here the concept, preclinical studies, and first clinical use of the device for the treatment of symptomatic epiphrenic esophageal diverticulum (EED). METHODS The MAGUS (MAgnetic Gastrointestinal Universal Septotome) device was designed based on previous knowledge of compression anastomosis and currently unmet needs. After initial design, the feasibility of the technique was tested on artificial septa in pigs. A clinical trial was then initiated to assess the feasibility and safety of the technique. RESULTS Animal studies showed that the MAGUS can perform a complete septotomy at various levels of the GI tract. In two patients with a symptomatic EED, uneventful complete septotomy was observed within 28 and 39 days after the endoscopic procedure. CONCLUSIONS This new system provides a way of performing endoluminal septotomy in a single procedure. It appears to be effective and safe for managing symptomatic EED. Further clinical applications where this type of remodeling of the GI tract could be beneficial are under investigation.
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Affiliation(s)
- François Huberland
- Bio, Electro and Mechanical Systems Department, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | - Sonia Dugardeyn
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Charlotte Sandersen
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
| | - Laureen Rocq
- Department of Pathology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Pauline van Ouytsel
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Alain Delchambre
- Bio, Electro and Mechanical Systems Department, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques Devière
- Champalimaud Foundation, Lisbon, Portugal,Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Daniel Blero
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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20
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Liu SQ, Li QF, Lv Y, Zhao JR, Luo RX, Zhang PF, Guo JZ, Zhang AP, Li QH. Magnetic compression anastomosis for rectal atresia following necrotizing enterocolitis: A case report. Medicine (Baltimore) 2020; 99:e23613. [PMID: 33327332 PMCID: PMC7738055 DOI: 10.1097/md.0000000000023613] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
RATIONALE Rectal atresia caused by necrotizing enterocolitis (NEC) is a serious and rare complication in children. Magnetic compression anastomosis (MCA) has been effectively applied in children with congenital oesophageal atresia and biliary atresia. Herein, we reported a case of successfully application of MCA in an infant with rectal atresia following NEC. PATIENT CONCERNS A 30 weeks premature birth female fetal infant was transferred to our neonatal intensive care unit due to premature delivery, low birth weight, and neonatal respiratory distress. On postpartum day 11, the infant developed abdominal distension and mucosanguineous feces. This infant was then clinically diagnosed as NEC. She underwent anesthesia and intestinal fistula operation on postpartum day 11 because of NEC. DIAGNOSIS After 3 months, radiographic examination revealed rectal atresia and stricture. INTERVENTIONS This infant was successfully treated with MCA following a cecum-rectal anastomosis and ileocecal valve was reserved. OUTCOMES On postoperative day 9, she passed the 2 magnets per rectum. In addition, there were no difficult defecation or fecal incontinence or other short-term complications. After the 7-month follow-up, the patient had an excellent clinical outcome. LESSONS MCA is a feasible and effective method for treating rectal atresia in infants.
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Affiliation(s)
- Shi-Qi Liu
- Department of Neonatal Surgery, the Children Hospital of Xi’an City, Xi’an
| | - Qi-Feng Li
- Xinjiang Institute of Pediatrics, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University
| | - Jing-Ru Zhao
- Department of Pediatrics, The Northwest Women's and Children's Hospital
| | - Rui-Xue Luo
- Corrosion & Protection Research Lab, The Northwest Institute for Nonferrous Metal Research (NIN)
| | - Peng-Fei Zhang
- Department of Pediatrics, The Northwest Women's and Children's Hospital
| | - Jin-Zhen Guo
- Department of Neonatal Intensive Care Unit, The Northwest Women's and Children's Hospital, Xi’an, Shanxi, China
| | - An-Peng Zhang
- Department of Pediatrics, The Northwest Women's and Children's Hospital
| | - Qing-Hong Li
- Department of Neonatal Intensive Care Unit, The Northwest Women's and Children's Hospital, Xi’an, Shanxi, China
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21
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Advances and Trends in Pediatric Minimally Invasive Surgery. J Clin Med 2020; 9:jcm9123999. [PMID: 33321836 PMCID: PMC7764454 DOI: 10.3390/jcm9123999] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 11/28/2020] [Accepted: 12/03/2020] [Indexed: 12/11/2022] Open
Abstract
As many meta-analyses comparing pediatric minimally invasive to open surgery can be found in the literature, the aim of this review is to summarize the current state of minimally invasive pediatric surgery and specifically focus on the trends and developments which we expect in the upcoming years. Print and electronic databases were systematically searched for specific keywords, and cross-link searches with references found in the literature were added. Full-text articles were obtained, and eligibility criteria were applied independently. Pediatric minimally invasive surgery is a wide field, ranging from minimally invasive fetal surgery over microlaparoscopy in newborns to robotic surgery in adolescents. New techniques and devices, like natural orifice transluminal endoscopic surgery (NOTES), single-incision and endoscopic surgery, as well as the artificial uterus as a backup for surgery in preterm fetuses, all contribute to the development of less invasive procedures for children. In spite of all promising technical developments which will definitely change the way pediatric surgeons will perform minimally invasive procedures in the upcoming years, one must bear in mind that only hard data of prospective randomized controlled and double-blind trials can validate whether these techniques and devices really improve the surgical outcome of our patients.
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22
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Liu SQ, Lv Y, Fang Y, Luo RX, Zhao JR, Luo RG, Li YM, Zhang J, Zhang PF, Guo JZ, Li QH, Han MX. Magnetic compression for anastomosis in treating an infant born with long-gap oesophageal atresia: A case report. Medicine (Baltimore) 2020; 99:e22472. [PMID: 33080683 PMCID: PMC7571919 DOI: 10.1097/md.0000000000022472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Neonatal long-gap esophageal atresia (LGEA) with tracheoesophageal fistula (TEF) is an uncommon but serious congenital malformation of the esophagus in newborns, and it remains challenging for pediatric surgeons. Magnetic compress has been shown to be effective for the treatment of LGEA in children and adults. However, the implementation of this unique technique for neonatal LGEA has not been evaluated. PATIENT CONCERNS A female infant was born at 37 weeks of gestation. Prenatal ultrasound imaging revealed signs of esophageal atresia, including the absence of the gastric bubble and polyhydramnios. DIAGNOSES A diagnosis of LGEA with TEF was confirmed at birth by contrast X-ray. INTERVENTIONS She was treated with magnetic compression anastomosis (MCA) following an esophago-esophagostomy. Two magnetic rings were customized, and the MCA was conducted during the same stage surgery of ligating the TEF. Under the magnetic force, the 2 magnet rings pulled along the gastric tube to achieve anastomosis. The postoperative permanent suction of these 2 pouches was instituted, and spontaneous growth was awaited. Magnet removal was performed at 36 days, and enteral nutrition was continued via a gastric tube for 4 weeks at post-operation. OUTCOMES The upper gastrointestinal contrast confirmed the anastomotic patency perfectly after 3 months. The patient was followed up for 18 months, and exhibited durable esophageal patency without dysphagia. LESSONS These results suggest that MCA is feasible and effective for treating LGEA in infants.
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Affiliation(s)
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University
| | | | - Rui-Xue Luo
- Northwest Institute for Nonferrous Metal Research (NIN)
| | | | | | | | | | | | - Jin-Zhen Guo
- Department of Neonatal Intensive Care Unit, The Northwest Women's and Children's Hospital, Xi’an, Shanxi, China
| | - Qing-Hong Li
- Department of Neonatal Intensive Care Unit, The Northwest Women's and Children's Hospital, Xi’an, Shanxi, China
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23
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Liu S, Lv Y. Constant magnetic field in treating congenital esophageal and anorectal malformation: a review. WORLD JOURNAL OF PEDIATRIC SURGERY 2020; 3:e000130. [DOI: 10.1136/wjps-2020-000130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 11/04/2022] Open
Abstract
BackgroundCongenital esophageal and anorectal malformation are common in neonates. Refractory esophageal anastomotic stricture and abnormal defecation after surgical correction in infants are challenging surgical problems. Magnetic compression anastomosis (MCA) using mated magnets with their interposed compressed tissue may result in serosa-to-serosa apposition.Data sourcesA literature search was performed to establish an algorithm for these accidents by the authors to identify relevant articles published from 1977 to 2019 in Google, Medline, ISI Web of Knowledge Ovid, CNKI and library document delivery, using search terms “magnetics”, “esophageal malformation”, “anorectal” and “perforation”. A total of 24 literatures were collected.ResultsMagnamosis is technically feasible for alimentary tract anastomoses in pediatric patients. The magnets are most commonly made of neodymium–iron–boron and samarium–cobalt alloys, which have been employed to create solid anastomosis for long-gap esophageal atresia and refractory esophageal stricture without thoracotomy in children in recent years. Furthermore, magnamosis can be used for the functional undiversion of ileostomy. In anorectal malformations with favorable anatomy, this procedure may avoid an operative repair such as posterior sagittal reconstruction.ConclusionTranslumenal anastomosis of digestive tract using the MCA is a reliable, minimally invasive and feasible method to treat congenital esophageal and anorectal malformation.
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Wolfe E, Zidane M, Hancock BJ, Lum Min SA, Zaritzky M, Keijzer R. Magnamosis for esophageal atresia is associated with anastomotic strictures requiring an increased number of dilatations. J Pediatr Surg 2020; 55:821-823. [PMID: 32061365 DOI: 10.1016/j.jpedsurg.2020.01.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 01/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE Magnamosis is a novel technique which utilizes high power magnets to anastomose the esophageal ends in children with esophageal atresia (EA) with or without a tracheoesophageal fistula (TEF), theoretically avoiding the need for thoracotomy. The objective of this study was to compare anastomotic stricture formation requiring dilatation after magnamosis versus after conventional anastomosis. METHODS Our center treated the first 3 cases of EA ± TEF with magnamosis in Canada. One was unsuccessful and excluded from our study. The number of postintervention dilatations was compared to controls from our database, which includes all children with EA ± TEF treated between 1991 and 2015. The controls had EA ± TEF treated with pouch-to-end anastomosis or colonic interposition (n = 65). Mann-Whitney U tests were used with p < 0.05 being significant. RESULTS The 2 magnamosis cases had a mean of 13.5 dilatations, compared to 2.6 for the controls. Those managed with pouch-to-end anastomosis or colonic interposition had a mean of 2.3 and 2.7 dilatations, respectively. We found that the cases required more dilatations than controls (p = 0.022) and pouch-to-end anastomosis (p = 0.021), but not than colonic interposition (p = 0.106). CONCLUSION Our results indicate that magnamosis is associated with more postintervention dilatations than conventional anastomotic techniques, suggesting that magnamosis results in more frequent and/or more resilient anastomotic strictures. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Emma Wolfe
- Departments of Surgery, Division of Pediatric Surgery, Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mazen Zidane
- Departments of Surgery, Division of Pediatric Surgery, Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Betty Jean Hancock
- Departments of Surgery, Division of Pediatric Surgery, Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suyin A Lum Min
- Departments of Surgery, Division of Pediatric Surgery, Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mario Zaritzky
- Department of Radiology, Division of Pediatric Radiology, University of Chicago, Chicago, IL, USA
| | - Richard Keijzer
- Departments of Surgery, Division of Pediatric Surgery, Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
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Muensterer OJ, Sterlin A, Oetzmann von Sochaczewski C, Lindner A, Heimann A, Balus A, Dickmann J, Nuber M, Patel VH, Manfredi MA, Jennings RW, Smithers CJ, Fauza DO, Harrison MR. An experimental study on magnetic esophageal compression anastomosis in piglets. J Pediatr Surg 2020; 55:425-432. [PMID: 31128845 DOI: 10.1016/j.jpedsurg.2019.04.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/09/2019] [Accepted: 04/27/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Fashioning a patent, watertight anastomosis in patients with esophageal atresia is a challenging task in pediatric surgery, particularly when performed under tension. A reproducible suture-less alternative would decrease operative time. We evaluated magnetic esophageal compression anastomoses in a novel bypass-loop swine model. METHODS Eight-week-old piglets underwent thoracotomy to mobilize the esophagus at the carina to create a U-shaped loop. Custom-made 8 mm diameter Neodymium Magnets were inserted into the esophagus proximal and distal to the loop, then mated side-to-side at the future anastomosis site. Pigs were observed for 8 (n = 4), 10 (n = 6), and 12 (n = 2) days and then sacrificed. The magnetic compression anastomosis was evaluated macroscopically, by radiography, burst pressure testing, and histology. RESULTS All 12 pigs survived until the endpoint. Separation of the magnets occurred at a median of 9 days. Contrast esophagrams showed patency and no leak. All anastomoses withstood pressures well over 13 kPa without leak. Histopathology showed epithelialized circular scar tissue. CONCLUSION Magnetic compression anastomoses of the esophagus using our specially-designed magnets are formed between the 8th and 10th postoperative day, are patent and mechanically resistant to supraphysiologic intraluminal pressures. These data lay the basis for a potential clinical application in patients born with esophageal atresia. LEVEL OF EVIDENCE Not applicable (experimental animal study).
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Affiliation(s)
- Oliver J Muensterer
- Department of Pediatric Surgery, University Medicine of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Alexander Sterlin
- Department of Pediatric Surgery, University Medicine of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Andreas Lindner
- Department of Pediatric Surgery, University Medicine of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Axel Heimann
- Department of Neurosurgical Pathophysiology, University Medicine of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alexandru Balus
- Division of Pediatric Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Jana Dickmann
- Translational Animal Research Center, University Medicine of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Maximilian Nuber
- Translational Animal Research Center, University Medicine of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Veeshal H Patel
- Division of Pediatric Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Michael A Manfredi
- Department of Surgery, Boston Children's Hospital, Boston, MA, United States of America
| | - Russell W Jennings
- Department of Surgery, Boston Children's Hospital, Boston, MA, United States of America
| | - Charles J Smithers
- Department of Surgery, Boston Children's Hospital, Boston, MA, United States of America
| | - Dario O Fauza
- Department of Surgery, Boston Children's Hospital, Boston, MA, United States of America
| | - Michael R Harrison
- Division of Pediatric Surgery, University of California San Francisco, San Francisco, CA, United States
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Zhao G, Ma J, Yan X, Li J, Ma F, Wang H, Liu Y, Lv Y. Optimized force range of magnetic compression anastomosis in dog intestinal tissue. J Pediatr Surg 2019; 54:2166-2171. [PMID: 30929946 DOI: 10.1016/j.jpedsurg.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/20/2019] [Accepted: 03/11/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Magnetic compression anastomosis (MCA) is a commonly used anastomosis method. MCA was widely used in tissues repair, gastroenterostomy, choledochoenterostomy, and so on. It is safer and more effective than stapler and manual surgical suturing. However, there are few detailed studies on the biomechanical characteristics and tissue transformation mechanisms of the anastomosis process. In this research, taking intestinal tissue as research object, we need to determine an optimal compressive force range to provide a biomechanical reference for the design of anastomats. METHODS Magnets with different magnetic force groups (2.06, 3.21, 6.27, 13.3 and 19.2 N) were implanted into each dog to form intestinal tissue side-to-side anastomoses. Five dogs were euthanized on each of postoperative day 1, day 3, and day 7. Anastomoses were then harvested and compared with respect to postoperative complications, histology and tear-resistance load capacity (TRLC). RESULTS The TRLC of anastomotic tissue formed by magnets with different magnetic forces differed markedly, but with the tissue growth, the TRLC differences between groups were decreased. Histology of anastomotic tissue showed that, in the initial stage, the anastomoses compressed by 2.06-N magnets did not form effectively, while the leakage appeared in the anastomoses compressed by 19.2-N magnets, in the rest groups, with magnetic force increasing, severity of ischemia and necrosis of compressed tissue increased and healing speed of anastomotic tissue improved. In the late stage, the influence of magnetic force for anastomotic tissue was gradually diminished. CONCLUSIONS The magnetic force applied on the magnetic compression anastomats affects the necrosis speed of compressed tissue and the healing speed of anastomotic tissue. The optimal compressive force range for intestinal compression anastomosis is 6.27 N to 13.3 N, and the actual optimal compression pressure is 79.8 kPa - 169 kPa. LEVEL OF EVIDENCE Magnetic compression anastomosis (MCA) is a commonly used anastomosis method. MCA was widely used in tissues repair, gastroenterostomy, choledochoenterostomy, and so on. It is safer and more effective than stapler and manual surgical suturing. However, there are few detailed studies on the biomechanical characteristics and tissue transformation mechanisms of the anastomosis process. In this research, taking intestinal tissue as research object, we need to determine an optimal compressive force range to provide a biomechanical reference for the design of anastomats.
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Affiliation(s)
- Guangbin Zhao
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, 710049, Xi'an, China.
| | - Jia Ma
- The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, 710061, Xi'an, China; Department of surgical oncology, the Third Affiliated Hospital, Xi'an Jiaotong University, Shaanxi Provincial People's Hospital, 710068, Xi'an, China.
| | - Xiaopeng Yan
- The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, 710061, Xi'an, China
| | - Jianhui Li
- The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, 710061, Xi'an, China; Department of surgical oncology, the Third Affiliated Hospital, Xi'an Jiaotong University, Shaanxi Provincial People's Hospital, 710068, Xi'an, China
| | - Feng Ma
- The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, 710061, Xi'an, China
| | - Haohua Wang
- The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, 710061, Xi'an, China
| | - Yaxiong Liu
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, 710049, Xi'an, China.
| | - Yi Lv
- The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, 710061, Xi'an, China.
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Slater BJ, Borobia P, Lovvorn HN, Raees MA, Bass KD, Almond S, Hoover JD, Kumar T, Zaritzky M. Use of Magnets as a Minimally Invasive Approach for Anastomosis in Esophageal Atresia: Long-Term Outcomes. J Laparoendosc Adv Surg Tech A 2019; 29:1202-1206. [PMID: 31524560 DOI: 10.1089/lap.2019.0199] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction: The majority of esophageal atresia (EA) patients undergo surgical repair soon after birth. However, factors due to patient characteristics, esophageal length, or surgical complications can limit the ability to obtain esophageal continuity. A number of techniques have been described to treat these patients with "long-gap" EA. Magnets are a nonsurgical alternative for esophageal anastomosis. The purpose of this study was to report long-term outcomes for the use of magnets in EA. Materials and Methods: Between July 2001 and December 2017, 13 patients underwent placement of a magnetic catheter-based system under fluoroscopic guidance at six institutions. Daily chest radiographs were obtained until there was union of the magnets. Magnets were then removed and replaced with an oro- or nasogastric tube. Complications and outcomes were recorded. The average length of follow-up was 9.3 years (range 1.42-17.75). Results: A total of 85% of the patients had type A, pure EA, and 15% had type C with previous fistula ligation. The average length of time to achieve anastomosis was 6.3 days (range 3-13). No anastomotic leaks occurred, and all of the patients had an expected esophageal stenosis that required dilation given the 10F coupling surface of the magnets (average 9.8, range 3-22). Six patients (46%) had retrievable esophageal stents, and two underwent surgery; yet all maintained their native esophagus without interposition. A total of 92% were on full oral feeds at the time of follow-up. Conclusion: The use of magnets for treatment of long-gap EA is safe and feasible and accomplished good long-term outcomes. The main complication was esophageal stricture, although all patients maintained their native esophagus. A prospective observational study is currently enrolling patients to evaluate the safety and benefit of a catheter-based magnetic device for EA.
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Affiliation(s)
- Bethany J Slater
- Department of Pediatric Surgery, University of Chicago, Chicago, Illinois
| | - Paula Borobia
- Department of Pediatric of Gastroenterology, Hospital de Niños, de La Plata, Argentina
| | - Harold N Lovvorn
- Department of Pediatric Surgery, Monroe Carell, Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Muhammad A Raees
- Department of Pediatric Surgery, Monroe Carell, Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Kathryn D Bass
- Department of Pediatric Surgery, Oishei Children's Hospital, Buffalo, New York
| | - Stephen Almond
- Department of Pediatric Surgery, Driscoll Children's Hospital, Corpus Christi, Texas
| | | | | | - Mario Zaritzky
- Department of Radiology, University of Chicago, Chicago, Illinois
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Emerging technologies in pediatric gynecology: new paradigms in women's health care. Curr Opin Obstet Gynecol 2019; 31:309-316. [PMID: 31369479 DOI: 10.1097/gco.0000000000000563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current review highlights the complexity of the pediatric and adolescent gynecology subspecialty as well as the recent and exciting opportunities for innovation within the field. RECENT FINDINGS The opportunities for concept, treatment, instrument, and knowledge-transfer innovation to better serve the specific needs of pediatric gynecology patients include novel approaches to neovagina creation using magnets, improving postoperative vaginal wound healing through newly designed and degradable vaginal stents, and complex Mullerian reconstructive surgical planning using virtual reality immersive experiential training. SUMMARY There is a significant window of opportunity to address the needs of pediatric, adolescent and adult gynecological patients with new innovative concepts and tools.
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Zhao G, Yan X, Ma L, Liu W, Zhang J, Guo H, Liu Y, Lv Y. Biomechanical and Performance Evaluation of Magnetic Elliptical-Ring Compressive Anastomoses. J Surg Res 2019; 239:52-59. [PMID: 30802705 DOI: 10.1016/j.jss.2019.01.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/20/2018] [Accepted: 01/25/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND After magnetic compressive anastomosis, anastomat passage through the narrow channels of the digestive tract is difficult owing to the device's large volume. Such passage can lead to mechanical damage to the digestive tract or anastomat's unstable excretion time. This article presents a new magnetic compressive anastomotic approach. METHODS A magnetic elliptical-ring compressive anastomat was designed and evaluated for placement and passage in vitro. Nine young adult dogs underwent laparotomy with intestinal tissue side-to-side anastomosis. Four different groups of magnetic compressive anastomats of two different magnetic force levels (20 N or 30 N) and shapes (round or elliptical) were implanted into each dog simultaneously. Three dogs were euthanized on each of postoperative day 1, day 4, and day 7. Anastomoses were then compared with respect to histology and tensile fracture force. RESULTS The magnetic elliptical-ring compressive anastomat was functional but produced less obstruction compared to its round counterpart during passage through the esophagus and intestine. Nine dogs underwent successful surgery and harvesting of 30 total anastomoses. Histology of anastomotic tissue showed that, along the newly formed tunnel connecting the two sides of anastomotic tissues, compressed tissues became thinner and fell off, and initial anastomoses formed on the seventh postoperative day. There were large differences in tensile fracture force among the anastomoses formed by magnets with different magnetic forces of the same structure. However, the magnetic compressive anastomat structure did not affect anastomotic repair during magnetic compression anastomosis. CONCLUSIONS The magnetic elliptical-ring compressive anastomat is an efficient anastomotic device that can be used easily and with good passage. The device has good biomechanical properties and can be used with endoscopy to reduce operative time.
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Affiliation(s)
- Guangbin Zhao
- State Key Laboratory for Mechanical Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaopeng Yan
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, China; Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an Jiaotong University, Xi'an, China
| | - Lei Ma
- State Key Laboratory for Mechanical Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wenyan Liu
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, China; Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an Jiaotong University, Xi'an, China
| | - Jing Zhang
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, China; Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an Jiaotong University, Xi'an, China
| | - Hongchang Guo
- State Key Laboratory for Mechanical Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yaxiong Liu
- State Key Laboratory for Mechanical Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Yi Lv
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, China; Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an Jiaotong University, Xi'an, China.
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Ellebaek MBB, Qvist N, Rasmussen L. Magnetic Compression Anastomosis in Long-Gap Esophageal Atresia Gross Type A: A Case Report. European J Pediatr Surg Rep 2018; 6:e37-e39. [PMID: 29796381 PMCID: PMC5966305 DOI: 10.1055/s-0038-1649489] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 03/23/2018] [Indexed: 12/20/2022] Open
Abstract
Esophageal atresia (EA) Gross type A (long-gap without tracheoesophageal fistula) is a rare and a surgical challenging form of EA that constitutes ∼6% of the children born with EA. We present the seventh reported case with successful esophagoesophagostomy obtained by magnetic compression of a long-gap EA type A without thoracotomy.
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Affiliation(s)
| | - Niels Qvist
- Department of Surgery, Odense University Hospital, Odense, Denmark
| | - Lars Rasmussen
- Department of Surgery, Odense University Hospital, Odense, Denmark
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Glenn IC, Bruns NE, Schomisch SJ, Ponsky TA. Creation of an Esophageal Atresia Animal Model Using a Bifurcated Esophagus to Maintain Digestive Tract Continuity. J Laparoendosc Adv Surg Tech A 2017; 27:1079-1084. [DOI: 10.1089/lap.2017.0180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ian C. Glenn
- Department of Surgery, Akron Children's Hospital, Akron, Ohio
| | | | - Steve J. Schomisch
- Department of Surgery, Case-Western Reserve University School of Medicine, Cleveland, Ohio
| | - Todd A. Ponsky
- Department of Surgery, Akron Children's Hospital, Akron, Ohio
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Woo R, Wong CM, Trimble Z, Puapong D, Koehler S, Miller S, Johnson S. Magnetic Compression Stricturoplasty For Treatment of Refractory Esophageal Strictures in Children: Technique and Lessons Learned. Surg Innov 2017; 24:432-439. [PMID: 28745145 DOI: 10.1177/1553350617720994] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Esophageal stricture is the most common complication following repair of esophageal atresia (EA). In general, these strictures are successfully managed using endoscopic techniques including bougie and balloon dilation, stenting, and chemotherapeutic agent application. If these techniques are unsuccessful, patients require segmental esophageal resection and reanastomosis or esophageal replacement. Magnetic compression anastomosis has been described in children. Herein we report our experience with magnetic compression stricturoplasty to treat refractory strictures after EA repair. METHODS We reviewed our experience using magnets to treat refractory strictures in 2 patients. Both patients failed multiple standard interventions. Because of near complete esophageal obstruction, both patients were candidates for esophageal replacement or segmental resection/anastamosis. In both patients, we applied neodymium-iron-boron magnets using fluoroscopic and endoscopic guidance. RESULTS The magnets were successfully positioned in both cases. Magnets were left in place for 7 and 10 days allowing for gradual compression stricturoplasty/anastamosis. Upon removal of the magnets, recanalization was visualized endoscopically and self-expanding stents were placed. There were no leaks or significant early complications. By 31 months post-magnetic stricturoplasty, both patients achieved durable esophageal patency without dysphagia. CONCLUSION Magnetic stricturoplasty was successful at establishing early patency of the esophagus in 2 patients with recalcitrant EA strictures. Fundamental knowledge of magnetism was critical in configuring magnet arrays for surgery. In both cases, early follow-up is promising. Further follow-up will define the long-term success of this technique.
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Abstract
BACKGROUND Obesity treatment options are of great interest worldwide with major developments in the past 20 years. From general surgery to natural orifice transluminal endoscopic surgery intervention nowadays, obesity surgical therapies have surely developed and are now offering a variety of possibilities. AREAS OF UNCERTAINTY Although surgery is the only proven approach for weight loss, a joint decision between the physician and patient is required before proceeding to such a procedure. With a lot of options available, the treatment should be individualized because the benefits of surgical intervention must be weighed against the surgical risks. DATA SOURCES Medline search to locate full-text articles and abstracts with obvious conclusions by using the keywords: obesity, surgical endoscopy, gastric bypass, bariatric surgery, and endoscopic surgery, alone and in various combinations. Additional relevant publications were also searched using the reference lists of the identified articles as a starting point. RESULTS Laparoscopic Roux-en-Y gastric bypass still is the most effective, less invasive, bariatric surgical intervention, although there are various complications encountered, such as postoperative hemorrhage (1.9%-4.4%), internal hernias, anastomotic strictures (2.9%-23%), marginal ulcerations (1%-16%), fistulas (1.5%-6%), weight gain, and nutritional deficiencies. However, the absence of parietal incisions, less pain, decreased risk of infection, and short hospital stay make room for endoscopic surgery as a possible valid option for obesity for both the doctors' and the patients' perspective. CONCLUSIONS The current tendency is to promote surgical treatment of obesity to a status of less invasive scars therefore promoting minimally invasive surgical techniques.
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Zhang H, Tan K, Fan C, Du J, Li J, Yang T, Lv Y, Du X. Magnetic compression anastomosis for enteroenterostomy under peritonitis conditions in dogs. J Surg Res 2017; 208:60-67. [DOI: 10.1016/j.jss.2016.08.091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/23/2016] [Accepted: 08/26/2016] [Indexed: 12/19/2022]
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Repair of esophageal atresia with proximal fistula using endoscopic magnetic compression anastomosis (magnamosis) after staged lengthening. Pediatr Surg Int 2016; 32:525-8. [PMID: 27012861 DOI: 10.1007/s00383-016-3889-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 12/11/2022]
Abstract
We describe the treatment of a patient with long-gap esophageal atresia with an upper pouch fistula, mircogastria and minimal distal esophageal remnant. After 4.5 months of feeding via gastrostomy, a proximal fistula was identified by bronchoscopy and a thoracoscopic modified Foker procedure was performed reducing the gap from approximately 7-5 cm over 2 weeks of traction. A second stage to ligate the fistula and suture approximate the proximal and distal esophagus resulted in a gap of 1.5 cm. IRB and FDA approval was then obtained for endoscopic placement of 10-French catheter mounted magnets in the proximal and distal pouches promoting a magnetic compression anastomosis (magnamosis). Magnetic coupling occurred at 4 days and after magnet removal at 13 days an esophagram demonstrated a 10 French channel without leak. Serial endoscopic balloon dilation has allowed drainage of swallowed secretions as the baby learns bottling behavior at home.
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Arun A, Gaston B, Kwiat D, Imamura-Ching J, Fechter R, Chen S, Jiang H, Harrison M, Roy S. Inductive Sensing to Detect Tissue Thickness Between Magnets for Potential Application in Magnetic Compression Based Anastomosis. J Med Device 2016. [DOI: 10.1115/1.4032615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Magnetic compression based anastomoses use magnetic force to necrose tissue between two magnets to create an anastomosis. Nickel-plated neodymium–iron–boron magnets are used in our study. The compression pressure between the magnets depends on the distance between the magnets, which is determined by the thickness of the compressed tissue and depends on bowel wall thickness and elasticity. It is critical to know the distance between the magnets once the tissue is compressed because the magnets must be within a critical distance of each other in order to create enough compressive force to necrose the tissue. We have developed an inductance sensor to detect the distance (tissue thickness) between the two magnets after the surgeon has deployed them. Inductance sensing is a contact-less sensing method that enables precise short-range detection of conducting surfaces. The inductor coil mounted on one magnet detects the second magnet by measuring the change in inductance due to eddy current induced on the nickel-plated surface of the second magnet. The change in the inductance is proportional to the change in distance between the magnets. The sensor was first calibrated by using polycarbonate sheets to simulate the intestine tissue. We are able to detect up to 6 mm of spacing between the magnets. Pig intestine from Yorkshire pigs was used to characterize the sensor. We are able to distinguish up to five distinct layers of the intestine from the large intestine. This sensing mechanism can indicate the operating surgeon the exact thickness of the tissue compressed between the two magnets. The surgeon can thus be sure of formation of a clean anastomosis and avoid the likelihood of the magnets sliding away or uncoupling.
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Affiliation(s)
- Anupama Arun
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA 94143 e-mail:
| | - Brandon Gaston
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143
| | - Dillon Kwiat
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143
| | - Jill Imamura-Ching
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143
| | - Richard Fechter
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143
| | - Shijie Chen
- School of Electrical Engineering, San Francisco State University, San Francisco, CA 94132
| | - Hao Jiang
- School of Electrical Engineering, San Francisco State University, San Francisco, CA 94132
| | - Michael Harrison
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143
| | - Shuvo Roy
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA 94143
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Magnets for therapy in the GI tract: a systematic review. Gastrointest Endosc 2015; 82:237-45. [PMID: 25936447 DOI: 10.1016/j.gie.2014.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 11/04/2014] [Indexed: 12/13/2022]
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