title: Magnetic compression biliary-enteric anastomosis for palliation of obstructive jaundice: initial clinical results.
abstract: OBJECTIVE
  To report initial clinical experience with a nonsurgical method for sutureless biliary-enteric anastomosis with use of two magnetic elements that potentially overcomes the disadvantages of other palliative methods.
  
  
  METHODS
  The technique involves percutaneous transhepatic insertion of one magnet into the bile duct under fluoroscopic guidance and insertion of a second magnet endoscopically into the duodenum. The adherence of the two magnets creates ischemic necrosis of bile duct and duodenal walls. When these tissues slough, the resulting hole allows enteric passage of the magnets and creates a biliary-enteric fistula for decompression of an obstructed biliary system. A magnetic compression biliary-enteric anastomosis (MCBEA) was created in 34 patients (nine men; mean age, 64 years; age range, 46-82 y) with malignant obstructive jaundice at the level of the middle or distal common bile duct.
  
  
  RESULTS
  There was no recurrent jaundice during the initial 30 postprocedural days. Total bilirubin levels decreased significantly in all patients 1 week after MCBEA formation (P < .0001), with normalization of bilirubin levels in eight of 34 patients. There was temporary occlusion caused by partial clogging of the bypass with coarse food in two cases, which was successfully revised endoscopically. Three patients required surgical revision as a result of tumor ingrowth. Median survival time was 10 months. The cause of death in all patients was progression of underlying malignancy.
  
  
  CONCLUSIONS
  Creation of a biliary-enteric anastomosis with magnetic compression is a feasible alternative for palliative treatment of obstructive jaundice with satisfactory results.
authors.affiliation: Blokhin Russian Oncology Research Center, Russian Research Centre of Surgery, Moscow, Russia.
authors.forename: Michael
authors.initials: M
authors.lastname: Avaliani
authors.forename: Nikolay
authors.initials: N
authors.lastname: Chigogidze
authors.forename: Andrei
authors.initials: A
authors.lastname: Nechipai
authors.forename: Boris
authors.initials: B
authors.lastname: Dolgushin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000295:instrumentation* / Q000379:methods; D019245:Compressive Strength; D004867:Equipment Design; D006801:Humans; D066298:In Vitro Techniques; D041781:Jaundice, Obstructive / Q000175:diagnosis* / Q000534:rehabilitation*; D008280:Magnetics / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010865:Pilot Projects; D016896:Treatment Outcome