Magnetic compression anastomosis for biliary obstruction: review and experience at Tokyo Medical University Hospital.
BACKGROUND
Magnetic compression anastomosis (MCA) is a revolutionary, minimally invasive method of performing choledochoenterostomy or choledochocholedochostomy without using surgical techniques in patients with biliary stricture or obstruction. Herein, we describe a case series of MCA for severe biliary stricture or obstruction, which could not be treated with conventional therapies.


METHODS
Two patients with biliary obstruction were treated using MCA for choledochocholedochostomy and choledochoenterostomy at Tokyo Medical University Hospital and Tokyo Medical University Hachioji Medical Center. Endoscopically, a samarium-cobalt (Sm-Co) rare-earth magnet was placed at the superior site of obstruction through the percutaneous transhepatic biliary drainage route and another Sm-Co magnet was placed at the inferior site of obstruction. A comprehensive computer-aided literature search for MCA was performed up to September 2009 by using MEDLINE and EMBASE.


RESULTS
MCA techniques enabled complete anastomosis in both cases without procedure-related complications.


CONCLUSIONS
The MCA technique is a revolutionary method of performing choledochocholedochostomy and choledochoenterostomy interventionally in patients with biliary obstruction, for whom the conventional endoscopic procedure is not available, or in candidates who are deemed unsuitable for surgery.
Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. itoi@tokyo-med.ac.jp
Takao
T
Itoi
Kazuhiko
K
Kasuya
Atsushi
A
Sofuni
Fumihide
F
Itokawa
Takayoshi
T
Tsuchiya
Toshio
T
Kurihara
Nobuhito
N
Ikeuchi
Mami
M
Takeuchi
Takeshi
T
Nagano
Hitoshi
H
Iwamoto
Eigoro
E
Yamanouchi
Motohide
M
Shimazu
Akihiko
A
Tsuchida
D002760:Cholangiopancreatography, Endoscopic Retrograde; D002768:Choledochostomy / Q000379:methods*; D003137:Common Bile Duct Diseases / Q000175:diagnosis / Q000601:surgery*; D006785:Hospitals, University; D006801:Humans; D008280:Magnetics; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D019736:Prostheses and Implants; D011474:Prosthesis Design; D014041:Tokyo; D016896:Treatment Outcome