title: Minimally invasive entero-enteral dual-path bypass using self-assembling magnets.
abstract: A minimally invasive method of entero-enteral bypass may be desirable for treatment of obstruction, obesity, or metabolic syndrome. We have developed a technology based on miniature self-assembling magnets which create large-caliber anastomoses (incisionless anastomosis system or IAS). The aim of this study was to assess (a) procedural characteristics of IAS deployment and (b) long-term integrity and patency of the resulting jejuno-ileal dual-path bypass.
  
  
  
  Endoscopic jejuno-ileal bypass creation using IAS magnets was performed in 8 Yorkshire pigs survived 3 months.
  
  
  
  The jejunal magnet was endoscopically deployed. However, the ileal magnet required surgical delivery given restraints of porcine anatomy. A 5-mm enterotomy was created through which the ileal magnet was inserted using a modified laparoscopic delivery tool. Magnets were manually coupled. Pigs underwent serial endoscopies for anastomosis assessment. Three-month necropsies were performed, followed by pressure testing of anastomoses and histological analysis.
  
  
  
  Jejuno-ileal bypass creation using self-assembling IAS magnets was successful in all 8 pigs (100 %). Patent, leak-free bypasses formed in all animals by day 10. All IAS magnets were expelled by day 12. Anastomoses were widely patent at 3 months, with mean maximal diameter of 30 mm. At necropsy, adhesions were minimal. Pressure testing confirmed superior integrity of anastomotic tissue. Histology showed full epithelialization across the anastomosis with no evidence of submucosal fibrosis or inflammation.
  
  
  
  Entero-enteral bypass using self-assembling IAS magnets is safe and technically feasible in the porcine model. IAS magnets can be rapidly delivered endoscopically or through a modified laparoscopic device. Expulsion of fused magnets avoids retention of prosthetic material. Anastomoses are widely patent and fully re-epithelialized. Three-month pressure testing reveals anastomotic tissue to be as robust as native tissue, while necropsy and histology suggests minimal/absent tissue inflammation. In human anatomy, a fully endoscopic jejuno-ileal bypass using IAS magnets may be feasible.
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. mryou@partners.org.
authors.forename: Marvin
authors.initials: M
authors.lastname: Ryou
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Aihara
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Thompson
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods*; D000818:Animals; D004867:Equipment Design; D007082:Ileum / Q000601:surgery*; D007581:Jejunoileal Bypass / Q000295:instrumentation / Q000379:methods*; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy; D059346:Magnets; D011312:Pressure; D034421:Sus scrofa; D013552:Swine
keywords: Anastomosis; Compression anastomosis; Dual-path bypass; Endoscopic anastomosis; Endoscopic bypass; Incisionless anastomosis system (IAS); Intestinal anastomosis; Magnetic anastomosis; SAMSEN; Self-assembling magnets for endoscopy; Side-to-side anastomosis; Surgical anastomosis