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Magnetic compression anastomosis for patients with a disconnected bile duct after living-donor related liver transplantation: a pilot study
submitted 24 October 2015
accepted after revision 23 February 2016
03 June 2016 (online)
Background and study aim: We present the use of the magnetic compression anastomosis (MCA) technique for treatment of disconnected bile duct after living-donor related liver transplantation (LDLT) using the recently introduced through-the-scope magnet.
Patients and methods: The MCA technique was used in patients with disconnected bile duct who could not be treated with either percutaneous or endoscopic procedures. All patients already had a percutaneous external biliary drainage catheter before the procedure. The magnet was placed percutaneously into the proximal side of the obstruction by pushing a 5-Fr catheter over a guidewire. Concurrently, endoscopic retrograde cholangiopancreatography (ERCP) including endoscopic papillary sphincterotomy was performed. The sister magnet was then carefully advanced to the opposite side of the obstruction with a 5-Fr catheter over a guidewire. After the confirmation of biliary recanalization, a guidewire was passed through the stricture and a percutaneous dilation of the stricture was performed with a balloon-tipped catheter. Endoscopic balloon dilation of the stricture, insertion of two plastic stents and the removal of the internal drainage catheter were performed during the first ERCP session. Stent exchange and multiple side-by-side stent placements were planned at regular intervals (3 monthly) for all patients.
Results: A total of six LDLT patients with disconnected bile duct (aged 37 – 68, four men) underwent the MCA technique between September 2014 and July 2015. Biliary recanalization was achieved 13 – 42 days after the magnet placement procedure. The success rate of the procedure was 100 %.
Conclusions: The MCA technique using a small magnet (diameter 2.4 mm) is effective and useful in LDLT patients with disconnected bile duct.
- 1 Yamanouchi E, Kawaguchi H, Endo I et al. A new interventional method: magnetic compression anastomosis with rare earth magnets. Cardiovasc Intervent Radiol 1998; 21: S155
- 2 Takao S, Matsuo Y, Shinchi H et al. Magnetic compression anastomosis for benign obstruction of the common bile duct. Endoscopy 2001; 33: 988-990
- 3 Mimuro A, Tsuchida A, Yamanouchi E et al. A novel technique of magnetic compression anastomosis for severe biliary stenosis. Gastrointest Endosc 2003; 58: 283-287
- 4 Okajima H, Kotera A, Takeichi T et al. Magnet compression anastomosis for bile duct stenosis after duct-to-duct biliary reconstruction in living donor liver transplantation. Liver Transpl 2005; 11: 473-475
- 5 Itoi T, Yamanouchi E, Ikeda T et al. Magnetic compression anastomosis: a novel technique for canalization of severe hilar bile duct strictures. Endoscopy 2005; 37: 1248-1251
- 6 Yazumi S, Chiba T. Biliary complications after right-lobe living-donor liver transplantation. J Gastroenterol 2005; 40: 861-865
- 7 Akita H, Hikita H, Yamanouchi E et al. Use of a metallic-wall stent in the magnet compression anastomosis technique for bile duct obstruction after liver transplantation. Liver Transpl 2008; 14: 118-120
- 8 Itoi T, Kasuya K, Sofuni A et al. Magnetic compression anastomosis for biliary obstruction: review and experience at Tokyo Medical University Hospital. J Hepatobiliary Pancreat Sci 2011; 18: 357-365
- 9 Jang SI, Kim J-H, Won JY et al. Magnetic compression anastomosis is useful in biliary anastomotic strictures after living donor liver transplantation. Gastrointest Endosc 2011; 74: 1040-1048
- 10 Perez-Miranda M, Aleman N, de la Serna Higuera C et al. Magnetic compression anastomosis through EUS-guided choledochoduodenostomy to repair a disconnected bile duct in orthotopic liver transplantation. Gastrointest Endosc 2014; 80: 520-521
- 11 Parlak E, Küçükay F, Köksal AŞ et al. Recanalization of complete anastomotic biliary obstruction after living donor related liver transplantation with a novel through-the-scope magnet. Liver Transpl 2015; 21: 711-712
- 12 Graziadei IW, Schwaighofer H, Koch R et al. Long-term outcome of endoscopic treatment of biliary strictures after liver transplantation. Liver Transpl 2006; 12: 718-725
- 13 Kasahara M, Egawa H, Takada Y et al. Biliary reconstruction in right lobe living-donor liver transplantation: comparison of different techniques in 321 recipients. Ann Surg 2006; 243: 559-566
- 14 Jang SI, Rhee K, Kim H et al. Recanalization of refractory benign biliary stricture using magnetic compression anastomosis. Endoscopy 2014; 46: 70-74
- 15 Lambe T, ÓRíordáin MG, Cahill RA et al. Magnetic compression in gastrointestinal and bilioenteric anastomosis: how much force?. Surg Innov 2014; 21: 65-73