Endoscopic Gastroenteric Anastomoses With Magnets (Egam): Three Years After

Introduction: Three years ago we presented a novel technique of gastroenteric anastomoses, formed by endoscopic magnet assisted nonsurgical technique as an alternative to enteral stents(SEMS) and surgery for malignancies involving the duodenum or gastric antrum. Aims & Methods: The purpose of this study is to evaluate three years of work with this technique and evaluate early and late complication rates. Patients: From December 2001 until November 2004, 21 patients with malignant biliary, gastric and duodenal obstruction were included in the study. All patients were deemed non-surgical candidates because of their advanced disease and poor performance status, according to AJCC classification. Methods: All patients had biliary drainage performed prior to EGAM either by ERC or PTC. Once the EGAM was completed, the patients were included in a monthly follow-up protocol with endoscopy, radiology, evaluation of symptoms, nutritional status, and the Karnoftsky rating scale. Results: The procedure was successful in 19 of 21 patients. All patients started with oral intake after one day of the procedure and were hospitalized for two days. Early complications was perforation of immature fistula in two patients. During the follow-up, 3 stent migrations and 1 obstruction of the stent by solid food, were presented. Ten patients maintained their baseline Karnofsky score, two patients increased this by one point and 1 patient increased this score by 2 points and is still alive. All patients had good patency of the anastomoses until their time of death. The mean survival was 4.3 months. Conclusion: Our results demonstrate the safety and efficacy of EGAM as a novel, non-surgical option for creating a gastroenteric anastomosis in human beings. We believe this minimally invasive technique is a valid alternative to SEMS with good results in long term follow up. More trials are necessary to confirm our findings.