Long Term Follow-up of Endoscopic Gastroenteric Anastomoses with Magnets (EGAM)

Introduction: A year ago we presented a novel technique with magnets as an alternative to stents and surgery for malignancies involving the duodenum or gastric antrum. Aim: The purpose of this study is to evaluate the long-term patency and complication rates of gastroenteric anastomoses, formed by endoscopic magnet assisted nonsurgical technique. Patients: From December 2001 until July 2003, 17 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 15 of 17 patients. During the follow-up, 2 distal stent migrations, 1 proximal stent migration and 1 obstruction of the stent by solid food, were presented.Ten patients maintained their baseline Karnofsky score, two patients increased their by one point and 1 patient increased their score by 2 points and is still alive. All patients had good patency of the anastomoses until their time of death. The mean survaival was 5.6 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 surgery in this particular subset of patients. Further studies are necessary to confirm our results and potentially expand the indications for the procedure.