ÖTLETEK . . .

 

AMIK  ELEINTE  MEGLEPŐEK

 

MÓDSZEREK . . .

 

AMIK  NEM  SZOKVÁNYOSAK

 

KÍSÉRLETEK ...

 

AMIK  SOKSZOR  ÚJSZERŰEK 

 

MŰTÉTEK . . .

 

AHOL MINDEZEKET

 

MEGVALÓSÍTJUK

 

New minimal invasive flexible Endoscopic intervention: MAGNEMOSIS (experimental results)

Szülőkategória: KONGRESSZUSOK
10. 08. 14

 

Krisztina Tari RN (1), Péter Lukovich MD (1), Attila Jónás MD (1), Kata Szabó MDS (2), Ibolyka Dudás MD (3), Gábor Váradi MD (4), Szilvia Kupcsulik MD (1), Bea Berényi MDS (2), Péter Pálházi MDS (2), Attila Zsirka, MD (1), Péter Kupcsulik, MD (1)

((1) Endoscopy, 1st Department of Surgery, Semmelweis University, Budapest, Hungary, Tel: +3613135216, e-mail: Ez az e-mail-cím a szpemrobotok elleni védelem alatt áll. Megtekintéséhez engedélyeznie kell a JavaScript használatát.; (2) Faculty of Medicine, Semmelweis University, Budapest; (3) Department of Diagnostic Radiology and Oncotherapy, Semmelweis University, Budapest; (4) Ödön Jávorszky Hospital, Vác;

Introduction:

Gastric outlet obstruction could be caused by benign (pyloric stenosis, chronic pancreatitis) and malignant (pancreatic-, bile duct-, distal stomach cancer) diseases. The "gold standard" palliative treatment is surgical creation of gastro-entero anastomosis (GEA). Besides, there are minimal invasive techniques as well, like laparoscopic GEA or duodenal self-expandable metal stent implantation. However, surgical interventions (even laparotomic and laparoscopic ways) are needed narcosis, by this way they are risky to the patients usually in poor general conditions caused by malnutrition and malignancy; self-expandable metal stents can be easily occluded or migrate.

Method:

At the 1st Department of Surgery, Semmelweis University an experimental endoscopic, X-ray guided gastro-entero anastomosis was created by using magnets. The theory of so called magnamosis is based on the compressive force of attached magnets placed into different luminal organs, which causes for first ischaemy, then adhesion, and after necrosis of the walls, in 7-10 days the anastomosis is created. After practicing the intervention on biosynthetic model the procedure was made on living porcine model as well. For the intervention two silicone-covered rare earth (NdFeB) magnets were used. The first magnet was introduced per orally into the duodenum by flexible endoscope and a guide wire. The second magnet was guided into the stomach with the same technique. The attachment of the magnets was helped by the guide wires and the endoscope under fluoroscopy. There were no any complications during the procedures.

Results:

Two weeks later the magnets were removed at the control endoscopy. The endoscope could have been managed through the anastomosis from the stomach into the jejunum.

Conclusions:

The magnetic creation of GEA is an easy way to make a bypass. This procedure could be an alternative palliative therapy for poor general conditioned patients with gastric outlet obstruction, because it is carried out without surgery and narcosis.

References:

P Lukovich, A Jónás, P Bata, K Tari, G Váradi, B Kádár, A M Sadat, P Kupcsulik :

Gastro-entero anastomosis with flexible endoscope with the help of rare-earth magnets on biosynthetic model: Hungarian Journal of Surgery. Volume 60, Number 2/April 2007

Chopita N, Vaillaverde A, Cope C, Bernedo A, Martinez H, Landoni N, Jmelnitzky A, Burgos H: Endoscopic gastroenteric anastomosis using magnets. Endoscopy 37 : 313–7 (2005)

Mimuro A, Tsuchida A, Yamanouchi E, Itoi T, Ozawa T, Ikeda T, Nakamura R, Koyanagi Y, Nakamura K: A novel technique of magnetic compression anastomosis for severe biliary stenosis. Gastrointest Endosc 58 : 283–7 (2003)