Background/Purpose

Previous studies have shown that a patent, watertight esophageal anastomosis can be accomplished safely using specially-shaped magnets in piglets. However, it is unclear whether such a magnetic esophageal compression anastomosis (MECA) remains patent in the long-term. The purpose of this study was to evaluate the long-term outcome of MECA in an experimental pig model over an observation period of 2 months.

Methods

Ten piglets underwent creation of an MECA with custom-made 8 mm magnets and a U-shaped esophageal bypass loop to allow peroral nutrition at eight weeks of life. Two weeks later, the bypass loop was closed surgically, requiring the pigs to swallow via the newly created magnetic compression anastomosis. The pigs were fed soft chow for 2 months. They were monitored for weight gain and signs of dysphagia. At the endpoint of two months, esophagoscopy and contrast esophagography was performed. After removal of the esophagus, the tissues were macroscopiocally and histologically assessed.

Results

Six piglets survived until the endpoint. In two pigs, closure of the bypass loop failed, these demonstrated mean weight gain of 792 gs/day [95% Confidence interval 575 to 1009 gs/day]. Weight gain in four pigs that exclusively fed via the magnetic anastomosis averaged 577 gs/day [95% confidence interval 434 to 719 gs/day (p = 0.18)]. There were no signs of dysphagia. All magnets passed with the stool within 16 days. After 2 months, a well-formed magnetic compression anastomosis was visible and easily negotiated with a 6.5 mm endoscope. Esophogram and macroscopic findings confirmed patentency of the esophageal anastomoses. Histopathology showed a circular anastomosis lined with contiguous epithelium.

Conclusion

MECA creates a long-term functional and patent anastomosis in pigs. This concept may facilitate minimally-invasive esophageal atresia repair by obviating a technically challenging and time-consuming hand-sewn anastomosis.

中文翻译：

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仔猪食管磁加压吻合术后远期疗效的实验研究

背景/目的

先前的研究表明，在仔猪身上使用特殊形状的磁铁可以安全地完成一项专利的、防水的食管吻合术。然而，目前尚不清楚这种磁性食管加压吻合术（MECA）是否长期保持专利。本研究的目的是在 2 个月的观察期内评估 MECA 在实验猪模型中的长期结果。

方法

十头小猪经历了一个 MECA 的创建，该 MECA 带有定制的 8 毫米磁铁和一个 U 形食道旁路环，以便在八周的生命中进行经口营养。两周后，通过外科手术关闭了旁路环，需要猪通过新创建的磁压缩吻合来吞咽。给猪喂食软饲料2个月。监测他们的体重增加和吞咽困难的迹象。在两个月的终点，进行了食管镜检查和对比食管造影。切除食道后，对组织进行宏观和组织学评估。

结果

六头小猪存活到终点。在两只猪中，旁路回路关闭失败，这些表明平均体重增加 792 克/天 [95% 置信区间 575 至 1009 克/天]。仅通过磁吻合术喂养的四头猪的体重增加平均为 577 gs/天 [95% 置信区间为 434 至 719 gs/天 ( p  = 0.18)]。没有吞咽困难的迹象。所有磁铁在 16 天内随粪便排出。2 个月后，使用 6.5 mm 内窥镜可以看到形状良好的磁力压缩吻合，并且很容易通过。食管造影和肉眼观察结果证实了食管吻合口的专利性。组织病理学显示圆形吻合口内衬有连续的上皮。

结论

MECA 在猪身上创造了一个长期的功能性和专利吻合。这一概念可以通过避免技术上具有挑战性和耗时的手工缝合吻合术来促进微创食管闭锁修复。