Background and aim: A 93-year-old woman who was bedridden with severe dementia was referred to our department with a 3-day history of repeated vomiting after meals. CT revealed significant dilatation of the duodenum up to the level of the third portion, which was compressed by a large, low-density mass. Upper GI endoscopy showed narrowing of the third portion of the duodenum with edematous mucosa covered with multiple white spots, where the endoscope was able to pass through with mild resistance. B cell lymphoma was histopathologically suspected from biopsy specimens of the mucosa. We performed gastro-jejunostomy via the magnetic compression anastomosis (MCA) technique. We prepared two neodymium magnets: flat-plate-shaped (15 × 3 mm) with a small hole 3 mm in diameter; a nylon thread was passed through each hole. We then confirmed the absence of no non-target tissue, including large vessels and intestine adjacent to the anastomosis where the magnets were to be placed using endoscopic ultrasonography (EUS) from the stomach. EUS-guided marking using biopsy forceps by biting the mucosa and placing a hemoclip was performed at the anastomosis site in the stomach. The magnet was pushed and delivered to the duodeno-jejuno junction, and another magnet was delivered to the marking point in the stomach. The magnets were attracted towards each other transmurally. The magnets fell into the colon by 11 days after starting the compression, and the completion of gastro-jejunostomy was confirmed.
Relevance for patients: Endoscopic gastro-jejunostomy using MCA is useful as a minimally invasive alternative treatment for duodenal obstruction. EUS for the preoperative local assessment and EUS-guided marking can ensure the safety of the MCA procedure.
Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Japan
Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, 100 Nishinokuchi, Sayama, Kumiyama-cho, Kuze-gun, Kyoto 613-0034, Japan
Tel: +81774 48 5500
Fax: +81774 44 7159
Michal Heger Department of Pharmaceutics, Utrecht University, the Netherlands
Department of Pharmaceutics, Jiaxing University Medical College, Zhejiang, China