Magnetic compression anastomosis for patients with a disconnected bile duct after living-donor related liver transplantation: a pilot study

Background and study aim: We present the use of the magnetic compression anastomosis (MCA) technique for treatment of disconnected bile duct after living-donor related liver transplantation (LDLT) using the recently introduced through-the-scope magnet. Patients and methods: The MCA technique was used in patients with disconnected bile duct who could not be treated with either percutaneous or endoscopic procedures. All patients already had a percutaneous external biliary drainage catheter before the procedure. The magnet was placed percutaneously into the proximal side of the obstruction by pushing a 5-Fr catheter over a guide-wire. Concurrently, endoscopic retrograde cholangiopancreatography (ERCP) including endoscopic papillary sphincterotomy was performed. The sister magnet was then carefully advanced to the opposite side of the obstruction with a 5-Fr catheter over a guidewire. After the confirmation of biliary recanalization, a guidewire was passed through the stricture and a percutaneous dilation of the stricture was performed with a balloon-tipped catheter. Endoscopic balloon dilation of the stricture, insertion of two plastic stents and the removal of the internal drainage catheter were performed during the first ERCP session. Stent exchange and multiple side-by-side stent placements were planned at regular intervals (3 monthly) for all patients. Results: A total of six LDLT patients with disconnected bile duct (aged 37-68, four men) underwent the MCA technique between September 2014 and July 2015. Biliary recanalization was achieved 13-42 days after the magnet placement procedure. The success rate of the procedure was 100%. Conclusions: The MCA technique using a small magnet (diameter 2.4mm) is effective and useful in LDLT patients with disconnected bile duct.