Holler Anne-Sophie, König Tatjana Tamara, Chen Caressa, Harrison Michael R, Muensterer Oliver J
Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, 55131 Mainz, Germany.
Department of Pediatric Surgery, Universitätsmedizin, Johannes-Gutenberg University, 55131 Mainz, Germany.
Children (Basel). 2022 Jul 25;9(8):1113. doi: 10.3390/children9081113.
The use of magnet compression to endoscopically create an esophageal anastomosis is an intriguing approach to esophageal atresia repair, but published cases with an existing available device have demonstrated mixed success. One major shortcoming has been the formation of subsequent severe, recalcitrant strictures after primary repair. To address the limitations of the existing device, we recently introduced and reported success with specially designed bi-radial magnets that exhibit a novel geometry and unique tissue compression profile. The aim of this study is to compare the outcomes using our novel device (novel group, NG) with those of previous reports which utilized the historical device (historic group, HG) in a PRISMA-compliant systematic review. Seven studies were eligible for further analysis. Additionally, one of our previously unreported cases was included in the analysis. Esophageal pouch approximation prior to primary repair was performed more frequently in the NG than in the HG (100% NG vs. 21% HG; = 0.003). There was no difference in the overall postoperative appearance of postoperative stricture (95% HG vs. 100% NG; = 0.64). The number of postoperative dilatations trended lower in the NG (mean 4.25 NG vs. 9.5 HG; = 0.051). In summary, magnetic compression anastomosis adds a new promising treatment option for patients with complex esophageal atresia. Prior approximation of pouches and a novel magnet design have the potential to lower the rate of stricture formation.
使用磁压缩技术在内镜下创建食管吻合术是一种用于食管闭锁修复的有趣方法，但已发表的使用现有可用设备的病例显示出不同的成功率。一个主要缺点是初次修复后会形成严重的、难以治疗的狭窄。为了解决现有设备的局限性，我们最近推出并报告了一种特殊设计的双辐射磁体的成功应用，该磁体具有新颖的几何形状和独特的组织压缩特性。本研究的目的是在一项符合PRISMA标准的系统评价中，将我们的新型设备（新型组，NG）与之前使用传统设备（传统组，HG）的报告结果进行比较。七项研究符合进一步分析的条件。此外，我们之前未报告的一个病例也纳入了分析。与HG组相比，NG组在初次修复前进行食管囊袋接近的频率更高（NG组为100%，HG组为21%；P = 0.003）。术后狭窄的总体外观无差异（HG组为95%，NG组为100%；P = 0.64）。NG组术后扩张次数有降低趋势（NG组平均为4.25次，HG组为9.5次；P = 0.051）。总之，磁压缩吻合术为复杂食管闭锁患者增加了一种有前景的新治疗选择。囊袋预先接近和新型磁体设计有可能降低狭窄形成率。
