Holler Anne-Sophie Bernadette, Kading Jacqueline C, Harrison Michael R, Muensterer Oliver J
Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Lindwurmstr. 4, 80337, Munich, Germany.
Neonatology, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
Surg Endosc. 2025 Aug 7. doi: 10.1007/s00464-025-12033-4.
Esophageal magnetic compression anastomosis (EMCA) represents an innovative minimally invasive approach for establishing esophageal continuity for patients with esophageal atresia, especially when comorbidities increase the risk of a thoracoscopic or open operation. Over the last 5 years, we have demonstrated favorable outcomes in our patients, but have also encountered cases in which EMCA was not successful. This report is an in-depth analysis of the failed EMCA attempts.
A retrospective chart review of all patients who were scheduled for EMCA was performed. All patients who failed magnet placement and underwent conventional repair instead were identified and presented as case series. Patient characteristics, intra- and postoperative data, reasons for failure, and follow-up data were analyzed.
From 2021 through 2024, EMCA was attempted in a total of 15 patients by our team on an intention-to-treat basis under compassionate care ethics. Placement of the magnets failed in 3 patients (20%). Every case showed specific characteristics that prohibited magnet coupling. In case 1, metal clips that had been placed during a prior lengthening procedure precluded mating of the magnets. In case 2, an atretic lower pouch was present and therefore the magnet could not be advanced toward the proximal end of the distal pouch. In the third case, an atypical bronchus was interposed between the two esophageal pouches, resulting in distance and tissue between the upper and lower pouch.
EMCA is a minimally invasive approach for endoscopic esophageal anastomosis creation in complex cases of esophageal atresia, or patients with comorbidities that confer a very high surgical risk. Careful patient selection and preparation is crucial to maximize the chance of success. Based on our current experience and case series, we propose certain anatomic variants and pre-existing factors as contraindications for EMCA.
食管磁压缩吻合术（EMCA）是一种创新的微创方法，用于为食管闭锁患者建立食管连续性，尤其是当合并症增加胸腔镜或开放手术风险时。在过去5年中，我们已在患者中取得了良好的治疗效果，但也遇到了EMCA未成功的病例。本报告是对EMCA失败尝试的深入分析。
对所有计划进行EMCA的患者进行回顾性病历审查。确定所有磁体放置失败并转而接受传统修复的患者，并将其作为病例系列呈现。分析患者特征、术中和术后数据、失败原因及随访数据。
2021年至2024年，我们团队在同情护理伦理下，基于意向性治疗原则，共对15例患者尝试了EMCA。3例患者（20%）磁体放置失败。每例均表现出阻止磁体耦合的特定特征。病例1中，先前延长手术中放置的金属夹妨碍了磁体配对。病例2中，存在闭锁的下袋，因此磁体无法向远侧袋的近端推进。在第三例中，两个食管袋之间有一个非典型支气管，导致上下袋之间存在距离和组织。
EMCA是一种微创方法，用于在复杂食管闭锁病例或手术风险非常高的合并症患者中进行内镜下食管吻合术。仔细的患者选择和准备对于最大化成功机会至关重要。基于我们目前的经验和病例系列，我们提出某些解剖变异和既往因素作为EMCA的禁忌证。
