Background

Bariatric/Metabolic GI anastomoses have been made with staples and/or sutures, but have generated troublesome leaks, fistulas, bleeding and deaths. The study aim was to evaluate the effectiveness and safety of anastomosis using linear magnets to achieve weight loss and remission of type 2 diabetes (T2D).

Methods

Patients with severe obesity BMI ≥35 kg/m2 with or without T2D underwent duodeno-ileostomy (DI) diversion. A linear magnet was delivered by endoscopy 250 cm proximal to the ileocecal valve, and a second magnet was positioned in the first duodenum; the intestines containing the magnets were apposed to initiate incision-less compression. Laparoscopic assistance was used to obtain bowel measurements, prevent other tissue interposition, and close Petersen’s mesenteric defect.

Results

Ongoing from November 18, 2021 in four centres, 40 patients were enrolled and underwent magnetic compression DI, 24 had a sleeve+ DI, 16 had DI post sleeve. Mean weight (kg) and BMI (kg/m2) at baseline were 117.6±15.8 and 44.4±4.9; at 6 months, 85.8±5.9 and 31.9±3.3. Total weight loss of 31.8±9.5 and BMI reduction of 12.5±3.3 corresponded to 62.0% EWL (range 55.0-77.0%). Mean HbA1C (%) dropped from 6.82±1.76 to 4.74+0.61 at 6 months; glucose (mg/ dL), from 134.3±40.0 to 85.64±12.37 (mean reduction, 48.7±44.7). No anastomotic bleeding or leakage at the magnetic DI was observed. Most had mild adverse events. Serious adverse events encountered: Choledocholithiasis, bowel occlusion, pelvic collections and sleeve fistula/hematoma, related to staples/sutures.

Conclusions

Side-to-side magnetic DI in adults with severe obesity appeared to be safe, achieved dramatic weight loss, and ameliorated T2D in the short term.