Long-term follow-up results after the recanalization of completely obstructed benign biliary strictures using magnetic compression anastomosis

Abstract

Background Benign biliary stricture (BBS) often responds to conventional nonsurgical approaches but remains challenging if obstruction is complete. Magnetic compression anastomosis (MCA) has emerged as a nonsurgical alternative. Methods MCA was performed in patients with completely obstructed BBS unresponsive to endoscopic or percutaneous techniques. One magnet was inserted through a percutaneous transhepatic biliary drainage pathway, while the other was advanced through an alternative route. After magnet approximation and recanalization, an internal catheter or fully covered self-expandable metal stent (FCSEMS) was placed across the newly formed tract for about 6 months. Patients were followed for a median of 75.2 months to assess complications and BBS recurrence. Results Of 113 patients who underwent MCA, technical success was achieved in 106 (93.8%) and clinical success in 105 (92.9%). One patient developed mild MCA-related cholangitis, which improved with conservative management. No MCA-related mortality or other major complications occurred. During follow-up, 14.3% had recurrence at a median of 23.7 months (range 3.3-64.9) after catheter or stent removal. No patients required surgical intervention during the study period. All recurrences were treated with repeat MCA or FCSEMS placement. Conclusion MCA was an effective nonsurgical treatment option for patients with completely occluded BBS refractory to standard interventions, and demonstrated a low recurrence rate in long-term follow-up.