Update Course Rewind: Magnet Therapy for Esophageal Atresia

The Flourish device is an FDA approved commercially available catheter-based magnet system for esophageal atresia.

Magnets placed in the proximal and distal ends of the esophagus attract one another and cause the esophagus to lengthen, then compression anastomosis happens as a result of ischemia in the tissue at the two ends.

The Flourish device has both oesophageal and gastric catheters with inner bullet-shaped magnets on each end that taper down to a 10 French pumling surface.

The proximal catheter has a suction port that can be used to suction saliva from the patient while being used.

For magnet therapy eligibility, there needs to be a gap length of less than 4 centimeters because at lengths greater than that the magnets will not attract one another.

There should be no fistula for magnet therapy, or if there is a fistula it must be repaired first.

Patients require a gastrostomy that can accommodate an 18 French catheter because that is the diameter of the gastric portion of the catheter.

Magnet therapy is not to replace esophageal atresia repair, it is another tool in the armamentarium particularly for patients who have cardiac disease or have had previous operations that might make them less of a candidate for reoperative surgery or at increased anesthetic risk.

In the presented case, after magnet placement the patient had an acute decompensation 4 days later and was transferred to another institution.

The case revealed an upper pouch fistula which had not previously been diagnosed, and when scoped it was determined to be a true upper pouch fistula rather than traumatic.

Dr. Rothenberg ligates all upper pouch fistulas and H-type fistulas thoracoscopically because the view is excellent and provides good control.

In the complication case, after fistula repair the surgeon was able to mobilize the two ends together and achieve primary anastomosis.

The patient developed a stricture post-operatively which is being dilated about once a month.

By classification of the International esophageal atresia Group, a gap must be at least 4 centimeters to be considered a long gap.

The indications for the magnet require a gap of less than 4 centimeters, and there is an incredibly high stricture rate with multiple strictures.

A patient with less than a 4 centimeter gap should be amenable to a primary anastomosis.

Magnets have been used sometimes for a staged repair rather than using internal traction sutures.

There is a possibility of trying to get the two ends together closer surgically and then using a magnet just for the anastomosis portion.