{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T23:59:19Z","timestamp":1785542359891,"version":"3.56.0"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Klinikum der Universit\u00e4t M\u00fcnchen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>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\u00a0years, 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00464-025-12033-4","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T16:55:11Z","timestamp":1754585711000},"page":"6406-6412","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Esophageal magnetic compression anastomosis for esophageal atresia repair: when not to use magnets\u2014our experience"],"prefix":"10.1007","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3901-5409","authenticated-orcid":false,"given":"Anne-Sophie Bernadette","family":"Holler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline C.","family":"Kading","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Harrison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver J.","family":"Muensterer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,7]]},"reference":[{"issue":"9","key":"12033_CR1","doi-asserted-by":"publisher","first-page":"945","DOI":"10.1007\/s00247-009-1305-7","volume":"39","author":"M Zaritzky","year":"2009","unstructured":"Zaritzky M, Ben R, Zylberg GI, Yampolsky B (2009) Magnetic compression anastomosis as a nonsurgical treatment for esophageal atresia. Pediatr Radiol 39(9):945\u2013949. https:\/\/doi.org\/10.1007\/s00247-009-1305-7. (Epub 2009 Jun 9 PMID: 19506849)","journal-title":"Pediatr Radiol"},{"issue":"7","key":"12033_CR2","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1016\/j.jpedsurg.2013.11.002","volume":"49","author":"M Zaritzky","year":"2014","unstructured":"Zaritzky M, Ben R, Johnston K (2014) Magnetic gastrointestinal anastomosis in pediatric patients. J Pediatr Surg 49(7):1131\u20131137. https:\/\/doi.org\/10.1016\/j.jpedsurg.2013.11.002. (Epub 2013 Nov 7 PMID: 24952802)","journal-title":"J Pediatr Surg"},{"key":"12033_CR3","doi-asserted-by":"publisher","first-page":"1202","DOI":"10.1089\/lap.2019.0199","volume":"29","author":"BJ Slater","year":"2019","unstructured":"Slater BJ, Borobia P, Lovvorn HN, Raees MA, Bass KD, Almond S, Hoover JD, Kumar T, Zaritzky M (2019) Use of magnets as a minimally invasive approach for anastomosis in esophageal atresia: long-term outcomes. J Laparoendosc Adv Surg Tech 29:1202\u20131206","journal-title":"J Laparoendosc Adv Surg Tech"},{"key":"12033_CR4","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-049627","volume":"148","author":"OJ Muensterer","year":"2021","unstructured":"Muensterer OJ, Evans LL, Sterlin A, Sahlabadi M, Aribindi V, Lindner A, K\u00f6nig T, Harrison MR (2021) Novel device for endoluminal esophageal atresia repair: first-in-human experience. Pediatrics 148:e2020049627","journal-title":"Pediatrics"},{"issue":"3","key":"12033_CR5","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1016\/j.jpedsurg.2023.09.006","volume":"59","author":"WG Lee","year":"2024","unstructured":"Lee WG, Evans LL, Chen CS, Fuchs JR, Zamora IJ, Bruzoni M, Harrison MR, Muensterer OJ (2024) Lessons learned from the first-in-human compassionate use of connect-EA\u2122 in ten patients with esophageal atresia. J Pediatr Surg 59(3):437\u2013444. https:\/\/doi.org\/10.1016\/j.jpedsurg.2023.09.006. 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(Epub 2023 Dec 19 PMID: 38184432)","journal-title":"J Pediatr Surg"}],"container-title":["Surgical Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-025-12033-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00464-025-12033-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-025-12033-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T20:04:35Z","timestamp":1759781075000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00464-025-12033-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,7]]},"references-count":11,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["12033"],"URL":"https:\/\/doi.org\/10.1007\/s00464-025-12033-4","relation":{},"ISSN":["0930-2794","1432-2218"],"issn-type":[{"value":"0930-2794","type":"print"},{"value":"1432-2218","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,7]]},"assertion":[{"value":"22 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Michael R. Harrison is an inventor on patents covering elements of the device design and is an officer and shareholder of Myka Laboratories and Magnamosis, Inc. Oliver J. Muensterer owns stock options in Myka Laboratories. Anne-Sophie Holler and Jaqueline C. Kading have no conflicts of interest or financial ties to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}},{"value":"Ethics board approval was granted through our institutional review board (project number 24\u20130986).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}