Duodeno-ileal magnetic compression anastomoses in metabolic surgery: a systematic review and meta-analysis.

BACKGROUND

Sutureless duodeno-ileal magnetic compression anastomosis (DI-MCA) is a novel technology for metabolic and bariatric surgery, but pooled evidence on feasibility, safety, and early efficacy is lacking.

OBJECTIVES

To systematically review feasibility, safety, and early efficacy of DI-MCA across device classes and procedural contexts.

SETTING

International; prospective clinical studies.

METHODS

MEDLINE, EMBASE, CENTRAL, Web of Science, and ClinicalTrials.gov were searched to 31 March 2026. Eligible studies reported DI-MCA using linear (LMAS), biofragmentable (BMAS), self-forming (SNAP/SNAP-S), or immediately-patent (IMPA-DI) devices. Cohort overlap was resolved by investigator correspondence. Proportions were pooled with Freeman-Tukey transformation; continuous outcomes with REML and Hartung-Knapp correction. Bias: MINORS; certainty: Grading of Recommendations, Assessment, Development, and Evaluations.

RESULTS

Twelve prospective studies (220 enrolled, 218 implanted) met inclusion criteria; after de-duplication, 153 enrolled adults (151 implanted) were verified-unique. The pooled device-related leak rate was .0% (95% confidence interval [CI] .0-1.7), with zero 30-day mortality. Efficacy is reported descriptively by procedural context. Primary DI-MCA with concurrent sleeve gastrectomy: 6-month percent total weight loss (%TWL) 28.1% (n = 24, LMAS 1.9 cm) and 10.7% (n = 17, BMAS 4-5 cm), with 12-month data in 5 patients (%TWL 34.0%). Revisional solo DI-MCA: %TWL 5.4% at 6 months (n = 24) and 5.3% at 12 months (n = 23). Solo biofragmentable DI-MCA in mild obesity with type 2 diabetes: 12-month %TWL 8.7% (n = 8/15); HbA1c 8.2%→6.6%. Protein-energy malnutrition (9.3%, 5/54) was confined to the SNAP subset. Certainty of evidence was low to very low.

CONCLUSIONS

DI-MCA is feasible, with no device-related anastomotic leak and no 30-day mortality; early efficacy is device- and context-dependent. All available data are derived from small, industry-sponsored single-arm studies in highly selected patients at experienced investigational centers, and support feasibility and early safety rather than comparative effectiveness or generalizability to routine practice. Larger comparative studies with longer follow-up are needed; the SNAP malnutrition signal warrants prospective surveillance.