BACKGROUND: Minimally invasive surgery may be further advanced with the novel biofragmentable magnetic anastomosis compression system. Two magnets may be swallowed, or placed by flexible endoscopy, in a side-to-side magnetic jejuno-ileostomy (MagJI) bipartition for weight and type 2 diabetes (T2D) reduction. MagJI markedly reduces the major complications of enterotomy, stapling/suturing, and retained foreign materials. METHODS: This was a prospective first-in-human investigation of feasibility, safety, and preliminary efficacy in adults with body mass index (BMI, kg/m2) ≥ 30.0- ≤ 40.0. After serial introduction via swallowing or endoscopy, linear magnets were laparoscopically guided to the distal ileum and proximal jejunum where they were aligned. Magnets fused over 7-21 days forming jejuno-ileostomy. PRIMARY ENDPOINTS: feasibility and severe adverse event (SAEs) incidence (Clavien-Dindo grade); secondary endpoints: weight, T2D reduction. RESULTS: Between 3-1 - 2024 and 6-30 - 2024, nine patients (mean BMI 37.3 ± 1.1) with T2D (all on T2D medications; mean HbA1C 7.1 ± 0.2%, glucose 144.8 ± 14.3 mg/dL) underwent MagJI. Mean procedure time: both magnets swallowed, 86.7 ± 6.3 min; one magnet swallowed with second delivered endoscopically, 113.3 ± 17.0 min. Ninety-day feasibility confirmed in 100.0%: 0.0% bleeding, leakage, infection, mortality. Most AEs grade I-II; no SAEs. At 6-month radiologic confirmation, all anastomoses were patent. Excess weight loss 17.5 ± 2.8 kg; mean BMI reduction 2.2 ± 0.3, HbA1C 6.1 ± 0.1% (p < 0.01), glucose 115.5 ± 6.5 mg/dL (p = 0.19); 83.0% dropped below 6.5% HbA1C and had markedly reduced anti-T2D medications. CONCLUSIONS: The swallowable, biofragmentable magnetic anastomosis system appeared to be feasible and safe in achieving incisionless, sutureless jejuno-ileostomy. The first-in-human MagJI procedure may offer minimally complicated anastomosis creation and moderate MBS weight loss and T2D reduction.

Charles University Prague Czech Republic

Hôpital du Sacré Cœur de Montréal Montreal Canada

Institute of Clinical and Experimental Medicine Prague Czech Republic

OB Klinika Prague Czech Republic

Westmount Square Surgical Center Westmount Canada

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Centers for Disease Control and Prevention. Adult obesity facts. Fact Sheet 2022. https://www.cdc.gov/obesity/data/adult.html#print.

Eurostat. Overweight and Obesity - BMI Statistics 2021. https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Overweight_and_obesity_-_BMI_statistics#Obesity_by_age_group

Carlsson LMS, Carlsson B, Jacobson P, et al. Association between delay in diabetes development and mortality in people with obesity: up to 33 years follow-up of the prospective Swedish Obese Subjects study. Diabetes Obes Metab. 2025;27(1):238–46. 10.1111/dom.16010. PubMed PMC

Gasoyan H, Tajeu G, Halpern MT, Sarwer DB. Reasons for underutilization of bariatric surgery: the role of insurance benefit design. Surg Obes Relat Dis. 2019;15(1):146–51. 10.1016/j.soard.2018.10.005. PubMed PMC

Murtha JA, Alagoz E, Breuer CR, et al. Individual-level barriers to bariatric surgery from patient and provider perspectives: a qualitative study. Am J Surg. 2021;224(1 Pt B):429–36. 10.1016/j.amjsurg.2021.12.022. PubMed PMC

Arterburn DE, Telem DA, Kushner RF, et al. Benefits and risks of bariatric surgery in adults. JAMA. 2020;324(9):879. 10.1001/jama.2020.12567. PubMed

Eisenberg D, Shikora SA, Aarts E, et al. American society for metabolic and bariatric surgery (ASMBS) and international federation for the surgery of obesity and metabolic disorders (IFSO): indications for metabolic and bariatric surgery. Surg Obes Relat Dis. 2022;18(12):1345–56. 10.1016/j.soard.2022.08.013. PubMed

Schauer PR, Bhatt DL, Kirwan JP, et al. STAMPEDE Investigators Bariatric surgery versus intensive medical therapy for diabetes — 5-year outcomes. N Engl J Med. 2017;376(7):641–51. 10.1056/NEJMoa1600869. PubMed PMC

Kirwan JP, Courcoulas AP, Cummings DE, et al. Diabetes remission in the alliance of randomized trials of medicine versus metabolic surgery in type 2 diabetes (ARMMS-T2D). Diabetes Care. 2022;45(7):1574–83. 10.2337/dc21-2441. PubMed PMC

Yang Y, Miao C, Wang Y, He J. The long-term effect of bariatric/metabolic surgery versus pharmacologic therapy in type 2 diabetes mellitus patients: a systematic review and meta-analysis. Diabetes Metab Res Rev. 2024;40(5):e3830. 10.1002/dmrr.3830. PubMed

Jamshidi R, Stephenson JT, Clay JG, et al. Magnamosis: magnetic compression anastomosis with comparison to suture and staple techniques. J Pediatr Surg. 2009;44(1):222–8. 10.1016/j.jpedsurg.2008.10.044. PubMed

Evans LL, Lee WG, Karimzada M, et al. Evaluation of a magnetic compression anastomosis for jejunoileal partial diversion in Rhesus macaques. Obes Surg. 2024;34:515–23. 10.1007/s11695-023-07012-4. PubMed PMC

Gagner M, Krinke T, LaPointe-Gagner M, Buchwald JN. Side-to-side duodeno-ileal magnetic compression anastomosis: design and feasibility of a novel device in a porcine model. Surg Endosc. 2023;37(8):6197–207. 10.1007/s00464-023-10105-x. PubMed

Gagner M, Abuladze D, Koiava L, et al. First-in-human side-to-side magnetic compression duodeno-ileostomy with the Magnet Anastomosis System. Obes Surg. 2023;33(8):2282–92. 10.1007/s11695-023-06708-x. PubMed PMC

Gagner M, Cadiere GB, Sanchez-Pernaute A, et al. Side-to-side magnet anastomosis system duodeno-ileostomy with sleeve gastrectomy: early multi-center results. Surg Endosc. 2023;37(8):6452–63. 10.1007/s00464-023-10134-6. PubMed PMC

Gagner M, Almutlaq L, Cadiere GB, et al. Side-to-side magnetic duodeno-ileostomy in adults with severe obesity with or without type 2 diabetes: early outcomes with prior or concurrent sleeve gastrectomy. Surg Obes Relat Dis. 2024;20(4):341–52. 10.1016/j.soard.2023.10.018. PubMed

Cadière GB, Poras M, Maréchal MT, et al. Sleeve gastrectomy with duodenoileal bipartition using linear magnets: feasibility and safety at 1-year follow-up. J Gastrointest Surg. 2024;28(5):640–50. 10.1016/j.gassur.2024.02.001. PubMed

Gagner M, Almutlaq L, Gnanhoue G, et al. Magnetic single-anastomosis side-to-side duodeno-ileostomy for revision of sleeve gastrectomy in adults with severe obesity: 1-year outcomes. World J Surg. 2024;48(10):2337–48. 10.1002/wjs.12304. PubMed

Dziakova J, Torres A, Odovic M, et al. Spanish experience with latero-lateral duodeno-ileostomy + sleeve gastrectomy with Magnet Anastomosis System. Obes Surg. 2024;34(9):3569–75. 10.1007/s11695-024-07432-w. PubMed

Fried M, Dolezalova K, Chambers AP, et al. A novel approach to glycemic control in type 2 diabetes mellitus, partial jejunal diversion: pre-clinical to clinical pathway. BMJ Open Diabetes Res Care. 2017;5(1):e000431. 10.1136/bmjdrc-2017-000431. PubMed PMC

Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96. 10.1097/SLA.0b013e3181b13ca2. PubMed

American Diabetes Association. Standards of care in diabetes-2023 abridged for primary care providers. Clin Diabetes 2022 Winter;41(1):4–31. 10.2337/cd23-as01. Erratum in: Clin Diabetes 2023 Spring;41(2):328. 10.2337/cd23-as01 PubMed PMC

Gagner M, Abuladze L, Buchwald JN, Almutlaq L. First-in-human side-to-side duodeno-ileal bipartition for weight loss and type 2 diabetes with the swallowable biofragmentable magnetic anastomosis system. J Am Coll Surg 2025; in press. PubMed