S193 The Efficacy and Safety of Magnetic Compression Anastomosis in the Management of Biliary Obstruction: A Systematic Review and Meta-Analysis

Introduction: Biliary obstruction can lead to significant clinical complications, including jaundice, cholangitis, and malabsorption. While endoscopic retrograde cholangiopancreatography and percutaneous transhepatic biliary drainage are effective first-line treatments, they often fail in cases of complete ductal occlusion. Magnetic compression anastomosis (MCA) has emerged as a minimally invasive alternative for recanalizing obstructed ducts. This meta-analysis aims to evaluate MCA’s efficacy, complication rates, and clinical utility across diverse patient populations. Methods: A comprehensive search of observational studies was conducted, with inclusion criteria focusing on studies evaluating MCA in biliary strictures. Technical success, recurrence rates, adverse events, procedural time, and time to recanalization were extracted and analyzed. A random-effects model was used for meta-analysis, with subgroup analyses to evaluate outcomes for first line vs salvage MCA. Sensitivity analyses were performed to assess the impact of study design and publication bias. Results: Twenty-four studies with 403 biliary strictures were included. MCA demonstrated a high overall technical success rate (91.7%), with first-line use showing slightly higher success (95.9%) than salvage MCA. Procedural time and time to recanalization were comparable across subgroups. Complication rates, including cholangitis (7.4%), were low, and recurrence rates were higher for salvage MCA (13%) compared to first-line use (6.8%), though not statistically significant. Conclusion: MCA is a highly effective, minimally invasive option for refractory biliary strictures, offering high technical success rates even after failed conventional therapies. However, heterogeneity among studies and a lack of randomized controlled trials limit definitive conclusions. Standardized protocols and prospective studies are needed to further refine MCA’s clinical applications and establish its role as a standard therapy.