Title: Endoscopic gastrointestinal bypass anastomosis using deformable self-assembled
magnetic anastomosis rings (DSAMARs) in a pig model
Version: 1 Date: 12 Nov 2023
Reviewer:  Pieter Hindryckx
Reviewer's report:
This is a very interesting preclinical proof-of-concept study demonstrating feasibility of
gastroenterostomy creation using 2 series of endoscopically/fluoroscopically placed magnets.
I have a few questions that I would like to have addressed by the authors
1) The procedural time seems to be quite long to me (longer than EUS-guided gastroenterostomy
with LAMS). Can the authors elaborate on this in the discussion: what are the most difficult and
time-consuming steps?
2) Based on the endoscopic picture and what I would expect, the created anastomosis looks
inflammatory and hence, you can expect an early stenosis after the magnets migrate. Do the
authors have any longer term data on the patency of the gastroenterostomy over time?
3) In some patients with malignant gastric outlet obstruction the stenosis can be very tight and
pinpoint. Do the authors expect any difficulty in passing the magnets through a tight and hard
stenosis only supported by a guidewire?
4) The mass of magnets that falls of after anastomosis creation is probably considerable (2x10
magnets all fixed to each other). I'm a bit afraid of the risk for downstream obstruction caused
by the magnets. Can the authors comment on this?
Title: Endoscopic gastrointestinal bypass anastomosis using deformable self-assembled
magnetic anastomosis rings (DSAMARs) in a pig model
Version: 1 Date: 12 Nov 2023
Reviewer:  Pieter Hindryckx
Reviewer's report:
This is a very interesting preclinical proof-of-concept study demonstrating feasibility of
gastroenterostomy creation using 2 series of endoscopically/fluoroscopically placed magnets.
I have a few questions that I would like to have addressed by the authors
1) The procedural time seems to be quite long to me (longer than EUS-guided gastroenterostomy
with LAMS). Can the authors elaborate on this in the discussion: what are the most difficult and
time-consuming steps?
2) Based on the endoscopic picture and what I would expect, the created anastomosis looks
inflammatory and hence, you can expect an early stenosis after the magnets migrate. Do the
authors have any longer term data on the patency of the gastroenterostomy over time?
3) In some patients with malignant gastric outlet obstruction the stenosis can be very tight and
pinpoint. Do the authors expect any difficulty in passing the magnets through a tight and hard
stenosis only supported by a guidewire?
4) The mass of magnets that falls of after anastomosis creation is probably considerable (2x10
magnets all fixed to each other). I'm a bit afraid of the risk for downstream obstruction caused
by the magnets. Can the authors comment on this?
Please review this paper.
user
Title: Endoscopic gastrointestinal bypass anastomosis using deformable self-assembled
magnetic anastomosis rings (DSAMARs) in a pig model
Version: 1 Date: 12 Nov 2023
Reviewer:  Pieter Hindryckx
Reviewer's report:
This is a very interesting preclinical proof-of-concept study demonstrating feasibility of
gastroenterostomy creation using 2 series of endoscopically/fluoroscopically placed magnets.
I have a few questions that I would like to have addressed by the authors
1) The procedural time seems to be quite long to me (longer than EUS-guided gastroenterostomy
with LAMS). Can the authors elaborate on this in the discussion: what are the most difficult and
time-consuming steps?
2) Based on the endoscopic picture and what I would expect, the created anastomosis looks
inflammatory and hence, you can expect an early stenosis after the magnets migrate. Do the
authors have any longer term data on the patency of the gastroenterostomy over time?
3) In some patients with malignant gastric outlet obstruction the stenosis can be very tight and
pinpoint. Do the authors expect any difficulty in passing the magnets through a tight and hard
stenosis only supported by a guidewire?
4) The mass of magnets that falls of after anastomosis creation is probably considerable (2x10
magnets all fixed to each other). I'm a bit afraid of the risk for downstream obstruction caused
by the magnets. Can the authors comment on this?
assistant