Safety and Efficacy of Magnetic Compression Anastomosis for Treatment of Complete Benign Biliary Strictures: A Systematic Review and Meta-Analysis.

BACKGROUND AND AIMS: Completely obstructed benign biliary strictures (BBS) are difficult to treat. Magnetic compression anastomosis (MCA) has recently been used in such cases with reportedly low complication rates. This study aimed to evaluate the safety and efficacy of MCA in the management of complete benign biliary obstruction. METHODS: Multiple databases were searched to identify studies evaluating the safety and efficacy of MCA in complete BBS from inception to December 26, 2025. Outcomes of interest included technical success (recanalization), stricture recurrence, procedure-related adverse events, and cholangitis. Pooled estimates with 95% CIs were calculated using a Mantel-Haenszel random-effects model. Heterogeneity was assessed using the I2 statistic. RESULTS: Six studies comprising 182 patients met the inclusion criteria. The pooled technical success rate of MCA was 92.6% (95% CI: 87.5%-95.7%). The pooled stricture recurrence rate was 18.5% (95% CI: 10.7%-30.2%). The pooled rate of procedure-related adverse events was 7.6% (95% CI: 1.9%-25.9%), and the pooled rate of postprocedure cholangitis was 3.8% (95% CI: 1.5%-9.2%). CONCLUSION: This meta-analysis demonstrates that MCA is a safe and effective treatment for complete benign biliary strictures. MCA appears to be a highly effective and minimally invasive therapeutic option for refractory biliary strictures, achieving high technical success rates even in patients who have failed conventional interventions. However, the current evidence base is limited by small, nonrandomized studies. Larger, preferably randomized, studies are needed to define optimal clinical indications, standardize treatment protocols, and clarify MCA's role as a potential standard-of-care therapy.