Simplified magnetic anchor-guided endoscopic submucosal dissection: an ex vivo porcine model

Abstract

Introduction and aimsEndoscopic submucosal dissection (ESD) is a well-established treatment for superficial gastrointestinal tumors and enables en bloc resection. Adequate tissue tension is important for safe and effective dissection. Simplified magnetic anchor-guided ESD (MAG-ESD) with a neodymium magnet has potential benefits, compared with other current traction methods. We evaluated the feasibility of simplified MAG-ESD in an ex vivo porcine model. Materials and methodsAn experimental study was conducted, utilizing the standard ESD technique. An external magnet and an internal magnet, both neodymium magnets, were used for the magnetic anchoring. The internal magnet was attached to an arm of a hemoclip with a 2-0 silk suture. After the incision, the clip with the internal magnet was placed at the edge of the lesion. The external magnet was maneuvered around the surface to apply adequate tension. ResultsA total of 15 en bloc ESDs (5 with no magnetic anchoring and 10 with magnetic anchoring) were carried out. Traction and dissection were feasible in all cases and the procedures were completed in fewer than 90min. Lesion size ranged from 15 to 50mm (mean 30mm). Two cases in the group with magnetic anchoring presented with punctate perforation (13.3%). ConclusionsOur study demonstrated the feasibility of simplified MAG-ESD and en bloc resection in an ex vivo porcine model.