Published online Apr 28, 2017. doi: 10.3748/wjg.v23.i16.2883
Peer-review started: January 19, 2017
First decision: February 10, 2017
Revised: February 24, 2017
Accepted: March 15, 2017
Article in press: March 15, 2017
Published online: April 28, 2017
Endoscopic submucosal dissection (ESD) is a well-established, minimally invasive treatment for superficial neoplasms of the gastrointestinal tract. The universal adoption of ESD has been limited by its slow learning curve, long procedure times, and high risk of complications. One technical challenge is the lack of a second hand that can provide traction, as in conventional surgery. Reliable tissue retraction that exposes the submucosal plane of dissection would allow for safer and more efficient dissection. Magnetic anchor guided endoscopic submucosal dissection (MAG-ESD) has potential benefits compared to other current traction methods. MAG-ESD offers dynamic tissue retraction independent of the endoscope mimicking a surgeon’s “second hand”. Two types of magnets can be used: electromagnets and permanent magnets. In this article we review the MAG-ESD technology, published work and studies of magnets in ESD. We also review the use of magnetic anchor guidance systems in natural orifice transluminal endoscopic surgery and the idea of magnetic non-contact retraction using surface ferromagentization. We discuss the current limitations, the future potential of MAG-ESD and the developments needed for adoption of this technology.
Core tip: Magnetic anchor guided endoscopic submucosal dissection (MAG-ESD) is a promising technology that can offer tissue retraction independent of the endoscope which acts like an endoscopist’s “second hand”. The objective of this article is to present a scientific review of the technology, published work, limitations, and future potential of MAG-ESD.