Basic Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 16, 2023; 15(10): 584-592
Published online Oct 16, 2023. doi: 10.4253/wjge.v15.i10.584
Magnetic anchor technique assisted endoscopic submucosal dissection for early esophageal cancer
Min Pan, Miao-Miao Zhang, Shu-Qin Xu, Yi Lyu, Xiao-Peng Yan
Min Pan, Miao-Miao Zhang, Shu-Qin Xu, Yi Lyu, Xiao-Peng Yan, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Min Pan, Department of Thoracic Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Miao-Miao Zhang, Shu-Qin Xu, Yi Lyu, Xiao-Peng Yan, National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Author contributions: Lyu Y and Yan XP conceived and designed the study; Pan M and Zhang MM performed the research and acquired the data; Xu SQ wrote the manuscript; Pan M and Zhang MM revised the manuscript; Lyu Y and Yan XP examined the final manuscript; and all authors read and approved the final manuscript.
Supported by the Key Research & Development Program-Social Development of Shaanxi Province of China, No. 2021SF-163; and the Innovation Capability Support Plan of Shaanxi Province of China, No. 2020KJXX-022.
Institutional animal care and use committee statement: All animal experiments conformed to the internationally accepted principles for the laboratory animal care committee of Xi’an Jiaotong University (approval NO. XJTULAC2019-1006) and were in accordance with the ethical standards for experimental animals of Xi’an Jiaotong University.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
ARRIVE guidelines statement: The authors have read the ARRIVE guidelines, and the manuscript was prepared and revised according to the ARRIVE guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Peng Yan, MD, PhD, Associate Research Scientist, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an 710061, Shaanxi Province, China. yanxiaopeng9966@163.com
Received: August 19, 2023
Peer-review started: August 19, 2023
First decision: August 31, 2023
Revised: September 12, 2023
Accepted: September 25, 2023
Article in press: September 25, 2023
Published online: October 16, 2023
Processing time: 53 Days and 14.8 Hours
Abstract
BACKGROUND

Esophageal cancer has high incidence globally and is often diagnosed at an advanced stage. With the widespread application of endoscopic technologies, the need for early detection and diagnosis of esophageal cancer has gradually been realized. Endoscopic submucosal dissection (ESD) has become the standard of care for managing early tumors of the esophagus, stomach, and colon. However, due to the steep learning curve, difficult operation, and technically demanding nature of the procedure, ESD has currently been committed to the development of various assistive technologies.

AIM

To explore the feasibility and applicability of magnetic anchor technique (MAT)-assisted ESD for early esophageal cancer.

METHODS

Isolated pig esophagi were used as the experimental model, and the magnetic anchor device was designed by us. The esophagi used were divided into two groups, namely the operational and control groups, and 10 endoscopists completed the procedure. The two groups were evaluated for the following aspects: The total operative time, perforation rate, rate of whole mucosal resection, diameter of the peering mucosa, and scores of endoscopists’ feelings with the procedure, including the convenience, mucosal surface exposure degree, and tissue tension. In addition, in the operational group, the soft tissue clip and the target magnet (TM) were connected by a thin wire through a small hole at the tail end of the TM. Under gastroscopic guidance, the soft tissue clip was clamped to the edge of the lesioned mucosa, which was marked in advance. By changing the position of the anchor magnet (AM) outside the esophagus, the pulling force and pulling direction of the TM could be changed, thus exposing the mucosal peeling surface and assisting the ESD.

RESULTS

Herein, each of the two groups comprised 10 isolated esophageal putative mucosal lesions. The diameter of the peering mucosa did not significantly differ between the two groups (2.13 ± 0.06 vs 2.15 ± 0.06, P = 0.882). The total operative time was shorter in the operational group than in the control group (17.04 ± 0.22 min vs 21.94 ± 0.23 min, P < 0.001). During the entire experiment, the TM remained firmly connected with the soft tissue clip and did not affect the opening, closing, and release of the soft tissue clip. The interaction between the TM and AM could provide sufficient tissue tension and completely expose the mucosa, which greatly assists the surgeon with the operation. There was no avulsion of the mucosa, and mucosal lesions were intact when peeled. Therefore, the scores of endoscopists’ feelings were higher in the operational group than in the control group in terms of the convenience (9.22 ± 0.19 vs 8.34 ± 0.15, P = 0.002), mucosal surface exposure degree (9.11 ± 0.15 vs 8.25 ± 0.12, P < 0.001), and tissue tension (9.35 ± 0.13 vs 8.02 ± 0.17, P < 0.001). The two groups did not significantly differ in the perforation rate and rate of whole mucosal resection.

CONCLUSION

We found MAT-assisted ESD safe and feasible for early esophageal cancer. It could greatly improve the endoscopic operation experience and showed good clinical application prospects.

Keywords: Magnetic surgery; Magnetic anchor technique; Magnetic anchor device; Endoscopic submucosal dissection; Early esophageal cancer

Core Tip: Esophageal cancer has high incidence globally and is often diagnosed at an advanced stage. Owing to the increased adaptation of endoscopic submucosal dissection (ESD), early diagnosis and treatment of esophageal cancer have improved. However, there are some limitations of ESD, such as a steep learning curve, longer surgical time, higher risk, and more complications. Magnetic anchor technique is a brand new ESD assistance technique with great potential in shortening the surgical time, improving endoscopists’ satisfaction, and providing sufficient tissue tension and perfect mucosal exposure, indicating that it has good prospects for clinical application.