Published online Oct 16, 2023. doi: 10.4253/wjge.v15.i10.584
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
Esophageal cancer has high incidence and poor prognosis globally. Endoscopic submucosal dissection (ESD) has become the standard therapy for managing early tumors of the esophagus, stomach, and colon. However, there are some deficiencies, such as a steep learning curve, difficult operation, and technically demanding nature of the procedure. Magnetic anchor technique (MAT) is a brand new ESD assistance technique to improve the procedure of ESD.
Although ESD has become the golden treatment for early esophageal cancer, some limitations such as a steep learning curve and plenty of complications can still significantly improve. It already had some assisted techniques, which had trouble in controlling and maintaining tissue tension. The magnetic anchor device designed by our own is aspired to solve the problems mentioned above.
This study aims to testify the feasibility and safety of MAT-assisted ESD for early esophageal cancer.
The experimental model used in this study was isolated pig esophagi, and the magnetic anchor device was designed by us, consisting of three parts: Target magnet (TM), anchor target (AM) and soft tissue clip. It was divided into two groups, namely the operational and control groups, and 10 endoscopists completed the procedure. In the operational group, the soft tissue clip together with the TM was connected by a thin wire through a small hole at the tail end of the TM, and was clamped to the edge of the lesioned mucosa, which was marked in advance. By changing the position of the 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. The two groups were evaluated for the following aspects by SPSS: 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.
The two groups did not significantly differ in the diameter of the peering mucosa, perforation rate and rate of whole mucosal resection. In the operational group, 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 assisted the endoscopists’ feelings with the operation, which 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). In addition, the total operative time was shorter in the operational group than in the control group.
The MAT-assisted ESD was safe and feasible for early esophageal cancer.
With the development of further internal animal experiments and the accumulation of operational experience, this technique has broad clinical application prospects.