Basic Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Nov 16, 2023; 15(11): 658-665
Published online Nov 16, 2023. doi: 10.4253/wjge.v15.i11.658
Animal experimental study on magnetic anchor technique-assisted endoscopic submucosal dissection of early gastric cancer
Min Pan, Miao-Miao Zhang, Lin Zhao, Yi Lyu, Xiao-Peng Yan
Min Pan, Miao-Miao Zhang, Lin Zhao, 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, 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
Lin Zhao, Zonglian College, 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; Zhao L wrote the manuscript; Pan M and Zhang MM revised the manuscript; Lyu Y and Yan XP examined the final manuscript; 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 review board statement: The study was reviewed and approved by the laboratory animal care committee of Xi’an Jiaotong University.
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 was in accordance with the ethical standards for experimental animals of Xi’an Jiaotong University.
Conflict-of-interest statement: All authors have nothing to disclose.
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, Assistant Professor, Associate Research Scientist, Chief Doctor, 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 12, 2023
Peer-review started: August 12, 2023
First decision: October 8, 2023
Revised: October 16, 2023
Accepted: October 26, 2023
Article in press: October 26, 2023
Published online: November 16, 2023
Processing time: 89 Days and 17.1 Hours
ARTICLE HIGHLIGHTS
Research background

Gastric cancer (GC) has high morbidity and mortality, which are already in the advanced stages when diagnosed, resulting in poor prognosis and a low survival rate. Endoscopic submucosal dissection (ESD) has become the main surgical method for early GC, improving the detection and therapy of GC. However, endoscopists are limited by some deficiencies of ESD, such as the steep learning curve and high technical skill requirements. Therefore, an assistant technique, the magnetic anchor technique (MAT), has been invented to improve the procedure of ESD.

Research motivation

ESD has become the standard therapy for early GC, but it still has the space for improvement. There are some assisted techniques, such as the clip-with-line method, pulley method, sheath traction method, and external forceps method, improving the endoscopists’ feeling of operation. However, recent assisted techniques also have trouble controlling and maintaining tissue tension. Our own designed assisted technique, MAT, are objective to solve the mentioned problems above.

Research objectives

This study aims to evaluate the safety and efficacy of MAT-assisted ESD in early GC.

Research methods

This was an ex vivo animal experiment. The experimental models were the isolated stomachs of pigs, which were divided into two groups, namely the study group (n = 6) with MAT-assisted ESD and the control group (n = 6) with traditional ESD. The magnetic anchor device for assisting ESD in the study group comprised three parts, an anchor magnet (AM), a target magnet (TM), and a soft tissue clip. The soft tissue clip and the TM, which were connected by a thin wire through the TM tail structure, were delivered to the pre-marked mucosal lesion through the gastroscopic operating hole under gastroscopic guidance. Then, the soft tissue clip was released by manipulating the operating handle of the soft tissue clip in a way that the soft tissue clip and the TM were fixed to the lesion mucosa. In vitro, ESD is aided by maneuvering the AM such that the mucosal dissection surface is exposed. Finally, Comparing the total surgical time, incidence of surgical complications, complete mucosal resection rate, specimen size, and the scores of endoscopist’s satisfaction with the procedure reflected their feelings about convenience during the surgical procedure between the two groups.

Research results

All operations were successfully completed. The total surgical time was shorter in the study group than in the control group (26.57 ± 0.19 vs 29.97 ± 0.28, P < 0.001), and during the operation in the study group, and there were no significant differences in the incidence of surgical complications (100% vs 83.3%), complete mucosal resection rate (100% vs 66.7%, P = 0.439), and specimen size (2.44 ± 0.04 cm vs 2.49 ± 0.02, P = 0.328) between the two groups. In the study group, there was no detachment of the soft tissue clip and TM and no mucosal tearing. The magnetic force between the AM and TM provided good mucosal exposure and sufficient tissue tension for ESD. Therefore, the scores of endoscopist’s satisfaction with the procedure were higher in the study group than in the control group (9.53 ± 0.10 vs 8.00 ± 0.22, P < 0.001).

Research conclusions

MAT-ESD is safe and effective for early GC.

Research perspectives

This ex vivo experiment provides a rudimentary for subsequent internal animal experiments and clinical research. With the accumulation of operational experience, this technique has broad clinical prospects.