Published online Nov 16, 2023. doi: 10.4253/wjge.v15.i11.658
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
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.
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.
This study aims to evaluate the safety and efficacy of MAT-assisted ESD in early GC.
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.
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).
MAT-ESD is safe and effective for early GC.
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.