Intestine – Endoscopic Submucosal Dissection of Early Gastric Cancer using Magnetic Anchor
Description:
We experienced endoscopic submucosal dissection using magnetic anchor for early gastric cancer.Endoscopic submucosal dissesection has been accepted as a superior treatment because it has many advantages, which are high en-bloc resection rate, low local recurrence rate and accurate histological staging. On the other hand, ESD has some disadvantage aspects. ESD is needs skillful endoscopic technique because it is one endoscope procedure.We have the experience tried about rubber band method and the other invasive devices.This study aims to evaluate the safety and efficacy of ESD using magnetic anchor for early gastric cancer.A magnetic anchor consists of three parts: magnetic weight, microforceps and connecting thread. The size of weight is 1.5 cm. It was designed to generate sufficient traction and to allow insertion into the gastric cavity through the esophagus.The magnetic control system was designed for clinical application in a standard endoscopic room. It consists of a 0.68 kOe/100 A extracorporeal electromagnet, at 10 cm from the center of the magnetic yoke.All patients were sedated by midazolam and pentazicine. All ESD procedure was begun using single-channel videogastroscope. And devise was needle knife and IT knife. The ethics committee approved this study and detailed written informed consent was obtained from all patients. This study was not financial supported.The case was 62 years old male.The early gastric cancer was located upper gastric body. Marking dots were placed approximately. After injection, mucosal cutting at the periphery of the marking dots was performed using IT knife. And submucosal layer under the lesion was dissected using same IT knife.We used magnetic anchor whenever endoscopists decided to need because of difficulty of dissection. Inside the gastric lumen, the magnetic weight was pushed out from the sheath, followed by microforceps. Considering the direction of the gravity, the tip of the mucosa was grasped on the proximal site from the gastroscope by the microforceps.In order to lift the tip of the mucosa, a magnetic force was generated according to increasing the electric current through the electromagnet of the magnetic control system.After lifting the tip of mucosa using magnetic anchor, dissection was restarted. Submucosal layer was recognized clearly.Swinging the patient's examining table controls the direction of the magnetic anchor for the most convenient position to extend the submucosal layer and pull the tissue.After endoscopic resection, both the resected tissue and the megnetic anchor were retrieved using a grasping forceps through endoscopic accessory cannel.This is the demographic information of enrolled 25 patients.There was no complication under the 30 minutes of exposure time to magnetic field. All magnetic anchors were safely retrieved.This showed the comparison between 25 ESD cases using magnetic anchor in this study and the size and location matched 337 cases. There were no statistical significant of the en bloc resection rate and the incidence of complications between both groups. However, the numbers of patients with the time of procedure more than 120 minutes were significantly fewer in the using magnetic anchor group.In conclusion, ESD using magnetic anchor is safe and useful for EGC of gastric body. The magnetic anchor system keeps possibility of minimum invasive endoscopic treatment like ESD and NOTES.
Contributed By:
Shinsuke Kiriyama, MD,
Intestine – Endoscopic Submucosal Dissection of Early Gastric Cancer using Magnetic Anchor
Tags: Health Medical Pharma, rubber band method, Shinsuke Kiriyama, single channel, gastric body, gastric cancer, proximal site
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