MAGNETIC ANCHOR-GUIDED ENDOSCOPIC SUBMUCOSAL DISSECTION USING A STAINLESS STEEL ANCHOR FOR GASTROINTESTINAL TUMORS

<p>Background & Aims: Endoscopic submucosal dissection (ESD) is associated with technical difficulty. The usefulness of magnetic anchor-guided (MAG) systems using neodymium magnets in difficult cases of ESD has been reported. However, problems of this procedure include the inability to deliver the magnetic anchor through the scope and sticking of the internal magnet on the endoscope. The aim of this study was to evaluate the feasibility of MAG systems using a stainless-steel anchor (SSA) for treatment of gastrointestinal tumors.</p><p>Methods: We examined 16 patients with a lesion in the stomach and 17 patients with a lesion in the colon who underwent MAG-ESD using SSA. The anchor consisted of a stainless steel bar attached to a hemoclip with 3-0 silk. After circumferential mucosal incision, the SSA was attached to the proximal mucosal edge of the lesion without retrieving and reinserting the endoscope. The external magnet was a handheld neodymium magnet, and was maneuvered around the abdominal surface to obtain adequate traction. The feasibility of MAG-ESD using SSA, en bloc resection rate, procedure time, rate of retrieval of SSA, and adverse events were evaluated.</p><p>Results: Sixteen patients (10 men, 6 women) had gastric lesions. Their median age was 70 years (range, 50-80 years), median tumor size was 22.5 mm (range, 12-55 mm), and median procedure time was 90 min (range, 27-205 min). Adequate counter traction was obtained in all cases. Seventeen patients (10 men, 7 women) had colonic lesions. Their median age was 73 years (range, 52-86 years). Adequate counter traction with good visualization was successfully obtained in 15 cases (88%). The median tumor size was 26.5 mm (range, 20-65 mm), and median procedure time was 90 min (range, 18-259 min). En bloc resection or complete en bloc resection was achieved in all cases, and the SSA was retrieved in all cases without adverse events.</p><p>Conclusions: MAG-ESD using SSA is feasible and safe, and may facilitate the treatment of all difficult lesions.</p>