Magnetic anchor-guided endoscopic submucosal dissection (MAG-ESD) using an extracorporeal
electromagnet was developed to provide excellent visualization and to facilitate complicated
ESD in patients with early gastric cancer (EGC), with its use being reported in several
studies over recent years [1]
[2]
[3]. Endoscopic submucosal tunnel dissection (ESTD) has been reported as a treatment
for the en bloc dissection of large early neoplastic lesions with higher dissection
speed and better radical cure rates than standard ESD [4]
[5]. This case report describes a new method, magnetic multidirectional anchor-guided
ESTD (MMAG-ESTD), for the treatment of large EGCs in human subjects.
A 54-year-old woman was referred to our hospital with a high grade intraepithelial
neoplasia extending from the gastric angle to the fundus. MMAG-ESTD was performed
using a gastroscope fitted with a soft transparent front cap. The magnetic anchor-guided
system consists of an interior magnet made of an Nd2Fe14B crystal, with a shell of
pure iron, and an internal device, which is a medical stainless steel column of 10 × 10 mm
([Fig. 1]).
Fig. 1 Photograph of the iron-shelled magnet, which is attached to a hemoclip with dental
floss.
After a partial mucosa cut was made transversely with a DualKnife, one magnetic anchor
consisting of an internal neodymium magnet with a hemoclip was attached to the proximal
mucosal edge of the lesion ([Fig. 2 a]). A submucosal tunnel was then created by submucosal dissection from the proximal
to the distal end. Unlike previous magnetic devices, this system requires no external
magnets, which makes the entire procedure simpler. The other two shells with hemoclips
were attached to the horizontal mucosal edge, which then attracted the internal magnet,
with adequate countertraction to create good visualization, thereby assisting the
submucosal dissection procedure ([Fig. 2 b]). The mucosal countertraction fully exposed the submucosal field of vision in three
directions. MMAG-ESTD was successful performed without adverse events ([Fig. 2 c]; [Video 1]).
Fig. 2 Endoscopic views showing: a after partial dissection, the mucosal edge with the magnetic anchor attached; b direct visualization of the submucosal layer that is achieved by traction via the
magnetic shells; c the large artificial ulcer left after magnetic multidirectional anchor-guided endoscopic
submucosal tunnel dissection.
Video 1 Magnetic multidirectional anchor-guided endoscopic submucosal tunnel dissection is
performed for a large gastric lesion.
By combining the advantages of both magnetic ESD and tunnel ESD, we hope that this
MMAG-ESTD system will facilitate difficult ESD procedures and enhance the field of
magnetic endoscopic surgery in future.
Endoscopy_UCTN_Code_TTT_1AO_2AG
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques
in gastroenterological endoscopy. All papers include a high
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