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An internal magnet traction device reduces procedure time for endoscopic submucosal dissection by expert and non-expert endoscopists: ex vivo study in a porcine colorectal model (with video)

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Abstract

Background

Efficacy of an internal magnet traction device (MTD) for gastric endoscopic submucosal dissection (ESD) by an expert endoscopist has been reported. We hypothesized that use of the MTD would enhance the performance of colorectal ESD in a non-expert endoscopist in ESD compared to the conventional technique. Primary aim of this study was to compare procedure times between conventional ESD (C-ESD) and MTD-assisted ESD (MTD-ESD) by expert and non-expert endoscopists in ESD. Secondary aims included rate of en bloc resection, iatrogenic injury, visualization score of the submucosal layer, and endoscopist satisfaction score.

Methods

A total of 56 lesions were created in an ex vivo porcine colorectum. Two endoscopists completed C-ESD (n = 28) and MTD-ESD (n = 28). Lesions measured 3 cm in diameter and were located on either the anterior or posterior colorectal wall. The MTD consisted of a small neodymium magnet and nylon monofilament attached to a through-the-scope clip. The first MTD was deployed on the opposing colorectal wall of the target lesion and a second MTD was then deployed directly onto the distal margin of the lesion.

Results

Total procedure time for MTD-ESD was significantly shorter than C-ESD for both expert (median: 15.8 vs. 19.3 min, p < 0.05) and non-expert (median: 21.3 vs. 33.9 min, p < 0.001) endoscopists. All lesions were resected en bloc. There was no iatrogenic muscularis propria injury in the MTD-ESD group. For both the expert and non-expert, scores for MTD-ESD were significantly higher for submucosal layer visualization (p < 0.05) and endoscopist satisfaction (p < 0.001) compared to C-ESD.

Conclusions

Use of the MTD significantly reduced procedure time for both expert and non-expert endoscopists performing ESD. Improving the efficiency, safety, and satisfaction of ESD with such a device particularly for non-expert endoscopists is appealing and could potentially minimize the complexity and duration of the procedure allowing for more widespread use of the technique.

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Abbreviations

EMR:

Endoscopic mucosal dissection

ESD:

Endoscopic submucosal resection

MTD:

Magnet traction device

C-ESD:

Conventional ESD

MTD-ESD:

Magnet traction device-assisted endoscopic submucosal dissection

TTS:

Through-the-scope

MAG:

Magnetic anchor-guided

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Funding

Small Grant Award 2018, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.

Author information

The endoscopic procedure and manuscript writing: AD. Endoscopic procedure and manuscript review: ACS. Preparation for ex vivo experiment: JLD, CAM, CJT. Data analysis and manuscript review: ER, LMWKS, CJG.

Correspondence to Elizabeth Rajan.

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Disclosures

Akira Dobashi and Elizabeth Rajan have intellectual property with Medtronic related to the magnet traction device. Christopher Gostout is Chief Medical Officer for Apollo Endosurgery and a consultant for Olympus Medical Systems. Andrew Storm, Louis M. Wong Kee Song, Jodie Deters, Charles Miller, Crystal Tholen have no conflicts of interest or financial ties to disclose.

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Dobashi, A., Storm, A.C., Wong Kee Song, L.M. et al. An internal magnet traction device reduces procedure time for endoscopic submucosal dissection by expert and non-expert endoscopists: ex vivo study in a porcine colorectal model (with video). Surg Endosc 33, 2696–2703 (2019). https://doi.org/10.1007/s00464-019-06817-8

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Keywords

  • Endoscopic submucosal dissection
  • Traction
  • Magnet
  • Colon
  • Porcine