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Efficacy and safety of an internal magnet traction device for endoscopic submucosal dissection: ex vivo study in a porcine model (with video)

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Abstract

Background

Appropriate traction allows for safer and easier endoscopic submucosal dissection (ESD). The aim of this study was to evaluate the efficacy and safety of an internal magnet traction device (MTD) for ESD in an ex vivo porcine model.

Methods

The MTD consisted of a small neodymium magnet and a suture attached to a through-the-scope clip. A circumferential mucosal incision was completed around a 30-mm diameter template that served as the target lesion. The first MTD was deployed at the proximal edge of the lesion. A second MTD was deployed on the wall opposite the lesion. With both magnets connected, this created traction or lifting of the target lesion towards the opposing wall during submucosal dissection. Primary endpoint was comparison of submucosal dissection times between conventional ESD (C-ESD) and MTD-assisted ESD (MTD-ESD).

Results

Twenty lesions along the anterior wall, posterior wall and greater curvature were resected using either C-ESD or MTD-ESD. The submucosal dissection time in MTD-ESD was significantly shorter than C-ESD (median: 6.4 [interquartile range {IQR} 4.6–8.7] min vs. 14.4 min [IQR 11.8–18.0], p < 0.05). There was a significant difference between MTD-ESD and C-ESD in total procedure times for lesions on the posterior gastric wall and greater curvature (median: 23.0 min [IQR 21.1–24.5] vs. 29.2 min [IQR 24.8–33.2], p < 0.05) with no difference for lesions on the anterior gastric wall (median: 18.8 min [IQR 15.5–20.5] vs. 17.1 min [IQR 13.1–20.0], p = 0.5). The number of muscularis propria injuries per lesion was significantly lower in MTD-ESD than C-ESD (median: 0 [IQR 0–0] vs. 1 [IQR 0–2], p < 0.05).

Conclusions

MTD for ESD is effective and safe when compared to C-ESD. This approach significantly reduced submucosal dissection times with less injury to the muscularis propria. Furthermore, MTD-ESD was particularly beneficial for more challenging gastric lesions located on the posterior wall and greater curvature.

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Abbreviations

ESD:

Endoscopic submucosal resection

MTD:

Magnet traction device

MTD-ESD:

Magnet traction device-assisted endoscopic submucosal dissection

C-ESD:

Conventional ESD

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Authors and Affiliations

  1. Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Akira Dobashi, Andrew C. Storm, Louis M. Wong Kee Song, Christopher J. Gostout, Jodie L. Deters, Charles A. Miller, Mary A. Knipschield & Elizabeth Rajan

Authors
  1. Akira Dobashi
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  2. Andrew C. Storm
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  3. Louis M. Wong Kee Song
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  4. Christopher J. Gostout
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Contributions

Endoscopic procedure, manuscript writing: AD. Preparation for ex vivo experiment: JL, CAM, and MAK. Data analysis and manuscript editing: ACS, LMWKS, CJG, and ER.

Corresponding author

Correspondence to Elizabeth Rajan.

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Disclosures

Akira Dobashi and Elizabeth Rajan have intellectual property with Medtronic. Christopher Gostout is Chief Medical Officer for Apollo Endosurgery and a consultant for Olympus Medical Systems. Andrew C. Storm, Louis M. Wong Kee Song, Jodie L. Deters, Charles A. Miller and Mary A. Knipschield have no conflict of interest or financial ties to disclose.

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Video: Magnet traction device-assisted endoscopic submucosal dissection (MTD-ESD) in an ex vivo porcine stomach. (MP4 42705 KB)

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Dobashi, A., Storm, A.C., Wong Kee Song, L.M. et al. Efficacy and safety of an internal magnet traction device for endoscopic submucosal dissection: ex vivo study in a porcine model (with video). Surg Endosc 33, 663–668 (2019). https://doi.org/10.1007/s00464-018-6486-4

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  • DOI: https://doi.org/10.1007/s00464-018-6486-4

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