A new sinker-assisted endoscopic submucosal dissection for colorectal cancer

doi:10.1016/S0016-5107(05)00546-8

Gastrointestinal Endoscopy

Volume 62, Issue 2, August 2005, Pages 297-301

https://doi.org/10.1016/S0016-5107(05)00546-8 Get rights and content

Background

Endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment for early gastric cancer, but it is not widely used to treat the colorectum because of its degree of technical difficulty. Thus, a noninvasive tool that facilitates the direct visualization of the submucosal layer is needed.

Methods

Traction-assisted dissection was performed on 4 superficial lesions. The system consisted of a metallic clip attached by a nylon line to a sinker 6 × 4 × 4 mm in size and weighing 1 g. After partially dissecting the submucosa, the clip was attached to the edge of the exfoliated mucosa and the weight of the sinker pulled down the partly resected lesion.

Observations

In all 4 cases, the sinker allowed direct visualization of the cutting line, and en bloc resection was successfully accomplished.

Conclusions

These preliminary results suggest that sinker-assisted ESD is effective for the complete removal of selected superficial early colorectal cancer.

Section snippets

Estimation of the depth of invasion

High-magnification colonoscopy (PCF240ZI or GIF-Q240Z; Olympus Optical Co, Ltd, Tokyo, Japan) and chromoendoscopy with indigo carmine (0.2%) and crystal violet (0.05%) were used to estimate the depth of invasion.20, 21 In every lesion, a noninvasive Fujii crypt pattern22, 23, 24, 25 was observed, indicating that they were suitable for endoscopic resection. No biopsies were performed before any procedure.

Sinker system

The new method was approved by the ethical committee of our hospital, and written informed

Results

En bloc resection was achieved in all 4 cases. High-magnification chromocolonoscopy revealed no residual neoplastic tissue after ESD. The mean operating time was 100 minutes, and the individual operating times were 120, 150, 50, and 80 minutes for cases 1 to 4, respectively. Histopathologic evaluations revealed intramucosal cancer in cases 2 and 4, while tubular adenoma with moderate atypia and tubular adenoma with severe atypia were diagnosed in cases 1 and 3, respectively. All margins were

Discussion

EMR as an indication for superficial early GI cancer is accepted not only in Japan but also in Western countries, although prospective studies are still needed to compare EMR techniques with laparoscopic surgery for patients with early colonic cancer.3, 20, 30 This technique is not widely used for flat lesions >20 mm, however, in large part, because of its technical difficulty. To remove such lesions, we developed the IT knife,¹⁵ but complications resulting from IT EMR (ESD) frequently occur,

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Efficacy, safety, and advantages of magnetic anchor–guided endoscopic submucosal dissection vs conventional endoscopic submucosal dissection: A retrospective paired cohort study
2024, Journal of Gastrointestinal Surgery
Endoscopic submucosal dissection (ESD) has been recommended as the first-line treatment for early gastric cancer (EGC). However, poor visualization of the operative field increases both the procedure time and the risk of complications, especially for large and difficult lesions. We introduced a novel technique, magnetic anchor–guided ESD (MAG-ESD) and compared it with conventional ESD (C-ESD) for the treatment of large EGCs in terms of efficacy, safety, and advantages.
Patients with large EGCs who underwent MAG-ESD or C-ESD at the First Affiliated Hospital of Xi’an Jiaotong University from March 2020 to March 2022 were retrospectively enrolled in this study. The patients in the MAG-ESD cohort were matched to those in the C-ESD cohort using propensity score–based matching. The operation time, submucosal dissection time, complete resection status, magnetic anchor, adverse event rate, and tumor recurrence rate were evaluated.
Twenty-two patients who underwent MAG-ESD were ultimately matched to those who underwent C-ESD. The median operation time of MAG-ESD and C-ESD was 43 minutes (IQR, 35.2-49.5) and 50.5 minutes (IQR, 42.0-76.0), respectively, among which the submucosal dissection time was 7.6 minutes (IQR, 5.2-10.4) and 14.8 minutes (IQR, 10.8-19.6), respectively. The operation time of MAG-ESD was shorter than that of C-ESD, especially the submucosal dissection time (P < .05). There was a lower incidence of adverse events associated with MAG-ESD (P < .05) when magnetic anchors were successfully placed and retrieved.
MAG-ESD is feasible, effective, safe, and simple for the treatment of large EGCs at different sites and has a high anchor success rate, which could shorten the operation time and reduce the adverse event rate.
The efficient of application of a fine magnetic traction system simplifies colorectal endoscopic submucosal dissection: A porcine study
2023, Asian Journal of Surgery
Sometimes it is difficult to maintain good visualization of the submucosal layer during colorectal endoscopic submucosal dissection (ESD). This study aimed to evaluate the feasibility and efficacy of a novel traction method, the fine magnetic traction system (FMTS), in colorectal ESD.
ESD was performed 10, 15, or 30 cm from the anus in the colorectums of 10 Bama miniature pigs with or without FMTS. The circumcision and dissection per unit time (cm²/min), en bloc resection, perforation and bleeding rates, size and integrity of the specimen and submucosal injection times were analysed.
A total of 60 ESD procedures were performed with or without FMTS assistance. The en bloc resection rates were 100% at 10 and 15 cm from the anus in both the control group (conventional ESD) and the FMTS group. However, at 30 cm from the anus, these rates were only 10% and 70% (p = 0.006). The resection speeds (control vs. FMTS) at the 10, 15, and 30 cm points were 0.35 ± 0.07 cm²/min vs. 0.39 ± 0.19 cm²/min (p = 0.56), 0.30 ± 0.09 cm²/min vs. 0.38 ± 0.02 cm²/min (p = 0.04), and 0.11 cm²/min vs. 0.26 ± 0.10 cm²/min, respectively.
The FMTS provides effective counter-traction and efficiently reduces the risks and difficulties of difficult colonic ESD in the porcine model.
Simplified magnetic anchor-guided endoscopic submucosal dissection: an ex vivo porcine model
2022, Revista de Gastroenterologia de Mexico
La disección endoscópica de la submucosa (DES) es un tratamiento bien establecido para las neoplasias superficiales del tracto gastrointestinal y permite la resección en bloque. La tracción adecuada del tejido es importante para una disección efectiva y segura. La DES guiada por anclaje magnético (DES-AM) con imán de neodimio (simplificada) tiene beneficios potenciales en comparación con otros métodos actuales de tracción. Evaluamos la factibilidad de la DES-AM simplificada en un modelo porcino ex vivo.
Diseño experimental, se empleó la técnica estándar de DES. Para el anclaje magnético (AM), utilizamos un imán externo y uno interno de neodimio. El imán interno de neodimio se fijó a una rama de un hemoclip con sutura seda 2-0. Después de la incisión, el clip con el imán interno se colocó al borde de la lesión y luego se maniobró un imán externo alrededor de la superficie para aplicar una tracción adecuada.
En total, se realizaron 15 DES (cinco sin AM y 10 con AM), de las cuales el 100% se completaron en bloque. En todos los casos, la tracción y la disección fueron factibles. Todos los procedimientos se completaron en menos de 90 minutos. El tamaño de las lesiones fue de 15 a 50 mm (promedio 30 mm). Dos casos presentaron perforación puntiforme en el grupo con AM (13.3%).
Nuestro estudio mostró la factibilidad de la DES-AM simplificada en un modelo porcino ex vivo y resección en bloque.
Endoscopic submucosal dissection (ESD) is a well-established treatment for superficial gastrointestinal tumors and enables en bloc resection. Adequate tissue tension is important for safe and effective dissection. Simplified magnetic anchor-guided ESD (MAG-ESD) with a neodymium magnet has potential benefits, compared with other current traction methods. We evaluated the feasibility of simplified MAG-ESD in an ex vivo porcine model.
An experimental study was conducted, utilizing the standard ESD technique. An external magnet and an internal magnet, both neodymium magnets, were used for the magnetic anchoring. The internal magnet was attached to an arm of a hemoclip with a 2-0 silk suture. After the incision, the clip with the internal magnet was placed at the edge of the lesion. The external magnet was maneuvered around the surface to apply adequate tension.
A total of 15 en bloc ESDs (five with no magnetic anchoring and 10 with magnetic anchoring) were carried out. Traction and dissection were feasible in all cases and the procedures were completed in fewer than 90 min. Lesion size ranged from 15 to 50 mm (mean 30 mm). Two cases in the group with magnetic anchoring presented with punctate perforation (13.3%).
Our study demonstrated the feasibility of simplified MAG-ESD and en bloc resection in an ex vivo porcine model.
Triple-loop clip for the traction-assisted colorectal endoscopic submucosal dissection: multidirectional triple-loop traction method
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2019, Gastrointestinal Endoscopy
Endoscopic submucosal dissection (ESD) is becoming the preferred method for certain early GI malignancies; however, very few U.S. physicians have adopted this technique. This is in part because of the technically challenging nature of the procedure and the long learning curve. Several endoscopic robots are under development to address these complexities.
This is a randomized, controlled, pilot study comparing conventional ESD versus robotic-assisted ESD (RESD) in an ex vivo bovine colon model. Five endoscopists without prior ESD or RESD experience were randomized into 2 groups (group 1, RESD after ESD; group 2, RESD before ESD). A standard template was used to create colonic lesions. The primary outcome was completeness of en bloc resection. Secondary outcomes included differences in procedure time, perforation rate, muscle injury rate, and National Aeronautical and Space Administration Task Load Index (NASA-TLX) to assess physical and mental workload.
Five endoscopists each performed 4 tissue resections (2 RESD and 2 ESD), for a total of 20 procedures. Complete en bloc resection was achieved in all RESD and in 50% of ESD (P < .0001). The perforation rate was higher in the ESD group (60% vs 30%, P = .18). Total procedure time (34.1 vs 88.6 min, P = .001) and dissection time (27.8 vs 79.4 minutes, P = .002) were lower for RESD. The NASA-TLX also revealed better results for RESD (28.4 vs 47.4, P = .01).
RESD appears to be more effective in obtaining en bloc resection with shorter procedure times and a lower perforation rate compared with conventional ESD as performed by ESD novices. RESD is also associated with lower physical and mental workloads.
History of submucosal dissection and its epic in France
2024, Hepato-Gastro et Oncologie Digestive

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New MethodA new sinker-assisted endoscopic submucosal dissection for colorectal cancer

Background

Methods

Observations

Conclusions

Section snippets

Estimation of the depth of invasion

Sinker system

Results

Discussion

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Am J Gastroenterol

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Lancet

Endoscopic mucosal resection for colorectal neoplastic lesions

Dis Colon Rectum

New technique of gastric biopsy

Stomach Intestine

New Method
A new sinker-assisted endoscopic submucosal dissection for colorectal cancer