A novel magnetic countertraction device for endoscopic submucosal dissection significantly reduces procedure time and minimizes technical difficulty

Background and study aims: In endoscopic submucosal dissection (ESD), effective countertraction may overcome the current drawbacks of longer procedure times and increased technical demands. The objective of this study was to compare the efficacy of ESD using a novel magnetic countertraction device with that of the traditional technique.

Methods: Each ESD was performed on simulated gastric lesions of 30 mm diameter created at five different locations. In total, 10 ESDs were performed using this novel device and 10 were performed by the standard technique.

Results: The magnetic countertraction device allowed directional tissue manipulation and exposure of the submucosal space. The total procedure time was 605 ± 303.7 seconds in the countertraction group vs. 1082 ± 515.9 seconds in the control group (P = 0.021).

Conclusions: This study demonstrated that using a novel magnetic countertraction device during ESD is technically feasible and enables the operator to dynamically manipulate countertraction such that the submucosal layer is visualized directly. Use of this device significantly reduced procedure time compared with conventional ESD techniques.

• References

• 1 Kang KJ, Kim KM, Kim JJ et al. Gastric extremely well-differentiated intestinal-type adenocarcinoma: a challenging lesion to achieve complete endoscopic resection. Endoscopy 2012; 44: 949-952
• 2 Nakamura M, Shibata T, Tahara T et al. The usefulness of magnifying endoscopy with narrow-band imaging to distinguish carcinoma in flat elevated lesions in the stomach diagnosed as adenoma by using biopsy samples. Gastrointest Endosc 2010; 71: 1070-1075
• 3 Ross AS, Waxman I. Flat and depressed neoplasms of the colon in Western populations. Am J Gastroenterol 2006; 101: 172-180
• 4 Morita T, Tomita N, Ohue M et al. Molecular analysis of diminutive, flat, depressed colorectal lesions: are they precursors of polypoid adenoma or early stage carcinoma?. Gastrointest Endosc 2002; 56: 663-671
• 5 Maiss J, Prat F, Wiesnet J et al. The complementary Erlangen active simulator for interventional endoscopy training is superior to solely clinical education in endoscopic hemostasis – the French training project: a prospective trial. Eur J Gastroenterol Hepatol 2006; 18: 1217-1225
• 6 Ishii N, Itoh T, Horiki N et al. Endoscopic submucosal dissection with a combination of small-caliber-tip transparent hood and flex knife for large superficial colorectal neoplasias including ileocecal lesions. Surg Endosc 2010; 24: 1941-1947
• 7 Imaeda H, Hosoe N, Ida Y et al. Novel technique of endoscopic submucosal dissection by using external forceps for early rectal cancer (with videos). Gastrointest Endosc 2012; 75: 1253-1257
• 8 Uraoka T, Kato J, Ishikawa S et al. Thin endoscope-assisted endoscopic submucosal dissection for large colorectal tumors (with videos). Gastrointest Endosc 2007; 66: 836-839
• 9 Chen PJ, Chu HC, Chang WK et al. Endoscopic submucosal dissection with internal traction for early gastric cancer (with video). Gastrointest Endosc 2008; 67: 128-132
• 10 Sakamoto N, Osada T, Shibuya T et al. Endoscopic submucosal dissection of large colorectal tumors by using a novel spring-action S-O clip for traction (with video). Gastrointest Endosc 2009; 69: 1370-1374
• 11 Parra-Blanco A, Nicolas D, Arnau MR et al. Gastric endoscopic submucosal dissection assisted by a new traction method: the clip-band technique. A feasibility study in a porcine model (with video). . Gastrointest Endosc 2011; 74: 1137-1141
• 12 Matsumoto K, Nagahara A, Sakamoto N et al. A new traction device for facilitating endoscopic submucosal dissection (ESD) for early gastric cancer: the “medical ring” . Endoscopy 2011; 43 : E67-68
• 13 Li CH, Chen PJ, Chu HC et al. Endoscopic submucosal dissection with the pulley method for early-stage gastric cancer (with video). Gastrointest Endosc 2011; 73: 163-167
• 14 Gotoda T, Oda I, Tamakawa K et al. Prospective clinical trial of magnetic-anchor-guided endoscopic submucosal dissection for large early gastric cancer (with videos). Gastrointest Endosc 2009; 69: 10-15