Ramírez-Ramírez M Á, Zamorano-Orozco Y, Beltrán-Campos E G
Departamento de Endoscopia, Hospital Regional Número 1 «Carlos Macgregor Sánchez Navarro» del Instituto Mexicano del Seguro Social, Ciudad de México, México.
Departamento de Endoscopia, Hospital Regional Número 1 «Carlos Macgregor Sánchez Navarro» del Instituto Mexicano del Seguro Social, Ciudad de México, México.
Rev Gastroenterol Mex (Engl Ed). 2021 Jan 27. doi: 10.1016/j.rgmx.2020.09.007.
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.
内镜黏膜下剥离术（ESD）是一种成熟的治疗浅表胃肠道肿瘤的方法，能够实现整块切除。足够的组织张力对于安全有效的剥离至关重要。与目前其他牵引方法相比，采用钕磁铁的简化磁锚引导ESD（MAG-ESD）具有潜在优势。我们在体外猪模型中评估了简化MAG-ESD的可行性。
采用标准ESD技术进行了一项实验研究。使用外部磁铁和内部磁铁，均为钕磁铁，用于磁锚定。内部磁铁用2-0丝线缝合固定在一个血管夹的臂上。切开后，将带有内部磁铁的夹子放置在病变边缘。通过在表面操作外部磁铁来施加足够的张力。
共进行了15例整块ESD（5例无磁锚定，10例有磁锚定）。所有病例中牵引和剥离均可行，手术在90分钟内完成。病变大小为15至50毫米（平均30毫米）。有磁锚定组中有2例出现点状穿孔（13.3%）。
我们的研究证明了简化MAG-ESD及在体外猪模型中整块切除的可行性。
