A Study On The Feasibility And Safety Of The Quickly Placed Magnetic Anchor-guided ESD

BackgroundEndoscopic submucosal dissection(ESD)is an progressive technique and has been established as a standard treatment for early gastrointestinal cancers by en bloc resection,accurate histopathological diagnosis and reduction of local recurrence.However,the lack of countertraction in ESD results in increased technical demands,procedure time and more adverse events,such as bleeding and perforation etc.Magnetic anchor guided endoscopic submucosal dissection(MAG-ESD)has been demonstrated to be useful in several studies which can provides adequate direction and degrees of traction in various locations thus effectively improves the surgical field of vision.However,the traditional magnetic anchor has the problem of the inability to deliver the magnetic anchor through the endoscope,which needs repeated retrieving and reinserting of the endoscope.To a certain extent,it increases difficulty and prolongs the process of ESD,especially in the colorectal ESD.To solve the problem,our team developed a new kind of magnetic anchor and this novel magnetic ancher can be quickly placed through biopsy channel.There is no clinical application of this magnetic anchor at home and abroad for now.Purpose:By collecting the clinical data(including general data,surgical efficiency,complications,etc.)of quickly placed magnetic anchor-guided ESD group and traditional ESD group,comparing and analyzing the data obtained from the two groups.the feasibility and safety of the quickly placed mgnetic anchor-guided ESD for the treatment of colorectal tumors are evaluated,and to realize the clinical application of the quickly placed mgnetic anchor-guided ESD.Methods:This retrospective study was conducted from May 2020 to January 2022 at The Second Affiliated Hospital of Harbin Medical University.112 patients with colorectal tumors who underwent endoscopic submucosal dissection was selected.According to the endoscopic treatment method,they were divided into the quickly placed magnetic anchor-guided ESD group and traditional ESD group.Among them,18 cases of lesions were removed in the quickly placed magnetic anchor-guided ESD group,traditional ESD group removed 94 cases of lesions.Relevant clinical statistics,surgical efficiency and complications were collected and compared in both groups to evaluate the feasibility and safety of the new magnetic anchor.Results:There were 112 patients in this study,including 18 in the quickly placed magnetic anchor-guided ESD group and 94 in the traditional ESD group.In terms of surgical efficiency,All the en block resection and R0 resection were achieved in the quickly placed magnetic anchor-guided ESD group.92 achieved whole resection and91 achieved R0 resection in the traditional ESD group,with no statistically significant difference.The stripping speed of the quickly placed magnetic anchor-guided ESD group and the traditional ESD group was 21.18(16.22,29.09)mm2/min and 14.58(10.10,18.15)mm2/min,respectively.After data analysis,the difference between groups was statistically significant(P=0.001 <0.05),and the stripping speed of the quickly placed magnetic anchor-guided ESD group was higher than traditional ESD group.The operation time was 24.50(15.75,66.50)minutes and 59.00(29.00 and58.00)minutes in the traditional ESD group,respectively.After data analysis,the difference was statistically significant(P=0.024 <0.05),and the operation time of the quickly placed magnetic anchor-guided ESD group was less than that of the traditional ESD group.In terms of complications,there was 1 no bleeding(5.60%)in the quickly placed magnetic anchor-guided ESD group,16 easy controled bleeding(88.90%),and 1 controllable bleeding(5.60%).In the traditional ESD group,there was1 no bleeding(1.10%),82 easy controled bleeding(87.20%),10 controllable bleeding(10.60%),and 1 difficult controled bleeding(1.10%).Neither group had postoperative delayed bleeding,perforation and electrocoagulation syndrome,and there was no significant difference in the occurrence of complications in both groups.Conclusions:We believe that the new quickly placed magnetic anchor-guided ESD is a feasible and safe method in treating the early colorectal tumor with en bloc resection,satisfactory submucosal visual field,and less adverse events.More patients can benefit in clinical applications in the future.