According to GLOBOCAN 2020 data, esophageal cancer is among the most common cancers worldwide; it ranks seventh in terms of incidence and is the sixth leading cause of cancer deaths1. In most cases, early esophageal cancer and precancerous lesions can be cured by minimally invasive endoscopic treatment, and the 5-year survival rate can reach 95%2. However, patients with advanced esophageal cancer have a low quality of life and poor prognosis, and their overall 5-year survival rate is < 20%2, 3. Because esophageal cancer is usually not diagnosed until an advanced stage, there are few options available to extend life expectancy beyond several months4. Therefore, it is very important to improve the screening methods for early esophageal cancer.
Endoscopic resection includes endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). ESD was developed on the basis of EMR in Japan and has become the standard of care for managing early tumors of the esophagus, stomach, and colon5. Compared to EMR, ESD can offer better outcomes, lower morbidity, lower cost, higher curative resection rates, and lower recurrence rates5, 6. ESD is performed using an endoscope, which makes the procedure technically challenging7–8. Consequently, ESD has a steep learning curve, longer surgical time, higher risk, and more complications (e.g., bleeding, pain, perforation, and stricture) than EMR9. In addition, for effective and safe dissection, adequate tissue tension and a clear anatomical plane are important10. To overcome these abovementioned challenges associated with the use of ESD, scholars have proposed several auxiliary methods of pulling mucosa, such as percutaneous traction-assisted method11, sinker system traction-assisted method12, mucosal forceps channel-assisted method13, S–O clip traction-assisted method14, “medical ring” traction-assisted method15, a Master and Slave Transluminal Endoscopic Robot (MASTER)16, a novel flexible endoscopic surgical platform17, and dual-scope endoscopic dissection method18. Although these methods play a certain role in ESD operation, their flexibility in controlling mucosal traction direction and traction force is poor, and some endoscopic platforms are still difficult to be clinically used on large scale.
Magnetic anchor guided-endoscopic submucosal dissection (MAG-ESD) is a new type of assistive technology that functions using a special traction force, which confers its potential advantages over other assistive technologies5. In 2004, Kobayashi T et al. 8 applied the principle of magnetic anchor technique to ESD and reported that this technique significantly improved endoscopic operation. MAG-ESD provides dynamic tissue contraction independent of the endoscope, thus mimicking the surgeon’s two hands5. A magnetic anchor comprises three parts: a hand-made magnetic weight made up of magnetic stainless steel, micro forceps, and a connecting thread that connects a hand-made magnetic weight made up of magnetic stainless steel with micro forceps19. Two types of magnets can be used: electromagnets and permanent magnets19. Presently, MAG-ESD is known to have achieved significant results in gastric cancer20 and colorectal cancer21, proving its safety and feasibility for promoting ESD of early cancer. In this article, we will elaborate on the use of MAT-assisted ESD in early esophageal cancer.