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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction and aims</span><p id="par0005" class="elsevierStylePara elsevierViewall">Endoscopic submucosal dissection &#40;ESD&#41; has been developed for treating early gastrointestinal lesions by enabling <span class="elsevierStyleItalic">en bloc</span> resection&#44; to make a safe histopathologic diagnosis and reduce local recurrence&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> However&#44; ESD is technically difficult and the limited field of vision can produce severe complications&#44; such as bleeding and perforation&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> Various devices and traction methods have been developed to facilitate ESD&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;16</span></a> Magnetic anchor-guided ESD &#40;MAG-ESD&#41;&#44; utilizing a large external magnet&#44; provides several degrees of traction&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> A simplified MAG-ESD method utilizing small neodymium magnets&#44; useful for daily practice&#44; has been described in resected porcine stomachs and the stomachs of live dogs&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> A prospective case series by Matsuzaki et al&#46; was recently published on 50 patients with stomach lesions&#44; utilizing the simplified MAG-ESD method&#44; in which successful resection was achieved in all cases&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Similar results were described in 48 cases with colorectal lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> To the best of our knowledge&#44; there are no Mexican reports on MAG-ESD&#46; In contrast&#44; training on animal models &#40;particularly utilizing the stomach&#41; to master the learning curve for ESD has been described and incorporated at several centers for ESD training courses&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> The aim of the present study was to evaluate the feasibility of performing simplified MAG-ESD in <span class="elsevierStyleItalic">ex vivo</span> porcine models&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075"><span class="elsevierStyleItalic">Ex vivo</span> porcine model</span><p id="par0010" class="elsevierStylePara elsevierViewall">Resected porcine stomachs &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; and in one case&#44; the colon&#44; were utilized&#46; They were prepared according to the recommendations established by Ram&#237;rez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> The procedures were performed by the same endoscopist &#40;Miguel &#193;ngel Ram&#237;rez Ram&#237;rez&#41;&#44; who was at the beginning of his learning curve in ESD training&#46; An expert in other advanced endoscopic procedures&#44; he had 7 years of experience in endoscopic procedure training in <span class="elsevierStyleItalic">ex vivo</span> models&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Neodymium magnet</span><p id="par0015" class="elsevierStylePara elsevierViewall">Internal and external permanent neodymium magnets &#40;Nd<span class="elsevierStyleInf">2</span>Fe<span class="elsevierStyleInf">12</span>B&#41; for experimental use &#40;Innova Endoscopy S&#46;A&#46; de C&#46;V&#46; Mexico City&#41; were employed&#46; Neodymium magnets are the strongest magnets available and are highly resistant to demagnetization&#44; due to their atomic structure&#46; The external magnet &#40;attraction force&#44; 845&#46;8<span class="elsevierStyleHsp" style=""></span>N&#59; magnetic flow density&#44; 534<span class="elsevierStyleHsp" style=""></span>Mt&#41; is shaped like a coin &#40;3<span class="elsevierStyleHsp" style=""></span>cm in diameter and 8<span class="elsevierStyleHsp" style=""></span>mm in height&#41; and the internal magnet &#40;5&#46;3<span class="elsevierStyleHsp" style=""></span>N&#44; 296<span class="elsevierStyleHsp" style=""></span>Mt&#41; is ring-shaped &#40;external diameter of 5<span class="elsevierStyleHsp" style=""></span>mm&#44; internal diameter of 1<span class="elsevierStyleHsp" style=""></span>mm&#44; height of 3<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Magnetic anchoring</span><p id="par0020" class="elsevierStylePara elsevierViewall">Magnetic anchoring &#40;MA&#41; consists of attaching the internal neodymium magnet to an arm of the hemoclip&#46; For MA preparation&#44; a hemoclip was initially inserted into the working channel of the endoscope that had a plastic transparent cap attached to the tip&#46; Once the hemoclip came out at the distal part of the endoscope&#44; the magnet was attached to one of its arms&#44; with 2-0 silk &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; It was then moved a few centimeters until it was completely covered by the plastic cap &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; ready to be introduced into the stomach or colon&#44; without injuring the mucosa&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">ESD procedure</span><p id="par0025" class="elsevierStylePara elsevierViewall">In the first training stage&#44; five ESD procedures were carried out with no MA&#46; In the second stage&#44; 10 ESD procedures were performed&#44; introducing the MA method&#46; From this point forward in the text we will refer to two groups&#58; the group with MA and the group without MA&#46; The ESD technique utilized was made up of 4 stages&#58; marking&#44; submucosal injection&#44; circumferential incision&#44; and submucosal dissection&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">ESD technique with no MA</span><p id="par0030" class="elsevierStylePara elsevierViewall">A single-channel endoscope &#40;GIF Q160&#59; Olympus Medical System Corp&#44; Tokyo&#44; Japan&#41; with a plastic transparent cap at the tip was employed&#44; together with an electrosurgical unit &#40;ERBE ICC&#44; T200 T&#252;bingen&#44; Germany&#41; and the following accessories&#58; a rotatable cylindrical-type instrument&#44; a cylindrical-type square knife&#44; and a ball-type IT knife &#40;Alton Medical Instruments CO&#46;&#44; LTD&#44; Shanghai&#44; China&#41;&#46; As the first step&#44; a simulated lesion larger than 15<span class="elsevierStyleHsp" style=""></span>mm was marked &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#44; followed by the submucosal injection of saline solution and methylene blue&#46; A circumferential incision was then made &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#44; and finally&#44; dissection was performed&#44; utilizing the cap for countertraction&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">MA-guided technique</span><p id="par0035" class="elsevierStylePara elsevierViewall">The stages of marking&#44; injection&#44; and circumferential incision were performed in the same manner&#46; Before proceeding to the dissection stage&#44; the endoscope was withdrawn so the magnetic anchor could be placed with the clip&#46; The endoscope was then reintroduced&#44; and the magnetic anchor was attached to the gastric mucosa at the edge of the lesion &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41;&#46; In the first case of the group with MA&#44; the cap remained at the tip of the endoscope during dissection&#46; However&#44; in the rest of the cases of that group &#40;9&#47;10&#41;&#44; once the clip with the magnet was deployed&#44; the endoscope was withdrawn&#44; and the cap was removed because we realized that it was no longer technically necessary&#44; and its removal improved the field of vision&#46; The external magnet was maneuvered around the surface of the <span class="elsevierStyleItalic">ex vivo</span> model to achieve adequate internal magnet traction and expose the correct dissection plane &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>&#41;&#46; When the dissection was completed&#44; the resected specimen and the <span class="elsevierStyleItalic">in situ</span> magnetic anchor were retrieved &#40;<a class="elsevierStyleCrossRef" href="#fig0040">Fig&#46; 8</a>&#41;&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia><elsevierMultimedia ident="fig0040"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Statistical analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">A descriptive analysis was carried out&#46; The categorical variables were expressed as percentage and the quantitative variables were expressed as mean and standard deviation&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Variables</span><p id="par0125" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">En bloc</span> resection &#40;categorical variable&#41;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0050" class="elsevierStylePara elsevierViewall">Adequate traction&#58; achieving adequate traction and countertraction at all angles through MA &#40;categorical variable&#41;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0055" class="elsevierStylePara elsevierViewall">Maximum duration &#40;90<span class="elsevierStyleHsp" style=""></span>min&#41; of the dissection procedure&#44; evaluated from the start of the circumferential cut to the end of the dissection &#40;quantitative continuous variable&#41;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4</span><p id="par0060" class="elsevierStylePara elsevierViewall">Size &#40;mm&#41; of the resected tissue &#40;discrete quantitative variable&#41;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5</span><p id="par0065" class="elsevierStylePara elsevierViewall">Perforation&#58; defined as the loss of gastrointestinal wall continuity &#40;categorical variable&#41;</p></li></ul></p><p id="par0070" class="elsevierStylePara elsevierViewall">Ninety minutes was considered the maximum time limit for successfully performing ESD&#46; We did not measure the time of each procedure because the feasibility of ESD performance&#44; not the comparison of the procedure duration variable&#44; was the aim of the study&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ethical considerations</span><p id="par0075" class="elsevierStylePara elsevierViewall">The good clinical practice and animal experimentation norms were met&#46; The study was conducted on <span class="elsevierStyleItalic">ex vivo</span> porcine models&#46; No animals <span class="elsevierStyleItalic">in vivo</span> or patients were involved&#44; and the equipment and accessories employed were exclusively those for use in animals&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">A total of 15 ESD procedures were carried out &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The first five cases were performed with no MA &#40;four in the stomach and one in the colon&#41; and 10 were performed with MA &#40;all in the stomach&#41;&#46; <span class="elsevierStyleItalic">En bloc</span> resection was achieved in 100&#37; of the cases&#46; MA enabled adequate traction and countertraction at all angles and adequate dissection in 100&#37; of the cases&#46; All the procedures were carried out in fewer than 90<span class="elsevierStyleHsp" style=""></span>min &#40;100&#37;&#41;&#46; Lesion size ranged from 15<span class="elsevierStyleHsp" style=""></span>mm to 50<span class="elsevierStyleHsp" style=""></span>mm &#40;mean 30<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Two cases in the group with MA &#40;13&#46;3&#37;&#41; presented with punctate perforation&#46; They were repaired and <span class="elsevierStyleItalic">en bloc</span> dissection was completed&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion and conclusions</span><p id="par0085" class="elsevierStylePara elsevierViewall">In the present study we found that simplified MAG-ESD was a feasible procedure in <span class="elsevierStyleItalic">ex vivo</span> models&#46; ESD has been developed for the treatment of early gastrointestinal lesions and its goal is <span class="elsevierStyleItalic">en bloc</span> resection for making a safe histopathologic diagnosis and reducing local recurrence&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> Training on animal models is the best way to master the learning curve for ESD&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> A formal sequential training program that includes <span class="elsevierStyleItalic">ex vivo&#44; in vivo</span>&#44; and human models can be useful in countries with a low volume of cases&#46; In the present study on <span class="elsevierStyleItalic">ex vivo</span> models&#44; MAG-ESD was successfully performed&#44; with <span class="elsevierStyleItalic">en bloc</span> resection in all cases&#44; even at the beginning of the learning curve of the operator&#44; as mentioned above&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> The fact that the operator is an expert in advanced endoscopic techniques could be an important factor in the present results&#44; which would not necessarily be the expected results for endoscopists with lower or different levels of experience&#46; In the present study&#44; we achieved traction and countertraction with the MA system at several angles during the ESD&#44; which was the equivalent of having a first assistant during surgery&#46; The MA technique could be incorporated into a future sequential training program&#44; reproducing our results in <span class="elsevierStyleItalic">in vivo</span> models&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The transparent cap at the tip of the endoscope is useful and indispensable for ESD because it enables dissection through countertraction&#44; but it can be a disadvantage regarding visualization when the diameter of the cap is small&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> In our study we found that leaving the cap at the tip of the endoscope in the MA procedures was unnecessary during the dissection stage&#44; and not having the cap enabled better visualization&#46; We used the cap in all five cases with no MA and in only one case in the group with MA&#46; The cap was removed in the remaining nine cases in that group&#46; Although the endoscope had to be withdrawn for its removal&#44; it resulted in a better field of vision&#46; In contrast&#44; Matsuzaki et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> did not specify that potential advantage&#46; Thus&#44; more studies are needed to determine whether cap removal is advantageous or not&#46; Importantly&#44; the cap was used in all the cases when the magnetic anchor was placed&#44; protecting both the mucosa and the anchor&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">There are considerable technical risks involved in the performance of ESD&#44; such as perforation&#46; Two meta-analyses reported perforation in an average of approximately 4&#46;5&#37; of cases during gastric ESD<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44;28</span></a> and 4&#46;8&#37; during colonic ESD&#46; Likewise&#44; in a large case series on perforation&#44; Minami et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> found that 98&#37; of the cases had successful closure with the clip and did not require surgery&#46; In our study&#44; we had 2 cases &#40;13&#37;&#41; of punctate perforation that were identified during the procedure and sutured&#44; and <span class="elsevierStyleItalic">en bloc</span> MAG-ESD was completed in 100&#37; of the cases&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Because we utilized an <span class="elsevierStyleItalic">ex vivo</span> model&#44; we could not evaluate the risk for bleeding&#44; and technically&#44; we were not faced with the problem of peristalsis&#46; Nevertheless&#44; sequential training should gradually shift towards live models and humans&#46; Future studies could be conducted on <span class="elsevierStyleItalic">in vivo</span> porcine models and then on humans &#40;performed by experts&#41; to measure the variables of bleeding and evaluate the factor of peristalsis and the physical barrier of the body to magnetic attraction&#44; utilizing the present study as a base and prior reference&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">A methodological limitation of the present study was the fact that there was lesion variability&#46; We included 14 gastric lesions and only one colonic lesion &#40;ESD without MA&#41;&#44; and so&#44; strictly speaking&#44; the feasibility of MAG-ESD was established only for gastric lesions&#46; However&#44; we consider that the results could be extrapolated to lesions of the colon&#44; but that was not evaluated&#46; Another limitation was that even though it was not a study aim&#44; the precise time of each ESD was not measured&#44; thus we could not evaluate whether procedure duration was related to lesion size or location&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusion</span><p id="par0110" class="elsevierStylePara elsevierViewall">Our study demonstrated the feasibility of simplified MAG-ESD and <span class="elsevierStyleItalic">en bloc</span> resection&#44; in an <span class="elsevierStyleItalic">ex vivo</span> porcine model&#46; The use of a cap at the tip of the endoscope was not needed during MAG-ESD&#44; improving visualization&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Financial disclosure</span><p id="par0115" class="elsevierStylePara elsevierViewall">No financial support was received in relation to this study&#47;article&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflict of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that there is no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and aims</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Endoscopic submucosal dissection &#40;ESD&#41; is a well-established treatment for superficial gastrointestinal tumors and enables <span class="elsevierStyleItalic">en bloc</span> resection&#46; Adequate tissue tension is important for safe and effective dissection&#46; Simplified magnetic anchor-guided ESD &#40;MAG-ESD&#41; with a neodymium magnet has potential benefits&#44; compared with other current traction methods&#46; We evaluated the feasibility of simplified MAG-ESD in an <span class="elsevierStyleItalic">ex vivo</span> porcine model&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">An experimental study was conducted&#44; utilizing the standard ESD technique&#46; An external magnet and an internal magnet&#44; both neodymium magnets&#44; were used for the magnetic anchoring&#46; The internal magnet was attached to an arm of a hemoclip with a 2-0 silk suture&#46; After the incision&#44; the clip with the internal magnet was placed at the edge of the lesion&#46; The external magnet was maneuvered around the surface to apply adequate tension&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">A total of 15 <span class="elsevierStyleItalic">en bloc</span> ESDs &#40;5 with no magnetic anchoring and 10 with magnetic anchoring&#41; were carried out&#46; Traction and dissection were feasible in all cases and the procedures were completed in fewer than 90<span class="elsevierStyleHsp" style=""></span>min&#46; Lesion size ranged from 15 to 50<span class="elsevierStyleHsp" style=""></span>mm &#40;mean 30<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Two cases in the group with magnetic anchoring presented with punctate perforation &#40;13&#46;3&#37;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Our study demonstrated the feasibility of simplified MAG-ESD and <span class="elsevierStyleItalic">en bloc</span> resection in an <span class="elsevierStyleItalic">ex vivo</span> porcine model&#46;</p></span>"
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      "es" => array:3 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivos</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La disecci&#243;n endosc&#243;pica de la submucosa &#40;DES&#41; es un tratamiento bien establecido para las neoplasias superficiales del tracto gastrointestinal y permite la resecci&#243;n en bloque&#46; La tracci&#243;n adecuada del tejido es importante para una disecci&#243;n efectiva y segura&#46; La DES guiada por anclaje magn&#233;tico &#40;DES-AM&#41; con im&#225;n de neodimio &#40;simplificada&#41; tiene beneficios potenciales en comparaci&#243;n con otros m&#233;todos actuales de tracci&#243;n&#46; Evaluamos la factibilidad de DES-AM simplificada en modelo porcino <span class="elsevierStyleItalic">ex vivo</span>&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Dise&#241;o experimental&#44; se emple&#243; la t&#233;cnica est&#225;ndar de DES&#46; Para el anclaje magn&#233;tico &#40;AM&#41;&#44; utilizamos un im&#225;n externo y un im&#225;n interno de neodimio&#46; El im&#225;n interno de neodimio se fij&#243; a una rama de un hemoclip con sutura seda 2-0&#46; Despu&#233;s de la incisi&#243;n&#44; el clip con el im&#225;n interno se coloc&#243; al borde de la lesi&#243;n y luego se maniobr&#243; un im&#225;n externo alrededor de la superficie para aplicar una tracci&#243;n adecuada&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">En total se realizaron 15 DES &#40;5 sin AM y 10 con AM&#41;&#44; de las cuales el 100&#37; se completaron en bloque&#46; En todos los casos la tracci&#243;n y la disecci&#243;n fueron factibles&#46; Todos los procedimientos se completaron en menos de 90<span class="elsevierStyleHsp" style=""></span>minutos&#46; El tama&#241;o de las lesiones fue de 15-50<span class="elsevierStyleHsp" style=""></span>mm &#40;promedio 30<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Dos casos presentaron perforaci&#243;n puntiforme en el grupo con AM &#40;13&#46;3&#37;&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Nuestro estudio mostr&#243; la factibilidad de la DES-AM simplificada en modelo porcino <span class="elsevierStyleItalic">ex vivo</span> y resecci&#243;n en bloque&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Introducci&#243;n y objetivos"
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            "titulo" => "Materiales y m&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
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        ]
      ]
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ram&#237;rez-Ram&#237;rez M&#193;&#44; Zamorano-Orozco Y&#44; Beltr&#225;n-Campos EG&#46; Disecci&#243;n endosc&#243;pica de la submucosa asistida con anclaje magn&#233;tico simplificado&#58; modelo porcino ex vivo&#46; Revista de Gastroenterolog&#237;a de M&#233;xico&#46; 2022&#59;87&#58;13&#8211;19&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Ex vivo</span> porcine stomach model&#46;</p>"
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      1 => array:8 [
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        "etiqueta" => "Figure 2"
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        "mostrarFloat" => true
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Magnetic anchoring&#44; showing the internal neodymium magnet attached to an arm of the clip with a 2-0 silk suture&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The transparent cap at the tip protects the mucosa and the magnet anchor&#44; given that the magnet cannot be completely introduced into the working channel&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
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        "figura" => array:1 [
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            "identificador" => "at0020"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Marking stage&#44; utilizing the rotatable cylindrical-type tip &#40;Alton Medical Instruments CO&#46;&#44; LTD&#44; Shanghai&#44; China&#41;&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Incision stage&#44; utilizing the ball-type IT knife &#40;Alton Medical Instruments CO&#46;&#44; LTD&#44; Shanghai&#44; China&#41;&#46;</p>"
        ]
      ]
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        "identificador" => "fig0030"
        "etiqueta" => "Figure 6"
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        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr6.jpeg"
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        "detalles" => array:1 [
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            "identificador" => "at0030"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Placement of the magnetic anchor to begin the dissection&#46; The magnetic anchor was attached to the gastric mucosa at the edge of the lesion&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "fig0035"
        "etiqueta" => "Figure 7"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr7.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Dissection stage&#44; showing the absence of the cap&#44; obtaining a better field of vision&#46;</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "fig0040"
        "etiqueta" => "Figure 8"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr8.jpeg"
            "Alto" => 1205
            "Ancho" => 905
            "Tamanyo" => 141638
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        "detalles" => array:1 [
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            "identificador" => "at0040"
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            "rol" => "short"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Specimen &#62; 5<span class="elsevierStyleHsp" style=""></span>cm retrieved in the <span class="elsevierStyleItalic">en bloc</span> resection of the lesion&#44; with the internal magnet <span class="elsevierStyleItalic">in situ&#46;</span></p>"
        ]
      ]
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        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">General population characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Magnet anchoring&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">No magnetic anchoring&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dissection tissue&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gastric 14 &#40;93&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;80&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Colonic 1 &#40;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean dissection size in mm &#40;range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;18 &#40;15-50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of cap&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">En bloc resection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Perforation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes 2 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No 8 &#40;80&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  """
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