Bora Keum, MD, PhD, from the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, in Seoul, Korea shares this VideoGIE case, “Efficacy of the magnetic marking clip method for preoperative localization of GI tumor.”

Various endoscopic localization methods for surgical resection of GI tumor have been suggested but there have been some controversies on the effectiveness and adverse events of those methods. We present a novel localization method for gastric and colonic tumor using the magnetic marking clip.

We have devised 2 magnetic marking clips (MMC), ring-type and rod-type, that are silicon-coated magnet fixed to an endoclip with nylon string. The MMC was applied on the center or margin of the tumor lesion during preoperative endoscopy. During surgery for tumor resection, another magnetic body with a long string was inserted into peritoneal space through a laparoscopic trocar and was used to detect the tumor location marked with the MMC.

We were trying to evaluate the effectiveness and safety of MMC method in 13 patients with gastric submucosal tumor and 12 patients with early colorectal cancer. And the exact location of their tumor lesions were not able to be recognized in laparoscopic view. The time required for detection ranged from 5 to 83 seconds in the stomach and 8 to 44 seconds in the colon. There were no patients experienced adverse events associated with the MMC procedure. The MMC method enabled simple and convenient tumor localization and showed excellent outcomes in accuracy of tumor localization for surgical resection.

Recently, laparoscopic surgery is mainly used to resect GI tumors; therefore, the importance of tumor localization has been well established. Without exact tumor localization, unnecessary excess tissue may be resected, or surgeons may not secure sufficient resection margins. There have been some reports on other localization methods, in which uncertain localization and complications including perforation were addressed. The MMC method showed simple performance and good result without any complications. The MMC method may be helpful to surgeons as well as physicians for performing accurate and easy tumor localization.

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