|
1
|
Shanshan W, Shuren W, Zongwang Z. Painkiller administration after endoscopic submucosal dissection surgery: a retrospective real-world study. Ann Med 2025; 57:2499698. [PMID: 40346960 PMCID: PMC12068328 DOI: 10.1080/07853890.2025.2499698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 03/19/2025] [Accepted: 04/07/2025] [Indexed: 05/12/2025] Open
Abstract
OBJECTIVES This study aimed to investigate the frequency of analgesic administration within 48 h after endoscopic submucosal dissection (ESD) or its derivative techniques across different segments of the digestive tract, as well as the timing of the initial analgesic administration. MATERIALS AND METHODS This retrospective observational study was built upon previous research. The primary outcomes assessed were the time to initial analgesic administration postoperatively and the frequency of analgesic use within 48 h after ESD surgery. Additionally, factors influencing painkiller administration in ESD patients were analyzed. RESULTS Of the 2162 patients included in the study, 570 (26.36%) required postoperative analgesic medications. Most patients required their initial analgesic within 8 h following ESD, with the highest demand observed within 2 h. Multivariate Cox regression analysis indicated that intraoperative administration of ketorolac reduced the likelihood of analgesic administration within 2 h postoperatively (hazard ratio [HR] = 0.35, 95% confidence interval [CI]: 0.15-0.79, p = 0.012). The time to first analgesic administration did not differ significantly among patients with varying surgical sites (H = 2.043, p = 0.843) or surgical methods (H = 8.647, p = 0.071). Similarly, no significant difference was observed in the frequency of analgesic use within 48 h across different surgical sites (H = 3.817, p = 0.576). However, patients who underwent endoscopic submucosal excavation (ESE) surgery exhibited a lower frequency of analgesic use compared to those who underwent endoscopic full-thickness resection (EFR) surgery (p = 0.038). CONCLUSIONS A subset of patients undergoing ESD exhibited a need for analgesics within the initial 48-hour postoperative period. Clinicians should carefully assess patients' pain needs and implement appropriate pain relief measures to improve postoperative outcomes. TRIAL REGISTRATION Chinese Clinical Trial Registry; ChiCTR2300072854.
Collapse
Affiliation(s)
- Wu Shanshan
- Department of Anesthesiology, Liaocheng People’s Hospital, Shandong University, Liaocheng, China
- Department of Anesthesiology, Liaocheng People’s Hospital, Liaocheng, China
| | - Wang Shuren
- Department of Anesthesiology, Liaocheng People’s Hospital, Shandong University, Liaocheng, China
| | - Zhang Zongwang
- Department of Anesthesiology, Liaocheng People’s Hospital, Shandong University, Liaocheng, China
- Department of Anesthesiology, Liaocheng People’s Hospital, Liaocheng, China
| |
Collapse
|
|
2
|
Zhou Y, Peng R, Chen X, Xie X, Chen J, Li R. The feasibility of endoscopic resection for esophageal gastrointestinal stromal tumor. Surg Endosc 2025; 39:3718-3726. [PMID: 40316748 DOI: 10.1007/s00464-025-11763-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Accepted: 04/20/2025] [Indexed: 05/04/2025]
Abstract
OBJECTIVES Esophageal gastrointestinal stromal tumor (e-GIST) is a rare type that is distinct from gastric GIST (g-GIST), and comprehensive studies are limited. The present study aims to compare the clinicopathological characteristics between e-GIST and g-GIST, evaluate the feasibility of using endoscopic resection (ER) to treat e-GIST, and explore its clinical implications. METHODS Patients with GISTs from January 2010 to May 2019 were enrolled in this study. Comprehensive clinicopathological, endoscopic, and follow-up data were collected and systematically analyzed. RESULTS There were 46 e-GIST patients and 366 g-GIST patients were enrolled. The distinct characteristics of e-GIST were as follows: (1) greater prevalence in male patients than in female patients, in contrast with the predominance of females among patients with g-GIST; (2) the median onset age was 61 years (range 20 to 80 years), with 58.7% of patients aged > 65 years in e-GIST; (3) the proportion of larger tumors was much more frequent in the esophagus; (4) greater incidence of ulceration/bleeding than in g-GIST; (5) increased mitotic count (≥ 5/50HPF). These factors collectively contribute to significantly shorter overall survival in e-GIST patients. Importantly, our analysis revealed that the outcomes of endoscopic resection (ER) were comparable to those of surgical resection for selected e-GISTs (tumor diameter ≤ 5 cm, without ulceration/bleeding, and mitotic count < 5/50HPF), with no significant differences in recurrence rate or survival time between these procedures. CONCLUSIONS This study highlights the distinct clinicopathological features of e-GIST from those of g-GIST with increased tumor size, ulceration/bleeding, and higher mitotic counts identified as significant prognostic factors. Our findings suggest that ER is a feasible and effective treatment approach for carefully selected e-GIST cases (tumor diameter ≤ 5 cm, without ulceration/bleeding), as assessed by endoscopic ultrasound (EUS). These results provide valuable insights for the management of this rare tumor subtype.
Collapse
Affiliation(s)
- Yanwu Zhou
- Department of Thoracic Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Ruyi Peng
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center of Digestive Diseases of Hunan Province, Changsha, China
| | - Xingcen Chen
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center of Digestive Diseases of Hunan Province, Changsha, China
| | - Xinxin Xie
- Department of Otolaryngology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jiefei Chen
- Department of Laboratory Medicine, Xiangya Medical School, Changsha, China
| | - Rong Li
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, China.
- Research Center of Digestive Disease, Central South University, Changsha, China.
- Clinical Research Center of Digestive Diseases of Hunan Province, Changsha, China.
| |
Collapse
|
|
3
|
Zhang AM, Jiang DM, Wang SP, Liu W, Sun BB, Wang Z, Zhou GY, Wu YF, Cai QY, Guo JT, Sun SY. Artificial intelligence-assisted endoscopic ultrasound diagnosis of esophageal subepithelial lesions. Surg Endosc 2025; 39:3821-3831. [PMID: 40335821 PMCID: PMC12116721 DOI: 10.1007/s00464-025-11767-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Accepted: 04/17/2025] [Indexed: 05/09/2025]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) is one of the most accurate methods for determining the originating layer of subepithelial lesions (SELs). However, the accuracy is greatly influenced by the expertise and proficiency of the endoscopist. In this study, we aimed to develop an artificial intelligence (AI) model to identify the originating layer of SELs in the esophagus and evaluate its efficacy. METHODS A total of 1445 cases of esophageal SELs were used to develop the model. An AI model stemming from YOLOv8s-seg and MobileNetv2 was developed to detect esophageal lesions and identify the originating layer. Two seniors and two junior endoscopists independently diagnosed the same test set. RESULTS The precision, recall, mean average precision @ 0.5, and F1-score of the AI model were 92.2%, 73.6%, 0.832, and 81.9%, respectively. The overall accuracy of the originating layer recognition model was 55.2%. The F1-scores of the second, third, and fourth layers were 47.1%, 51.7%, and 66.1%, respectively. The accuracy of the AI system in differentiating layers 2 and 3 from four was 76.5% and was similar to that of senior endoscopists (74.9-79.8%, P = 0.585) but higher than that of junior endoscopists (65.6-66.7%, P = 0.045). CONCLUSIONS The EUS-AI model has shown high diagnostic potential for detecting esophageal SELs and identifying their originating layers. EUS-AI has the potential to enhance the diagnostic ability of junior endoscopists in clinical practice.
Collapse
Affiliation(s)
- Ai-Meng Zhang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, Liaoning Province, China
| | - Dai-Min Jiang
- Research Center for Innovation, SonoScape Medical Corporation, Shenzhen, 518107, Guangdong Province, China
| | - Shu-Peng Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, Liaoning Province, China
| | - Wen Liu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, Liaoning Province, China
| | - Bei-Bei Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, Liaoning Province, China
| | - Zhe Wang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning Province, China
| | - Guo-Yi Zhou
- Research Center for Innovation, SonoScape Medical Corporation, Shenzhen, 518107, Guangdong Province, China
| | - Yao-Fu Wu
- Digital Information Development Department, SonoScape Medical Corporation, Shenzhen, 518107, Guangdong Province, China
| | - Qing-Yun Cai
- Product Management Department, SonoScape Medical Corporation, Shenzhen, 518107, Guangdong Province, China
| | - Jin-Tao Guo
- Department of Gastroenterology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, Liaoning Province, China.
- Engineering Research Center of Ministry of Education for Minimally Invasive, Gastrointestinal Endoscopic Techniques, Shenyang, 110004, Liaoning Province, China.
| | - Si-Yu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, Liaoning Province, China
- Engineering Research Center of Ministry of Education for Minimally Invasive, Gastrointestinal Endoscopic Techniques, Shenyang, 110004, Liaoning Province, China
| |
Collapse
|
|
4
|
Chen Y, Zhu X, Ding S, Chen M, Yang J, Deng K. Minimally invasive treatment strategies for submucosal tumors of the upper gastrointestinal tract: Advances in innovative endoscopy-based therapies. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109626. [PMID: 39874944 DOI: 10.1016/j.ejso.2025.109626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Revised: 01/01/2025] [Accepted: 01/18/2025] [Indexed: 01/30/2025]
Abstract
The increasing detection of submucosal tumors (SMTs) in the upper gastrointestinal tract (UGI) is due to the increased clinical use of endoscopy and imaging technology. Some of these SMTs have malignant potential and may cause clinical symptoms. Thus, it is recommended in clinical guidelines to consider resection of these SMTs. Endoscopic techniques have become widely used in the diagnosis and treatment of SMT in the UGI as compared with traditional surgery due to their advantages of minimally invasive, quick recovery, and economical cost. Recently, new endoscopic techniques and instruments have been continuously implemented, leading to revolutionary innovation in endoscopic treatments. However, the safety and efficacy of these innovative techniques remain unclear. Therefore, we have comprehensively summarized the various techniques used in the treatment of UGI tumors in recent years, evaluated the indications and effects of each technique, and compared their benefits and disadvantages. We hope that this review will provide a more comprehensive reference for clinical and endoscopic practitioners, and help them develop more individualized treatment plans for different patients. This will ultimately expand the patient population that can benefit from these innovative technologies.
Collapse
Affiliation(s)
- Yuxiang Chen
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xinrui Zhu
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Shasha Ding
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Mo Chen
- Department of Gerontology, Tibetan Chengdu Branch Hospital of West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; Department of Gerontology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, 610041, China
| | - Jinlin Yang
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Kai Deng
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
|
5
|
Zu QQ, You Y, Chen AZ, Wang XR, Zhang SH, Chen FL, Liu M. Combined application of the preclosure technique and traction approach facilitates endoscopic full-thickness resection of gastric submucosal tumors. World J Gastrointest Surg 2025; 17:95704. [PMID: 40162422 PMCID: PMC11948139 DOI: 10.4240/wjgs.v17.i3.95704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 10/04/2024] [Accepted: 11/04/2024] [Indexed: 02/24/2025] Open
Abstract
BACKGROUND Gastrointestinal submucosal tumors (SMTs) mostly grew in the lumen, but also some of the lesions were extraluminal, in which the stomach was the most common site. Gastrointestinal stromal tumor account for a large proportion of SMT. Due to the deep lesion location of gastric SMT, endoscopic submucosal dissection related techniques are difficult to operate, while endoscopic full-thickness resection (EFTR) has been widely used in clinical practice because it is less invasive and can preserve the physiological structure and function of the stomach. However, complete closure of the gastrectomy site after EFTR is critical. If the closure is incomplete, it may cause peritonitis, late perforation and other conditions, and even require further surgical intervention. Although there are currently a number of suture devices and techniques that can be used to promote closure, they have the problem of requiring additional equipment or being inconvenient to use. Although metal clips are widely used, their effectiveness depends on the size and tension of the defect. Therefore, an effective and convenient endoscopic closure technique is urgently needed to solve the closure problem of gastric SMTs after treatment. AIM To investigate the effect of combined application of the preclosure technique and dental floss traction in gastric wound closure following EFTR. METHODS In this study, the data of 94 patients treated for gastric SMTs at the Gastrointestinal Endoscopy Center of the Affiliated Union Hospital of Fujian Medical University from April 2022 to May 2023 were retrospectively analyzed. The patients were divided into a preclosure group (54 patients) and a non-preclosure group (40 patients) on the basis of the timing of wound closure with titanium clips after dental floss traction-assisted EFTR. Each patient in the preclosure group had their wounds preclosed with titanium clips after subtotal lesion resection, whereas each patient in the non-preclosure group had their wounds closed with titanium clips after total lesion resection. The lesion size, wound closure time, number of titanium clips used, incidence of postoperative complications, and postoperative hospitalization time were compared between the two groups. RESULTS The wound closure time was significantly shorter in the preclosure group than in the non-preclosure group (6.69 ± 2.109 minutes vs 11.65 ± 3.786 minutes, P < 0.001). The number of titanium clips used was significantly lower in the preclosure group (8.93 ± 2.231) than in the non-preclosure group (12.05 ± 4.495) (P < 0.001). There was no significant difference between the two groups in terms of the need for an indwelling gastric tube or the length of postoperative hospital stay (6.41 ± 1.31 vs 6.13 ± 1.06 days). For all patients in the preclosure group and the non-preclosure group, resection was completed successfully without bleeding, abdominal pain, abdominal distension, or other postoperative complications. CONCLUSION Application of the preclosure technique combined with dental floss traction can be used intraoperatively to effectively close the surgical wound in patients undergoing EFTR, reliably preventing the tumor from falling into the peritoneal cavity.
Collapse
Affiliation(s)
- Qing-Qing Zu
- Department of Gastrointestinal Endoscopy Nursing, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
- Fujian Clinical Research Center for Digestive System Tumors and Upper Gastrointestinal Diseases, Fuzhou 350001, Fujian Province, China
| | - Yan You
- Department of Gastrointestinal Endoscopy Nursing, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Ai-Zhi Chen
- Department of Gastrointestinal Endoscopy Nursing, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Xiu-Rong Wang
- Department of Gastrointestinal Endoscopy Nursing, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Si-Han Zhang
- Department of Gastroenterology, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Feng-Lin Chen
- Department of Gastroenterology, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
- Fujian Clinical Research Center for Digestive System Tumors and Upper Gastrointestinal Diseases, Fuzhou 350001, Fujian Province, China
| | - Miao Liu
- Department of Gastrointestinal Endoscopy Nursing, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| |
Collapse
|
|
6
|
Liu-Burdowski J, Park J. Treatment of Early Gastric Cancer. Surg Clin North Am 2025; 105:55-63. [PMID: 39523076 DOI: 10.1016/j.suc.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
Gastric cancer is a highly prevalent malignancy in Asia; however, its incidence is rising in the United States. Traditionally, methods of treatment include surgery and chemotherapy. Endoscopy has become an alternative method with a low recurrence rate when used to treat early gastric cancers. Endoscopic mucosal resection and endoscopic submucosal dissection are the 2 mainstay methods of endoscopy treatment. They are advantageous compared to surgery as they are less invasive and maintain anatomic integrity for the patient. However, lesion selection is crucial for success. In this article, the authors describe the 2 methods in detail in the treatment of early gastric cancers.
Collapse
Affiliation(s)
- Jennifer Liu-Burdowski
- Department of Gastroenterology, Danbury Hospital, Nuvance Health, 111 Osborne Street, Danbury, CT 06801, USA.
| | - Jiyoon Park
- Norwalk Hospital, Nuvance Health, 34 Maple Street, Norwalk, CT 06856, USA
| |
Collapse
|
|
7
|
Wei W, Zheng X, Ye Y, Li H, Hong Y, Cai J. Mucosal snare resection-endoscopic submucosal excavation for gastric submucosal tumors: a retrospective study (with video). Front Oncol 2025; 15:1534196. [PMID: 39926287 PMCID: PMC11802413 DOI: 10.3389/fonc.2025.1534196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Accepted: 01/02/2025] [Indexed: 02/11/2025] Open
Abstract
Aims This study aimed to compare the clinical outcomes of patients with submucosal tumors treated with endoscopic submucosal excavation (ESE) and those treated with mucosal snare resection-endoscopic submucosal excavation (MSR-ESE). Methods We retrospectively analyzed clinical data from patients who underwent ESE or MSR-ESE at the Second Affiliated Hospital of Zhejiang University School of Medicine between January 2023 and January 2024. Factors such as operation time, intraoperative perforation, postoperative adverse events, postoperative fasting time, antibiotic use, hospitalization duration, costs, and pathological diagnosis were compared between the two procedures. Results A total of 180 patients with submucosal tumors were included in this study. The MSR-ESE group consisted of 75 patients (41.7%), while the ESE group had 105 patients (58.3%). Propensity score matching (PSM) showed no significant differences in postoperative antibiotic use, fasting time, or intraoperative perforation between the two groups (P>0.05). However, the MSR-ESE group demonstrated shorter operation and hospitalization times, lower hospitalization costs, and a reduced incidence of postoperative peritonitis (P<0.05). Multivariate logistic regression analysis identified operation time as an independent risk factor for unplanned intraoperative perforation, with the likelihood of perforation increasing significantly as operation time increased (P=0.007, OR=1.015, 95% CI, 1.004 to 1.026). Conclusion MSR-ESE outperforms ESE with shorter operation times, lower costs, and fewer postoperative complications, making it a safe and effective treatment for gastric submucosal tumors.
Collapse
Affiliation(s)
- Wei Wei
- Department of Gastroenterology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaolong Zheng
- Department of Gastroenterology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yongli Ye
- Department of Gastroenterology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hongxia Li
- Department of Gastroenterology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yiping Hong
- Department of Gastroenterology, The Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Jianting Cai
- Department of Gastroenterology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
|
8
|
Chen Y, Chen M, Wang Z, Wu J, Yang J, Yang L, Deng K. Correlation of preoperative CT features with intra- and postoperative parameters of endoscopic resection in patients with gastric submucosal tumor (1~3 cm). Surg Endosc 2025; 39:259-268. [PMID: 39528660 DOI: 10.1007/s00464-024-11349-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 10/09/2024] [Indexed: 11/16/2024]
Abstract
OBJECTIVES Endoscopic resection of gastric submucosal tumors (SMTs) possesses minimal trauma, expedited recovery, and reduced costs. Nonetheless, intraoperative challenges, including imprecise surgical risk assessment, prevail. Hence, we investigated the correlation between preoperative CT observation features and perioperative parameters for predicting outcomes in SMT patients. METHODS Subjects diagnosed with SMT and undergoing endoscopic surgery conducted at West China Hospital's Endoscopy Center from September 2019 to October 2023 were retrospectively selected. Endoscopic ultrasonography (EUS) and computer tomography (CT) were utilized for evaluating SMT. The study assessed the correlation between preoperative CT findings and perioperative parameters. RESULTS Increased lesion size on contrast-enhanced CT correlates with increased operative duration, hospital stay, postoperative antibiotic use. Of utmost significance, we observed a significantly higher intraoperative perforation rate for patients with tumor outgrowth compared to those with lesion involvement of the lumen (96.88% vs 29.11%, P < 0.001). These patients also demonstrated an increased risk of postoperative blood stream infections (P = 0.012), necessitating higher antibiotic grade (P = 0.048), along with prolonged gastrostomy tube retention (P = 0.001) and hospitalization (P = 0.018). In addition, CT provides a more accurate and comprehensive assessment of tumor size (P = 0.037) and growth pattern (P = 0.026) than EUS. CONCLUSION CT assessment of tumor size closer to reality than EUS. Importantly, these features can assist in pinpointing lesions with elevated surgical complexity and high risk of complications, leading to improved preoperative preparation, thereby increasing anticipation of surgical risks and reducing incidence of complications.
Collapse
Affiliation(s)
- Yuxiang Chen
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Mo Chen
- Department of Gerontology, Tibetan Chengdu Branch Hospital of West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Gerontology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, 610041, China
| | - Zhu Wang
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Junchao Wu
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jinlin Yang
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Li Yang
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Kai Deng
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China.
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
|
9
|
Li P, Tang GM, Li PL, Zhang C, Wang WQ. Endoscopic resection of a giant irregular leiomyoma in fundus and cardia: A case report. World J Gastrointest Endosc 2024; 16:678-685. [PMID: 39735393 PMCID: PMC11669962 DOI: 10.4253/wjge.v16.i12.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 09/26/2024] [Accepted: 10/10/2024] [Indexed: 12/12/2024] Open
Abstract
BACKGROUND Endoscopic resection of giant gastric leiomyomas, particularly in the fundus and cardia regions, is infrequently documented and presents a significant challenge for endoscopic surgery. CASE SUMMARY Herein, a case of a 59-year-old woman with a giant gastric leiomyoma was reported. The patient presented to the department of hepatological surgery with a complaint of right upper abdominal pain for one month and worsening for one week. The patient was diagnosed as gastric submucosal tumor (SMT), gallstone, and cholecystitis combined with computed tomography and gastroendoscopy prior to operation. Upon admission, following a multi-disciplinary treatment discussion, it was determined that the patient would undergo a laparoscopic cholecystectomy and endoscopic resection of gastric SMT. It took 3 hours to completely resect the lesion by Endoscopic submucosal excavation and endoscopic full-thickness resection, and about 3 hours to suture the wound and take out the lesion. The lesion, ginger-shaped and measuring 8 cm × 5 cm, led to transient peritonitis post-surgery. With no cardiac complications, the patient was discharged one week after surgery. CONCLUSION Endoscopic resection of a giant leiomyoma in the cardiac fundus is feasible and suitable for skilled endoscopists.
Collapse
Affiliation(s)
- Peng Li
- Department of Gastroenterology, Central Hospital Affiliated to Chongqing University of Technology, Chongqing 400054, China
| | - Guang-Ming Tang
- Department of Gastroenterology, Central Hospital Affiliated to Chongqing University of Technology, Chongqing 400054, China
| | - Pei-Lin Li
- Department of Hepatological Surgery, Central Hospital Affiliated to Chongqing University of Technology, Chongqing 400054, China
| | - Chun Zhang
- Department of Pathology, Central Hospital Affiliated to Chongqing University of Technology, Chongqing 400054, China
| | - Wei-Qiang Wang
- Department of Gastroenterology, Central Hospital Affiliated to Chongqing University of Technology, Chongqing 400054, China
| |
Collapse
|
|
10
|
Ao J, Huang S, Liao S, Huang L, Zhong E, Zhao P, Wang D. Guidewire-assisted piecemeal resection of a giant gastric tumor. Endoscopy 2024; 56:E13-E14. [PMID: 38194981 PMCID: PMC10776273 DOI: 10.1055/a-2218-3297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Affiliation(s)
- Jixiang Ao
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Silin Huang
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Suhuan Liao
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Longbin Huang
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Erzhen Zhong
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Pengcheng Zhao
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Dongfang Wang
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| |
Collapse
|
|
11
|
Mendes RR, Mascarenhas A, Correia J, Estevinho MM, Pereira Rodrigues J, Conceição D, Saraiva S, Mão De Ferro S, Nascimento CN, Loureiro R, Costa MS, Gravito-Soares E, Chaves J, Libânio D, Dinis Ribeiro M, Archer S, Küttner Magalhães R, Bronze S, Noronha Ferreira C, Tarrio I, Araújo T, Barreiro P. Colorectal Endoscopic Full-Thickness Resection: A Portuguese Multicenter Experience Based on a Retrospective Cohort. GE - PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2024:1-9. [DOI: 10.1159/000541642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2025]
Abstract
Introduction: Endoscopic full-thickness resection (EFTR) is a minimally invasive endoscopic technique that allows the resection of complex colorectal lesions, such as non-lifting, peri-appendicular, peri-diverticula, and subepithelial lesions. Published data suggest that EFTR has a technical success and R0 resection rates of 89 and 79%, respectively, and an adverse event rate of 12%. This study summarizes the EFTR experience in nine Portuguese centers with regard to its efficacy and safety. Methods: This was a multicenter uncontrolled retrospective study, including 129 colorectal EFTRs between March 2017 and September 2023. The main outcomes were procedural and technical success, R0 resection, curative resection, adverse events, and recurrence rate. Results: 129 EFTR procedures were conducted, with a technical success rate of 88.4% (114/129). Most lesions were in the right colon, with a median resection size of 25 [10–45] mm. R0 and curative resection rates were 75.9% (85/112) and 58.0% (65/112), respectively. Adverse events occurred in 13.2% (17/129) of patients, mostly due to immediate perforation, appendicitis, or delayed bleeding, needing surgery in 5.4% (7/129). Local recurrence occurred in 5.4% (5/92) of resections. Conclusion: This real-life multicenter study highlights the utility of colorectal EFTR for management of complex and carefully chosen lesions, with an acceptable adverse events rate and need for surgery.
Collapse
|
|
12
|
Zhang H, Huang Z, Zhong Y, Su S. Clinical efficacy analysis of endoscopic band electrocision ligation surgical method in the treatment of small submucosal tumors of the gastric fundus. MINIM INVASIV THER 2024:1-9. [PMID: 39392255 DOI: 10.1080/13645706.2024.2413113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 09/22/2024] [Indexed: 10/12/2024]
Abstract
BACKGROUND The aim of this study was to compare and analyze the clinical effects of endoscopic submucosal dissection (ESD) and endoscopic band electrocision ligation (EEL) in the removal of gastric submucosal tumors (SMTs). METHOD We analyzed the clinical data of 130 patients with gastrointestinal SMTs (diameter ≤10 mm) who underwent endoscopic resection, including 62 cases in the EEL group and 68 in the ESD group, and compared indicators such as surgical time, intraoperative and postoperative complications, postoperative hospital stay, and surgical cost, between the EEL and ESD group. RESULTS EEL surgery time (8.9 ± 1.1 min) was significantly shorter than the ESD group (62.3 ± 2.8 min) (p < .05), EEL surgery cost (5126.8 ± 26.5 yuan) was significantly lower than the ESD group (15721.3 ± 39.6 yuan) (p < .05), and intraoperative blood loss was also markedly lower in the EEL group (5.6 ± 1.7 ml) compared to the ESD group (42.3 ± 3.5 ml) (p < .05). There was no statistically significant difference in postoperative hospitalization time or postoperative complication incidence between the two groups (p > .05). CONCLUSIONS In treating gastric muscular, mucosal, or submucosal tumors with a diameter of less than 10 mm, the EEL surgical method was superior to the ESD surgical method in terms of surgical time, intraoperative blood loss, and cost. There was no difference in hospital stay and postoperative complication rate between the two methods, which was worthy of clinical application.
Collapse
Affiliation(s)
- Hui Zhang
- Department of Gastroenterology, The Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, China
| | - Zhisheng Huang
- Department of Gastroenterology, The Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, China
| | - Yingyun Zhong
- Department of Gastroenterology, The Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, China
| | - Shuguang Su
- Department of Pathology, The Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, China
| |
Collapse
|
|
13
|
Costa C, Mesquita P, Estevinho M, Correia J, Rodrigues J, Freitas T. Appendiceal Submucosal Tumor: The Potential of Endoscopic Full-Thickness Resection in a Rare Entity. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2024; 31:367-369. [PMID: 39360174 PMCID: PMC11444662 DOI: 10.1159/000535226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/02/2023] [Indexed: 10/04/2024]
Affiliation(s)
- Catarina Costa
- Gastroenterology Department, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal
| | - Pedro Mesquita
- Gastroenterology Department, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal
| | - Manuela Estevinho
- Gastroenterology Department, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal
- Biomedicine Department, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Correia
- Gastroenterology Department, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal
| | - Jaime Rodrigues
- Gastroenterology Department, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal
| | - Teresa Freitas
- Gastroenterology Department, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal
| |
Collapse
|
|
14
|
Wang W, Wang J, Fan Z, He K. Concerns about the study of Yzet et al. on treatment of residual colorectal neoplasia after endoscopic resection. Endoscopy 2024; 56:722-723. [PMID: 39208789 DOI: 10.1055/a-2292-9059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Affiliation(s)
- Wanjun Wang
- Digestive Endoscopy Department and General Surgery Department, Jiangsu Province People's Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
- Gastroenterology Department, The Affiliated Changzhou No 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jiankun Wang
- Digestive Endoscopy Department and General Surgery Department, Jiangsu Province People's Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
| | - Zhining Fan
- Digestive Endoscopy Department and General Surgery Department, Jiangsu Province People's Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
| | - Kexin He
- Digestive Endoscopy Department and General Surgery Department, Jiangsu Province People's Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
| |
Collapse
|
|
15
|
Kormann S, Semadeni GM, Weber M, Brand S, Borovicka J, Frei R. Combining Endoscopic Submucosa Dissection and Endoscopic Full-Thickness Resection for Resection of a Gastric Schwannoma Mimicking Gastrointestinal Stroma Tumor. ACG Case Rep J 2024; 11:e01440. [PMID: 39040957 PMCID: PMC11262815 DOI: 10.14309/crj.0000000000001440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/14/2024] [Indexed: 07/24/2024] Open
Abstract
Subepithelial gastric tumors are a diagnostic challenge. Endoscopic ultrasound allows differentiation. Lesions originating from the submucosal layer can be resected using endoscopic submucosal dissection (ESD). Surgery or endoscopic full-thickness resection (EFTR) techniques are alternatives. We present a patient with an 11 × 8 mm submucosal tumor in the gastric antrum suggestive of a gastrointestinal stromal tumor, originating from the muscularis propria. Eventually endoscopic resection was performed, combining ESD and EFTR (hybrid ESD-EFTR). Contrary to expectations, histology revealed a gastric schwannoma. This case illustrates an efficient and safe endoscopic hybrid technique for the removal of submucosal gastric lesions.
Collapse
Affiliation(s)
- Stefan Kormann
- Department of Gastroenterology / Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Gian-Marco Semadeni
- Department of Gastroenterology / Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Matthias Weber
- Department of Pathology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Stephan Brand
- Department of Gastroenterology / Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jan Borovicka
- Department of Gastroenterology / Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Remus Frei
- Department of Gastroenterology / Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| |
Collapse
|
|
16
|
Li J, Xu D, Huang WF, Hong SK, Zhang JY. Efficacy and Safety of Endoscopic Resection for Gastric Gastrointestinal Stromal Tumors Originating from the Muscularis Propria. Dig Dis Sci 2024; 69:2184-2192. [PMID: 38653945 DOI: 10.1007/s10620-024-08359-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/13/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND The role of endoscopic resection (ER) in gastric gastrointestinal stromal tumors (GISTs) has not been fully elucidated. AIMS The purpose of this work was to evaluate the clinical effectiveness and safety of ER in patients with GISTs originating from the muscularis propria (MP). METHODS A total of 233 consecutive patients with gastric GISTs originating from the MP layer, who underwent ER between February 2012 and May 2023, were included in this study. Clinical characteristics, tumor features, and outcomes were recorded and compared between patients who underwent en bloc resection and piecemeal resection. RESULTS Among the 233 patients, the median size of GISTs was 12 mm (range 5-60 mm). Risk assessment categorized 190 patients as very low risk, 26 as low risk, 10 as moderate risk, and 7 as high risk. The procedures performed included endoscopic submucosal excavation (127 cases), endoscopic full-thickness resection (103 cases), and submucosal tunneling endoscopic resection (3 cases). The complete and R0 resection rate was 93.1%. Complications occurred in 4.7% of cases (perioperative perforations 1.7%, perioperative bleeding 1.3%, both 0.9%), resulting in conversion to surgery in 1.3% of cases. Risk factors associated with piecemeal resection were tumor size [odds ratio (OR) 0.402, 95% confidence interval (CI) 0.207-0.783; P = 0.007] and shape (OR 0.045, 95% CI 0.009-0.235; P < 0.001). CONCLUSIONS ER is proven to be an effective and reasonably safe approach for gastric GISTs originating from the MP. Notably, larger tumor size and irregular shape are identified as risk factors for piecemeal resection during ER procedures.
Collapse
Affiliation(s)
- Ji Li
- Department of Gastroenterology and Hepatology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China
| | - Dong Xu
- Department of Gastroenterology and Hepatology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China
| | - Wei-Feng Huang
- Department of Gastroenterology and Hepatology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China
| | - Shao-Kun Hong
- Department of General Surgery, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China
| | - Jin-Yan Zhang
- Department of Gastroenterology and Hepatology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China.
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
| |
Collapse
|
|
17
|
Akahoshi K, Tamura S, Akahoshi K, Shiratsuchi Y, Koga H, Oya M, Ohishi Y, Koga T. Efficacy and histologic frequencies of endoscopic ultrasonography-guided tissue acquisition using conventional fine-needle aspiration needles for gastric subepithelial hypoechoic mass. Australas J Ultrasound Med 2024; 27:89-96. [PMID: 38784701 PMCID: PMC11109998 DOI: 10.1002/ajum.12382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Introduction/Purpose For gastric subepithelial lesions (GSELs) showing a hypoechoic mass (HM) on endoscopic ultrasonography (EUS) imaging, the utility of EUS-guided tissue acquisition using conventional fine-needle aspiration needles (EUS-TA-CFNAN) and the frequency of histological types remain unclear. This study aimed to examine this issue. Methods This prospective observational study enrolled 291 consecutive patients who underwent EUS-TA-CFNAN for GSELs showing an HM (GSELHM) on EUS imaging. Immunohistochemical analysis was performed for all EUS-TA-CFNAN and surgically resected specimens. The main outcome measures were the technical results of EUS-TA-CFNAN and the frequency of histological types in GSELHM. Results The endoscopic ultrasound-guided tissue acquisition using conventional fine-needle aspiration needle diagnosis rate for GSELHM was 80.1% (95% confidence interval [CI]: 75.0-84.5, 233/291). It was significantly lower for antrum (P = 0.004) and lesions smaller than 2 cm (P = 0.003). There were no adverse events. The immunohistochemical diagnoses of EUS-TA-CFNAN included 149 cases of gastrointestinal stromal tumour (GIST) (51.2%), 48 cases of leiomyoma (16.5%), 11 cases of schwannoma (3.8%), 8 cases of the ectopic pancreas (2.7%), 5 cases of subepithelial lesion like cancer (1.7%), 12 cases of other lesions (4.1%), and 58 cases of undiagnosable lesions (19.9%). The frequency of malignant or potentially malignant tumour in GSELHM was 55.0% (95% CI: 49.1-60.8, 160/291). Surgery was performed in 149 patients according to the conclusive EUS-TA-CFNAN results, in which the diagnostic accuracy of EUS-TA-CFNAN was 97.3% (95% CI: 94.7-99.9, 145/149). Conclusion The use of EUS-TA-CFNAN for GSELHMs is safe and accurate. Gastric subepithelial lesions showing a hypoechoic mass have a reasonably high possibility of containing malignant or potentially malignant tumours, including GISTs.
Collapse
Affiliation(s)
| | | | | | | | - Hidenobu Koga
- Clinical Research Support OfficeAso Iizuka HospitalIizukaJapan
| | - Masafumi Oya
- Department of PathologyAso Iizuka HospitalIizukaJapan
| | | | - Tadashi Koga
- Department of SurgeryAso Iizuka HospitalIizukaJapan
| |
Collapse
|
|
18
|
Wen XP, Wan QQ. Nomogram to predict gas-related complications during transoral endoscopic resection of upper gastrointestinal submucosal lesions: Clinical significance. World J Gastrointest Endosc 2024; 16:5-10. [PMID: 38313461 PMCID: PMC10835473 DOI: 10.4253/wjge.v16.i1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/13/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024] Open
Abstract
Transoral endoscopic resections in treating upper gastrointestinal submucosal lesions have the advantages of maintaining the integrity of the gastrointestinal lumen, avoiding perforation and reducing gastrointestinal fistulae. They are becoming more widely used in clinical practice, but, they may also present a variety of complications. Gas-related complications are one of the most common, which can be left untreated if the symptoms are mild, but in severe cases, they can lead to rapid changes in the respiratory and circulatory systems in a short period, which can be life-threatening. Therefore, it is important to predict the occurrence of gas-related complications early and take preventive measures actively. Based on the authors' results in the prepublication of the article "Nomogram to predict gas-related complications during transoral endoscopic resection of upper gastrointestinal submucosal lesions," and in conjunction with our evaluation and additions to the relevant content, radiographs may help screen patients at high risk for gas-related complications. Controlling blood glucose levels, shortening the duration of surgery, and choosing the most appropriate surgical resection may positively impact the prognosis of patients at high risk for gas-related complications during transoral endoscopic resection of upper gastrointestinal submucosal lesions.
Collapse
Affiliation(s)
- Xu-Peng Wen
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Qi-Quan Wan
- Department of Transplant Surgery, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| |
Collapse
|
|
19
|
Novel Sequence of Endoscopic Therapy for the Management of Colonic Adenocarcinoma and Surrounding Adenoma. ACG Case Rep J 2023; 10:e01008. [PMID: 36891183 PMCID: PMC9988281 DOI: 10.14309/crj.0000000000001008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
An 80-year-old man with a history of an orthotopic heart transplant was found to have a 25 × 40 mm centrally ulcerated mass at the hepatic flexure during evaluation of anemia. Owing to comorbidities, the patient was deemed to be a poor surgical candidate and was referred to the advanced endoscopy team to explore palliative and potentially curative options. We present a novel sequence of intervention involving full-thickness resection with subsequent morcellation clean-up to achieve complete endoscopic removal of a neoplastic lesion.
Collapse
|
|
20
|
Wu ZW, Ding CH, Song YD, Cui ZC, Bi XQ, Cheng B. Colon Sparing Endoscopic Full-Thickness Resection for Advanced Colorectal Lesions: Is It Time for Global Adoption? Front Oncol 2022; 12:967100. [PMID: 35912240 PMCID: PMC9327091 DOI: 10.3389/fonc.2022.967100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
The majority of colon lesions are <10 mm in size and are easily resected by endoscopists with appropriate basic training. Lesions ≥10 mm in size are difficult to remove technically and are associated with higher rates of incomplete resection. Currently, the main endoscopic approaches include endoscopic mucosal resection (EMR) for lesions without submucosal invasion, and endoscopic submucosal dissection (ESD) for relatively larger lesions involving the superficial submucosal layer. Both of these approaches have limitations, EMR cannot reliably ensure complete resection for larger tumors and recurrence is a key limitation. ESD reliably provides complete resection and an accurate pathological diagnosis but is associated with risk such as perforation or bleeding. In addition, both EMR and ESD may be ineffective in treating subepithelial lesions that extend beyond the submucosa. Endoscopic full-thickness resection (EFTR) is an emerging innovative endoscopic therapy which was developed to overcome the limitations of EMR and ESD. Advantages include enabling a transmural resection, complete resection of complex colorectal lesions involving the mucosa to the muscularis propria. Recent studies comparing EFTR with current resection techniques and radical surgery for relatively complicated and larger lesion have provided promising results. If the current trajectory of research and development is maintained, EFTR will likely to become a strong contender as an alternative standard of care for advanced colonic lesions. In the current study we aimed to address this need, and highlighted the areas of future research, while stressing the need for multinational collaboration provide the steppingstone(s) needed to bring EFTR to the mainstream.
Collapse
Affiliation(s)
- Zhong-Wei Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chao-Hui Ding
- Department of Emergency Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yao-Dong Song
- Department of Emergency Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zong-Chao Cui
- Department of Emergency Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiu-Qian Bi
- Department of Emergency Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo Cheng
- Department of Emergency Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Bo Cheng,
| |
Collapse
|