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Wang SS, Ji MY, Huang X, Li YX, Yu SJ, Zhao Y, Shen L. Double-nylon purse-string suture in closing postoperative wounds following endoscopic resection of large (≥ 3 cm) gastric submucosal tumors. World J Gastroenterol 2024; 30:1143-1153. [PMID: 38577185 PMCID: PMC10989488 DOI: 10.3748/wjg.v30.i9.1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/04/2024] [Accepted: 02/02/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Endoscopic full-thickness resection (EFTR) of gastric submucosal tumors (SMTs) is safe and effective; however, postoperative wound management is equally important. Literature on suturing following EFTR for large (≥ 3 cm) SMTs is scarce and limited. AIM To evaluate the efficacy and clinical value of double-nylon purse-string suture in closing postoperative wounds following EFTR of large (≥ 3 cm) SMTs. METHODS We retrospectively analyzed the data of 85 patients with gastric SMTs in the fundus of the stomach or in the lesser curvature of the gastric body whose wounds were treated with double-nylon purse-string sutures after successful tumor resection at the Endoscopy Center of Renmin Hospital of Wuhan University. The operative, postoperative, and follow-up conditions of the patients were evaluated. RESULTS All tumors were completely resected using EFTR. 36 (42.35%) patients had tumors located in the fundus of the stomach, and 49 (57.65%) had tumors located in the body of the stomach. All patients underwent suturing with double-nylon sutures after EFTR without laparoscopic assistance or further surgical treatment. Postoperative fever and stomach pain were reported in 13 (15.29%) and 14 (16.47%) patients, respectively. No serious adverse events occurred during the intraoperative or postoperative periods. A postoperative review of all patients revealed no residual or recurrent lesions. CONCLUSION Double-nylon purse-string sutures can be used to successfully close wounds that cannot be completely closed with a single nylon suture, especially for large (≥ 3 cm) EFTR wounds in SMTs.
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Affiliation(s)
- Shan-Shan Wang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei province, China
| | - Meng-Yao Ji
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei province, China
| | - Xu Huang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei province, China
| | - Yan-Xia Li
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei province, China
| | - Shi-Jie Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei province, China
| | - Yu Zhao
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei province, China
| | - Lei Shen
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei province, China
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Li X, He J, Zhu Z, Xiao Y, Jiang Y, Cheng Q, Hu Y. The value of single-channel endoscopic traction and kiss suture technique in closing wounds caused by endoscopic resection of gastrointestinal muscularis propria tumors. Surg Endosc 2023; 37:7709-7716. [PMID: 37563343 DOI: 10.1007/s00464-023-10277-6] [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: 03/30/2023] [Accepted: 07/02/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND To investigate the value of single forceps endoscopic traction stapling suture technique (SFETSST) in closing wounds caused by endoscopic resection of gastrointestinal muscularis propria tumor (GMPT). METHODS Consecutive patients who underwent submucosal tumor excavation (ESE) and endoscopic full-thickness resection (EFR) for GMPT in the Second Affiliated Hospital of Xiamen Medical College from January 2015 to January 2022 were retrospectively collected. They were divided into the SFETSST group and the standard group (patients who receive single forceps traction-free endoscopic suture technique). The healing effects were compared between the two groups. RESULTS Seventy-seven patients were included in our study with 50 patients included in SFETSST group. The baseline characteristics had no significant difference between the two groups. The technical success rate of wound suture in SFETSST cluster was significantly upper than that within standard cluster (100% vs. 88.89%, P = 0.04). The wound suture time in SFETSST cluster was significantly lower than that within standard cluster (33.19 ± 10.64 min, P < 0.001). Moreover, the incidence rates of intra-operative and postoperative complications in SFETSST cluster were lower than standard cluster (0 vs. 7.41%, P = 0.051 and 0 vs. 11.11%, P = 0.016). Interestingly, the SFETSST cluster had lower cost of consumables (2485.40 ± 591.78 vs. 4098.52 ± 1903.06 Yuan, P = 0.01) and shorter hospital stay (4.96 ± 0.90 vs. 7.19 ± 2.45, P < 0.001) than standard cluster. CONCLUSION Our study showed that to fully closure the full-thickness defects of digestive tract, SFETSST was effective, safe, and economical, which was worth popularizing.
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Affiliation(s)
- Xiaohua Li
- Department of Gastroenterology, The Second Affiliated Hospital of Xiamen Medical College, No. 566 Jimei Shengguang Road, Xiamen, 361021, Fujian, China.
| | - Jie He
- Department of Gastroenterology, The Second Affiliated Hospital of Xiamen Medical College, No. 566 Jimei Shengguang Road, Xiamen, 361021, Fujian, China
| | - Zhongmei Zhu
- Department of Gastroenterology, The Second Affiliated Hospital of Xiamen Medical College, No. 566 Jimei Shengguang Road, Xiamen, 361021, Fujian, China
| | - Yaxuan Xiao
- Department of Gastroenterology, The Second Affiliated Hospital of Xiamen Medical College, No. 566 Jimei Shengguang Road, Xiamen, 361021, Fujian, China
| | - Yuecui Jiang
- Department of Gastroenterology, The Second Affiliated Hospital of Xiamen Medical College, No. 566 Jimei Shengguang Road, Xiamen, 361021, Fujian, China
| | - Qinghong Cheng
- Department of Gastroenterology, The Second Affiliated Hospital of Xiamen Medical College, No. 566 Jimei Shengguang Road, Xiamen, 361021, Fujian, China
| | - Youzhen Hu
- Department of Gastroenterology, The Second Affiliated Hospital of Xiamen Medical College, No. 566 Jimei Shengguang Road, Xiamen, 361021, Fujian, China
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Du C, He Z, Li L, Ning B, Zhang B, Zhai Y, Ma Y, Han K, Wang H, Tang P, Chai N, Linghu E. Endoscopic resection for the treatment of non-gastric gastrointestinal stromal tumors: A retrospective study from a large tertiary hospital in China. Clin Res Hepatol Gastroenterol 2023; 47:102152. [PMID: 37257690 DOI: 10.1016/j.clinre.2023.102152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/14/2023] [Accepted: 05/29/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND AIMS Few studies on endoscopic resection (ER) for the treatment of non-gastric gastrointestinal (GI) stromal tumors (GISTs) have been conducted, and most have been case reports or case series. The aim of this study was to evaluate the effectiveness and safety of ER for non-gastric GISTs. METHODS From January 2010 to December 2022, 329 patients who were diagnosed with GISTs underwent ER. After excluding 302 patients with gastric GISTs, we retrospectively assessed the data of 27 patients with non-gastric GISTs. The main outcome measures were en bloc resection, complete resection, residual disease, recurrence, and complications. RESULTS A total of 15(55.6%) females and 12(44.4%) males with a mean age of 53.8 ± 11.0 years were assessed. There were 19 (70.4%) GISTs in the esophagus, 2 (7.4%) in the duodenum, 3 (11.1%) in the colon and 3 (11.1%) in the rectum. The median tumor size was 12.0 mm (range 4.0-35.0 mm). Most of the GISTs (20, 74.1%) were very low risk, and the remaining 7(25.9%) were low risk. Both en bloc resection and complete resection were achieved in 25(92.6%) patients. Piecemeal resection mainly resulted from a larger tumor size, an irregular shape, and an extraluminal growth pattern. No residual disease or recurrence was noted during the follow-up period. The median operation time was 23 min (range 2-125 min). After excluding the operation time of EER, the operation time was prolonged to 37 min (range 12-125 min). Only one patient experienced mild abdominal pain, leading to a complication rate of 3.7%. No severe complications requiring for surgical interventions occurred. CONCLUSION ER was an effective and safe method for non-gastric GISTs in selected cases. GISTs of a small size and regular shape with an intraluminal growth pattern require complete resection.
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Affiliation(s)
- Chen Du
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Zhengting He
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Longsong Li
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Bo Ning
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Bo Zhang
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Yaqi Zhai
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Yan Ma
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Ke Han
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Hongbin Wang
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Ping Tang
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Ningli Chai
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China.
| | - Enqiang Linghu
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China.
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Kahaleh M, Bhagat V, Dellatore P, Tyberg A, Sarkar A, Shahid HM, Andalib I, Alkhiari R, Gaidhane M, Kedia P, Nieto J, Kumta NA, Dixon RE, Salameh H, Mavrogenis G, Bassioukas S, Abe S, Arentes VN, Morita FH, Sakai P, de Moura EG. Subepithelial tumors: How does endoscopic full-thickness resection & submucosal tunneling with endoscopic resection compare with laparoscopic endoscopic cooperative surgery? Endosc Int Open 2022; 10:E1491-E1496. [PMID: 36397865 PMCID: PMC9666078 DOI: 10.1055/a-1922-7890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/10/2022] [Indexed: 10/15/2022] Open
Abstract
Background and study aims Endoscopic techniques are rapidly emerging for resection of subepithelial tumors (SETs). Submucosal tunneling for endoscopic resection (STER), endoscopic full-thickness resection (EFTR) and laparoscopic endoscopic cooperative surgery (LECS) are current alternatives to open surgery. In this study, we aimed to compare the three endoscopic techniques. Patients and methods Consecutive patients who underwent resection of a submucosal esophageal or gastric lesion at several tertiary care centers were included in a dedicated registry over 3 years. Demographics, size and location of resected lesion, histology of specimen, length of procedure, adverse events (AEs), duration of hospital stay, and follow-up data were collected. Results Ninety-six patients were included (47.7 % male, mean age 62): STER n = 34, EFTR n = 34, LECS n = 280. The lesions included leiomyoma, gastrointestinal stromal tumors (GISTs) and other. The mean lesion size was 28 mm (STD 16, range 20-72 mm). The majority of lesions in the EFTR and laparoscopic-assisted resection group were GISTs. There was no significant difference in clear resection margins, post-procedure complication rates, recurrence rate and total follow-up duration between the groups. However, the LECS group had a procedure time at least 30 minutes longer than STER or EFTR ( P < 0.01). Total hospital stay for the laparoscopic-assisted resection group was also longer when compared to STER (1.5) and EFTR (1.8) ( P < 0.01). Conclusions STER, EFTR, and laparoscopic-assisted resection are efficacious approaches for resection of SETs with similar R0 resection rates, complication rates, and AE rates. Laparoscopic assisted resection appears more time-consuming and is associated with a longer hospital stay.
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Affiliation(s)
- Michel Kahaleh
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Vicky Bhagat
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Peter Dellatore
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Amy Tyberg
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Avik Sarkar
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Haroon M. Shahid
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Iman Andalib
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Resheed Alkhiari
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Monica Gaidhane
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Prashant Kedia
- Gastroenterology, Methodist Hospital, Dallas, Texas, United States
| | - Jose Nieto
- Borland-Groover Clinic, Jacksonville, Florida, United States
| | - Nikhil A. Kumta
- Gastroenterology, Mount Sinai Hospital, New York, New York, United States
| | - Rebekah E. Dixon
- Gastroenterology, Mount Sinai Hospital, New York, New York, United States
| | - Habeeb Salameh
- Gastroenterology, Mount Sinai Hospital, New York, New York, United States
| | | | | | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Flavio H. Morita
- Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Paulo Sakai
- Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Pal P, Ramchandani M, Inavolu P, Reddy DN, Tandan M. Endoscopic Full Thickness Resection: A Systematic Review. JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0042-1755304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Abstract
Background Endoscopic full thickness resection (EFTR) is an emerging therapeutic option for resecting subepithelial lesions (SELs) and epithelial neoplasms. We aimed to systematically review the techniques, applications, outcomes, and complications of EFTR.
Methods A systematic literature search was performed using PubMed. All relevant original research articles involving EFTR were included for the review along with case report/series describing novel/rare techniques from 2001 to February 2022.
Results After screening 7,739 citations, finally 141 references were included. Non-exposed EFTR has lower probability of peritoneal contamination or tumor seeding compared with exposed EFTR. Among exposed EFTR, tunneled variety is associated with lower risk of peritoneal seeding or contamination compared with non-tunneled approach. Closure techniques involve though the scope (TTS) clips, loop and clips, over the scope clips (OTSC), full thickness resection device (FTRD), and endoscopic suturing/plicating/stapling devices. The indications of EFTR range from esophagus to rectum and include SELs arising from muscularis propria (MP), non-lifting adenoma, recurrent adenoma, and even early gastric cancer (EGC) or superficial colorectal carcinoma. Other indications include difficult locations (involving appendicular orifice or diverticulum) and full thickness biopsy for motility disorders. The main limitation of FTRD is feasibility in smaller lesions (<20–25 mm), which can be circumvented by hybrid EFTR techniques. Oncologic resection with lymphadencetomy for superficial GI malignancy can be accomplished by hybrid natural orifice transluminal endoscopic surgery (NOTES) combining EFTR and NOTES. Bleeding, perforation, appendicitis, enterocolonic fistula, FTRD malfunction, peritoneal tumor seeding, and contamination are among various adverse events. Post OTSC artifacts need to be differentiated from recurrent/residual lesions to avoid re-FTRD/surgery.
Conclusion EFTR is safe and effective therapeutic option for SELs, recurrent and non-lifting adenomas, tumors in difficult locations and selected cases of superficial GI carcinoma.
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Affiliation(s)
- Partha Pal
- Department of Interventional Endoscopy, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Mohan Ramchandani
- Department of Interventional Endoscopy, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Pradev Inavolu
- Department of Interventional Endoscopy, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Duvvuru Nageshwar Reddy
- Department of Interventional Endoscopy, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Manu Tandan
- Department of Interventional Endoscopy, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
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Meng X, Hu YF, Mao XL, Zheng HH, Zhou SK, Zhang Y. Clinical outcomes of endoscopic versus laparoscopic resection for senile patients with gastric gastrointestinal stromal tumours (2 to 4 cm) originating from the muscularis propria layer. PRZEGLAD GASTROENTEROLOGICZNY 2022; 17:196-202. [PMID: 36127936 PMCID: PMC9475475 DOI: 10.5114/pg.2022.118463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 07/13/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Currently, there still are no selection criteria for endoscopic resection (ER) versus laparoscopic resection (LR) of gastric gastrointestinal stromal tumours (GIST) (2 to 4 cm) originating from the muscularis propria layer (MP-GISTs). AIM To investigate and compare the long-term prognosis of ER and LR for resecting gastric MP-GISTs, with at least 5 years of follow-up. MATERIAL AND METHODS Between January 2010 and December 2015, 134 patients with gastric MP-GISTs were consecutively enrolled in this study. The main comparison measurements included the short-term and long-term outcomes between the ER group (n = 89) and the LR group (n = 45). RESULTS In this study, there were no significant differences in the rates of complete resection (p = 0.220) and short-term complications (p = 0.663) between the ER group and the LR group. The ER group had a shorter operation time (50.1 ±18.2 min vs. 120.6 ±32.5 min, p < 0.001), shorter hospital stays (5.1 ±1.9 days vs. 6.4 ±3.7 days, p = 0.026), and lower hospitalization costs (16639.5 ±5091.3 CNY vs. 24030.4 ±6803.1 CNY, p < 0.001) than the LR group. The ER group had a lower rate of long-term complications than the LR group (p = 0.001) during the follow-up period (84.2 ±17.9 months vs. 89.0 ±16.8 months, p = 0.207). CONCLUSIONS Our results showed that ER was a more feasible treatment approach than LR when the gastric MP-GIST was located in or near the cardia/pylorus. ER also had several other advantages over LR, such as a shorter procedure time, shorter hospital stay, and lower hospitalization costs.
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Affiliation(s)
- Xi Meng
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang Province, China
| | - Yun-Fei Hu
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang Province, China
| | - Xin-Li Mao
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang Province, China
- Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, Zhejiang Province, China
| | - Hai-Hong Zheng
- Department of Pathology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, Zhejiang Province, China
| | - Shen-Kang Zhou
- Department of Gastrointestinal Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, Zhejiang Province, China
| | - Yu Zhang
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang Province, China
- Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, Zhejiang Province, China
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Dalal I, Andalib I. Advances in endoscopic resection: a review of endoscopic submucosal dissection (ESD), endoscopic full thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER). Transl Gastroenterol Hepatol 2022; 7:19. [PMID: 35548477 PMCID: PMC9081920 DOI: 10.21037/tgh-2020-10] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/21/2020] [Indexed: 08/30/2023] Open
Abstract
Subepithelial lesions are often detected incidentally in patients undergoing an endoscopy. They are common tumors of the gastrointestinal (GI) tract which can originate from different layers of the GI tract wall. These lesions can be further classified based on GI layer of origin and unique histochemical staining. While most are benign and asymptomatic, some of these lesions have malignant potential with distant metastases. However, current diagnostic modalities including endoscopy with biopsy or endoscopic ultrasound with fine needle aspiration are not always reliable. In addition, management of these lesions has historically involved surgical resection via open or laparoscopic approaches. In recent years, with advancement in endoscopic techniques and improvement in endoscopists' skills, less invasive procedures such as endoscopic submucosal dissection (ESD), endoscopic full thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER) have been developed and now are being used by endoscopists worldwide. Upon reviewing the literature, multiple studies have shown the advantages of these endoscopic techniques when compared with surgical treatment. As a result, there has been a dramatic shift towards minimally invasive endoscopic procedures for the management of these subepithelial lesions. In this review article, we will discuss these endoscopic resection techniques in detail, their safety and efficacy, as well as comparison studies to other therapeutic modalities.
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Affiliation(s)
- Ishita Dalal
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson, New Brunswick, New Jersey, USA
| | - Iman Andalib
- Department of Gastroenterology and Hepatology, Mount Sinai South Nassau, Oceanside, New York, USA
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Granata A, Martino A, Ligresti D, Zito FP, Amata M, Lombardi G, Traina M. Closure techniques in exposed endoscopic full-thickness resection: Overview and future perspectives in the endoscopic suturing era. World J Gastrointest Surg 2021; 13:645-654. [PMID: 34354798 PMCID: PMC8316845 DOI: 10.4240/wjgs.v13.i7.645] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/29/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023] Open
Abstract
Exposed endoscopic full-thickness resection (EFTR) without laparoscopic assistance is a minimally invasive natural orifice transluminal endoscopic surgery technique that is emerging as a promising effective and safe alternative to surgery for the treatment of muscularis propria-originating gastric submucosal tumors. To date, various techniques have been used for the closure of the transmural post-EFTR defect, mainly consisting in clip- and endoloop-assisted closure methods. However, the recent advent of dedicated tools capable of providing full-thickness defect suture could further improve the efficacy and safety of the exposed EFTR procedure. The aim of our review was to evaluate the efficacy and safety of the different closure methods adopted in gastric-exposed EFTR without laparoscopic assistance, also considering the recent advent of flexible endoscopic suturing.
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Affiliation(s)
- Antonino Granata
- Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo 90127, Italy
| | - Alberto Martino
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Dario Ligresti
- Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo 90127, Italy
| | - Francesco Paolo Zito
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Michele Amata
- Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo 90127, Italy
| | - Giovanni Lombardi
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Mario Traina
- Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo 90127, Italy
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Perales J, Visrodia K, Sethi A. Managing endoscopic challenges on the road to resect a large ulcerated gastric GI stromal tumor. VideoGIE 2021; 6:219-221. [PMID: 34027252 PMCID: PMC8117606 DOI: 10.1016/j.vgie.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jorge Perales
- Columbia University Medical Center, New York Presbyterian Hospital, New York, New York
| | - Kavel Visrodia
- Columbia University Medical Center, New York Presbyterian Hospital, New York, New York
| | - Amrita Sethi
- Columbia University Medical Center, New York Presbyterian Hospital, New York, New York
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10
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Jung AL, Park SW, Hong GY, Moon HC, Eun SJ. Endoscopic Full-Thickness Resection for Gastric Subepithelial Lesions Arising from the Muscularis Propria. Clin Endosc 2020; 54:131-135. [PMID: 32819051 PMCID: PMC7939773 DOI: 10.5946/ce.2020.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/21/2020] [Indexed: 12/17/2022] Open
Abstract
Most cases of gastric subepithelial lesions follow a good clinical course; however, some lesions progress to malignant tumors, and treatment of tumors with a high risk of malignancy is essential. Surgical excision has been the primary treatment for tumors originating from the propria muscle layer, but it has the disadvantages of being invasive and causing postoperative functional abnormalities. With the development of endoscopic techniques and instruments, the role of endoscopic resection, which is a less invasive method for the removal of gastric subepithelial lesions, has been attracting attention. We performed an endoscopic full-thickness resection for 8 patients with gastric subepithelial lesions originating from the muscularis propria. No fatal complications occurred. Our findings suggest the need to develop various devices for resection and closure and to accumulate further experience through additional studies to prevent complications and specimen loss.
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Affiliation(s)
- Ah Lon Jung
- Division of Gastroenterology, Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Sang Wook Park
- Division of Gastroenterology, Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Gun Young Hong
- Division of Gastroenterology, Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Hyeong Chul Moon
- Division of Gastroenterology, Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Seo Joon Eun
- Division of Gastroenterology, Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
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Liu AQ, Chiu PWY. Third space endoscopy: Current evidence and future development. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2020; 9:42-52. [DOI: 10.18528/ijgii200007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/04/2025] Open
Affiliation(s)
- Alex Qinyang Liu
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Philip Wai Yan Chiu
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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12
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Li LY, Li BW, Mekaroonkamol P, Chen HM, Shen SS, Luo H, Dacha S, Xue Y, Cristofaro S, Keilin S, Willingham F, Cai Q. Mucosectomy device-assisted endoscopic resection of gastric subepithelial lesions. J Dig Dis 2020; 21:215-221. [PMID: 32129564 DOI: 10.1111/1751-2980.12856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Some gastrointestinal subepithelial tumors (SETs) have malignant potential and complete resection may be required. However, endoscopic submucosal dissection (ESD) can be a tedious procedure and requires a long and extensive training to master. Devices for endoscopic full-thickness resection (EFTR) are limited and are not widely available. We report here a simpler endoscopic method to resect small SETs using a commercially available endoscopic mucosal resection (EMR) kit and enucleation technique. METHODS All patients with SET who underwent device-assisted resection at our tertiary care hospital from April 2015 to November 2016 were enrolled in this retrospective study. All procedures were performed by a single expert endoscopist with an advanced endoscopy trainee. A mucosectomy and a limited dissection under mucosa were performed to preserve the mucosa before a device-assisted enucleation of the tumor to facilitate endoscopic closure of the defect closure in all cases. RESULTS A total of 12 patients aged 38-70 y, of whom six were males, were included. Most of the tumors originated from the muscularis propria and were located at the proximal gastric body. The mean procedural duration was 53 minutes (range 23-91 min). The average size of the lesions was 13 mm (range 9-21 mm). The mean duration of hospitalization was 1.3 days. Bleeding and intentional perforation were all successfully managed during the procedure and did not result in any clinically significant adverse event. CONCLUSION A device-assisted EFTR using a commercially available EMR kit is a safe and feasible method for the endoscopic resection of small gastric extrovert SETs.
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Affiliation(s)
- Lian Yong Li
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.,Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bai Wen Li
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.,Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Parit Mekaroonkamol
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Hui Min Chen
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.,Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shan Shan Shen
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.,Department of Gastroenterology, Drum Tower Hospital affiliated to the Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Hui Luo
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.,Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Sunil Dacha
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Yue Xue
- Department of Pathology, Emory University School of Medicine, Atlanta, GA
| | - Sarah Cristofaro
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Steven Keilin
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Field Willingham
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Qiang Cai
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
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13
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Resection of the gastric submucosal tumor (G-SMT) originating from the muscularis propria layer: comparison of efficacy, patients' tolerability, and clinical outcomes between endoscopic full-thickness resection and surgical resection. Surg Endosc 2020; 34:4053-4064. [PMID: 32016516 PMCID: PMC7394934 DOI: 10.1007/s00464-019-07311-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/28/2019] [Indexed: 02/06/2023]
Abstract
Background and aims Endoscopic full-thickness resection (EFTR) has been increasingly applied in the treatment of gastric submucosal tumors (G-SMTs) with explorative intention. This study aimed to compare the efficacy, tolerability, and clinical outcomes of EFTR and surgical intervention for the management of muscularis propria (MP)-derived G-SMTs. Methods Between September 2011 and May 2019, the clinical records of patients with MP-derived G-SMTs undergoing EFTR at our endoscopic unit were collected. A cohort of people with primary MP-derived G-SMTs treated by surgery was matched in a 1:1 ratio to EFTR group with regard to patients’ baseline characteristics, clinicopathologic features of the tumor and the procedure date. The perioperative outcomes and follow-up data were analyzed. Results In total, 62 and 62 patients were enrolled into the surgery and EFTR group, respectively, with median follow-up of 786 days. The size of G-SMTs (with ulceration) ranged from 10 to 90 mm. For patients with tumor smaller than 30 mm, surgery and EFTR group presented comparable procedural success rate (both were 100%), en bloc resection rate (100% vs. 94.7%), tumor capsule rupture rate (0% vs. 5.3%), and pathological R0 resection rate (both were 100%). EFTR had a statistically significant advantage over surgery for estimated blood loss (3.12 ± 5.20 vs. 46.97 ± 60.73 ml, p ≤ 0.001), discrepancy between the pre- and postprocedural hemoglobin level (5.18 ± 5.43 vs. 9.84 ± 8.25 g/L, p = 0.005), bowel function restoration [1 (0–5) vs. 3 (1–5) days, p ≤ 0.001], and hospital cost (28,617.09 ± 6720.78 vs. 33,963.10 ± 13,454.52 Yuan, p = 0.033). The patients with tumor larger than 30 mm showed roughly the same outcomes after comparison analysis of the two groups. However, the clinical data revealed lower en bloc resection rate (75.0% vs. 100%, p = 0.022) and higher tumor capsule rupture rate (25.0% vs. 0%, p = 0.022) for EFTR when compared to surgery. The procedure time, duration of postprocedural fasting and antibiotics usage, and hospital stay of the two groups were equivalent. The occurrence rate of adverse events within postoperative day 7 were 74.2% and 72.6% after EFTR and surgery, respectively (p = 1.000). No complications occurred during the follow-up. Conclusion For treatment of MP-derived G-SMTs (with or without ulceration), our study showed the feasibility and safety of EFTR, which also provided better results in terms of procedural blood loss, the postoperative bowel function restoration and cost-effectiveness when compared to surgery, whereas the surgery was superior in en bloc resection rate for G-SMTs larger than 30 mm. The postprocedural clinical outcomes seemed to be equivalent in these two resection methods.
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14
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Shichijo S, Uedo N, Yanagimoto Y, Yamamoto K, Kono M, Fukuda H, Shimamoto Y, Nakagawa K, Ohmori M, Arao M, Iwatsubo T, Iwagami H, Inoue S, Matsuno K, Matsuura N, Nakahira H, Maekawa A, Kanesaka T, Takeuchi Y, Higashino K, Ohmori T, Ishihara R. Endoscopic full-thickness resection of gastric gastrointestinal stromal tumor: a Japanese case series. Ann Gastroenterol 2019; 32:593-599. [PMID: 31700236 PMCID: PMC6826078 DOI: 10.20524/aog.2019.0413] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/13/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are potentially malignant and are indicated for resection. The standard treatment for resectable GISTs is surgery, although endoscopic resection has been reported outside Japan. This study retrospectively analyzed the results of endoscopic resection of GISTs in Japan. METHOD We identified patients with GISTs treated only by endoscopic resection in our institute between January 2016 and December 2018, and analyzed their clinical and pathological characteristics. RESULTS During the study period, 8 GISTs were resected only by endoscopy: 7 were located in the upper third of the stomach and 1 in the middle. All were intraluminal growth type. Median (range) tumor diameter was 20 (10-35) mm. All tumors were resected en bloc with a median (range) operation time of 67.5 (50-166) min. Complete perforation occurred in 5 cases, but the serosa remained in 2 and the outer layer of the muscularis propria remained in 1. The defect was endoscopically closed with clip-and-endoloop purse-string suturing (n=3), simple endoclipping (n=2), or over-the-scope clipping (n=2), and 1 did not require closure because the outer longitudinal muscle was preserved. Oral feeding was commenced on postoperative day (POD) 3 (median; range 2-4), and the patient was discharged on POD 6 (median; range 4-11). No serious adverse event developed after the procedures. CONCLUSION Endoscopic resection for selected cases of small intraluminal GISTs is feasible, making it a viable alternative treatment option to laparoscopic surgery.
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Affiliation(s)
- Satoki Shichijo
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Noriya Uedo
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Yoshitomo Yanagimoto
- Department of Gastroenterological Surgery (Yoshitomo Yanagimoto, Kazuyoshi Yamamoto, Takeshi Ohmori), Osaka International Cancer Institute, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery (Yoshitomo Yanagimoto, Kazuyoshi Yamamoto, Takeshi Ohmori), Osaka International Cancer Institute, Japan
| | - Mitsuhiro Kono
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Hiromu Fukuda
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Yusaku Shimamoto
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Kentaro Nakagawa
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Masayasu Ohmori
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Masamichi Arao
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Taro Iwatsubo
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Shuntaro Inoue
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Kenshi Matsuno
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Akira Maekawa
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Koji Higashino
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Takeshi Ohmori
- Department of Gastroenterological Surgery (Yoshitomo Yanagimoto, Kazuyoshi Yamamoto, Takeshi Ohmori), Osaka International Cancer Institute, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
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Clinicopathological Features and Prognosis of Small Gastric Gastrointestinal Stromal Tumors (GISTs). J Gastrointest Surg 2019; 23:2136-2143. [PMID: 31012047 DOI: 10.1007/s11605-018-04070-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 11/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the present study was to evaluate the safety of endoscopic surgery, the clinicopathological features, and prognoses of small gastric gastrointestinal stromal tumors (GISTs). METHODS Small gastric GIST patients (diameter: 0.10-2.00 cm) resected endoscopically in Zhongshan Hospital were retrospectively identified and clinicopathological features and outcomes were collected. The relationship between clinicopathological characteristics and tumor recurrence was analyzed. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal tumor diameter for predicting malignant potential. RESULTS All lesions were completely removed by endoscopy and En bloc resection was 98.5%. The most frequent location was the gastric fundus (60.3%) and the average diameter of all lesions was 1.20 cm (range: 0.10-2.00 cm). Mitoses were calculated as more than 5/50 HPF in 44 (6.8%) patients and nuclear atypia was moderate in 243 (37.5%) patients, severe in 1 (0.2%). Necrosis, mucosal infiltration, and vascular infiltration were detected in 8 (1.2%), 5 (0.7%), and 3 (0.5%) patients, respectively. Tumor size was positively correlated with mitotic index (P < 0.001) and nuclear atypia (P < 0.001). After a median follow-up of 54 months, four patients were confirmed local recurrence. ROC curve analysis identified 1.45 cm as the best cut-off value to predict malignant potential (95% CI: 0·694-0·774). Survival analysis showed that patients with tumor diameters larger than 1.45 cm were associated with more local recurrences after resection (P = 0.011). CONCLUSIONS Endoscopic surgery is feasible and safe for small gastric GISTs, especially those in favorable locations. Small gastric GISTs bear a good prognosis as a whole but those with diameters larger than 1.45 cm should receive more intensive surveillance or undergo endoscopic surgery.
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16
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Huberty V, Leclercq L, Hiernaux M, Verset L, Sandersen C, Beyna T, Neuhaus H, Deviere J. Endoscopic full-thickness resection using an endoluminal-suturing device: a proof-of-concept study. Endosc Int Open 2019; 7:E1310-E1315. [PMID: 31673599 PMCID: PMC6805186 DOI: 10.1055/a-0860-5387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/14/2019] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Endoscopic full-thickness resection (EFTR) is used to achieve R0 resection in difficult situations and as a way to overcome the limitations of endoscopic submucosal dissection. Multiple techniques have been described but adequate tools are still under evaluation. In this study, we evaluated the safety and feasibility of non-exposed endoscopic full-thickness resection using a novel endoscopic suturing device. Materials and methods Full-thickness resections of gastric predetermined lesions were performed on five pigs using the Endomina platform. After creating virtual lesion > 20 mm, sutures were placed around it using this triangulation platform. After tightening the knots, the bulging lesion, internalized into the gastric lumen, was cut with a needle knife. Results R0 resections of large lesions (42 to 60 mm) were achieved in all cases. One perforation occurred and prompted us to improve the procedure by shortening the sutures for more maneuverability and reinforcing the suture line before section. Procedure duration dropped by 50 % between the first case and the fourth case. Histological analysis confirmed successful full-thickness resection of all resected specimens. Conclusion EFTR using this triangulation platform seems feasible for lesions > 20 mm. Additional possible improvements were identified to simplify the procedure before moving to human trials.
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Affiliation(s)
- Vincent Huberty
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium,Corresponding author Vincent Huberty, MD Erasme Hospital, ULB, CP572/10Route de lennik 8081070 BrusselsBelgium+0032 2 555 46 97
| | | | | | - Laurine Verset
- Department of Anatomopathology, Erasme Hospital, Université Libre de Bruxelles, Belgium
| | | | - Thorsten Beyna
- Department of Gastroenterology, Evangelisches Krankenhaus, Dusseldorf, Dusseldorf, Germany
| | - Horst Neuhaus
- Department of Internal Medicine, Evangelisches Krankenhaus, Dusseldorf, Dusseldorf, Germany
| | - Jacques Deviere
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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17
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Dellatore P, Bhagat V, Kahaleh M. Endoscopic full thickness resection versus submucosal tunneling endoscopic resection for removal of submucosal tumors: a review article. Transl Gastroenterol Hepatol 2019; 4:45. [PMID: 31304422 DOI: 10.21037/tgh.2019.05.03] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 05/07/2019] [Indexed: 12/15/2022] Open
Abstract
Submucosal tumors (SMT) are protuberant lesions with intact mucosa that have a wide differential. These lesions may be removed by standard polypectomy, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or surgically. However, in lesions that arise from the muscularis propria, full thickness resection is recommended. This can be completed using either endoscopic full thickness resection (EFTR) or submucosal tunneling endoscopic resection (STER). EFTR can be accomplished by completing a full thickness resection followed by defect closure or by securing gastrointestinal wall patency before resection. STER is an option that first creates a mucosal dissection proximal to the lesion to allow a submucosal tunnel to be created. Using this tunnel, the lesion may be resected. When comparing STER to EFTR, there was no significant difference when evaluating tumor size, operation time, rate of complications, or en bloc resection rate. However, suture time, amount of clips used, and overall hospital stay were decreased in STER. With these differences, EFTR may be more efficacious in certain parts of the gastrointestinal tract where a submucosal tunnel is harder to accomplish.
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Affiliation(s)
- Peter Dellatore
- Department of Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Vicky Bhagat
- Department of Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Michel Kahaleh
- Department of Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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18
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Zhang X, Modayil R, Criscitelli T, Stavropoulos SN. Endoscopic resection for subepithelial lesions-pure endoscopic full-thickness resection and submucosal tunneling endoscopic resection. Transl Gastroenterol Hepatol 2019; 4:39. [PMID: 31231706 DOI: 10.21037/tgh.2019.05.01] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/26/2019] [Indexed: 02/06/2023] Open
Abstract
Endoscopic full-thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER) are the frontier of therapeutic endoscopic. These two methods rely on the skillset and equipment of endoscopic submucosal dissection (ESD) while going beyond the boundaries of the gastrointestinal lumen. They are both representatives of natural orifice transluminal endoscopic surgery, with STER being a direct off-shoot of peroral endoscopic myotomy (POEM). Both techniques are designed for the removal of gastrointestinal tumors originating from the muscularis propria but tend to be used in different organs and come with respective challenges. In this review we will go over the history, indication, technique and literature of these two techniques.
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Affiliation(s)
- Xiaocen Zhang
- Mount Sinai St. Luke's-West Hospital Center, New York, NY, USA
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19
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Chen H, Li B, Li L, Vachaparambil CT, Lamm V, Chu Y, Xu M, Cai Q. Current Status of Endoscopic Resection of Gastric Subepithelial Tumors. Am J Gastroenterol 2019; 114:718-725. [PMID: 31082838 DOI: 10.14309/ajg.0000000000000196] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Most gastrointestinal (GI) subepithelial tumors (SETs) are identified incidentally during endoscopic examination and are located in the stomach. Some SETs are malignant or have the potential to become malignant. Tumors originating from deeper layers, such as the muscularis propria or serosa, are not easy to diagnose and resect. Current guidelines recommend yearly endoscopic surveillance of SETs smaller than 2 cm. This recommendation may not be cost-effective in managing GI SETs. Endoscopic resection results not only in obtaining sufficient tissue for pathological diagnosis but also in resection and curing the tumor. Many different endoscopic methods for resection of GI SETs have been published in the literature. To avoid confusion, we have divided these methods into standard endoscopic submucosal dissection, modified endoscopic submucosal dissection, submucosal tunneling endoscopic resection, and nonexposed and exposed endoscopic full-thickness resection. These procedures offer less invasive approaches than surgery for resection of GI SETs and may be the most cost-effective in taking care of patients with GI SETs.
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Affiliation(s)
- Huimin Chen
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Baiwen Li
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianyong Li
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Gastroenterology, PLA 306th Hospital, Beijing, China
| | - Cicily T Vachaparambil
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vladimir Lamm
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yuan Chu
- Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Meidong Xu
- Endoscopic Center, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qiang Cai
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
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Wang W, Li P, Ji M, Wang Y, Zhu S, Liu L, Zhang S. Comparison of two methods for endoscopic full-thickness resection of gastrointestinal lesions using OTSC. MINIM INVASIV THER 2019; 28:268-276. [PMID: 30987491 DOI: 10.1080/13645706.2019.1602544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background and aims: The aim of this study was to compare and analyze the feasibility and safety of two methods of endoscopic full-thickness resection (EFTR) for the management of challenging epithelial and subepithelial neoplasms that are not amenable to resection techniques.Material and methods: This was a retrospective case series study of patients who underwent one of two methods of EFTR, resection using ESD knives and post-resection closure with OTSC (Group 1), or closure with OTSC and secondary EFTR with snare (Group 2).Results: Of 11 patients, six were in Group 1 and five in Group 2. The mean time of the EFTR procedure was 76.83 ± 34.97 min in Group 1 which is significantly longer than that of Group 2 (p = .0128). The mean time of OSTC closure and length of hospital stay of Group 1 were also longer compared to Group 2, but the difference was not significant. Complete resection (R0) and technical success rates of Group 1 and Group 2 were 83.3% and 100% (p = .338), respectively. VAS scores of Group 1 immediately after the operation and after 24 h are significantly higher than those of Group 2 (p = .047 and p = .009, respectively). In Group 1, one patient had delayed perforation which led to fever and pneumoperitoneum, and one patient developed abdominal pain. No complications associated with the endoscopic procedure were observed in Group 2.Conclusion: EFTR of pre-resection closure are potentially faster compared with the concept of applying closure after EFTR. Larger prospective controlled studies comparing these two techniques are warranted in the future.
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Affiliation(s)
- Wenhai Wang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| | - Ming Ji
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| | - Yongjun Wang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| | - Shengtao Zhu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| | - Lihua Liu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
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Affiliation(s)
- Vincent Huberty
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Laurine Verset
- Department of Anatomopathology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques Deviere
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Hajiyeva G, Ngamruengphong S. Diagnostic full thickness resection—Motility disorders, neurologic disorders, and staging of mucosal neoplasms. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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23
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Friedel D, Zhang X, Modayil R, Stavropoulos SN. Endoscopic full-thickness resection. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Chiu PWY. Future of full thickness resection – Devices, indications, robotics, what is missing. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Duan TY, Tan YY, Wang XH, Lv L, Liu DL. A comparison of submucosal tunneling endoscopic resection and endoscopic full-thickness resection for gastric fundus submucosal tumors. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 110:160-165. [PMID: 29284271 DOI: 10.17235/reed.2017.4699/2016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM Both submucosal tunneling endoscopic resection (STER) and endoscopic full-thickness resection (EFTR) are effective methods for gastric fundus submucosal tumors (SMTs). However, there is little data that compares the two methods. The aim of this study was to compare the safety and efficacy of STER and EFTR for the treatment of SMTs in the gastric fundus. METHODS Clinical data was retrospectively collected from patients with gastric fundus SMTs who underwent STER or EFTR at our hospital from April 2011 to May 2016. Epidemiological data (gender, age), tumor size, procedure-related parameters, complications, postoperative hospital stay, cost and follow-up data were compared. RESULTS A total of 43 patients were enrolled: 15 underwent STER and the remaining 28 cases underwent EFTR. There were no significant differences between the two groups with regard to gender, age, tumor size, en bloc resection rate, operation time, pathohistological results and cost (p > 0.05). However, patients who underwent EFTR had a longer suture time, required a larger number of clips for closure and a prolonged postoperative hospital stay (p < 0.05). No recurrence was noted in either the STER or the EFTR group during a mean follow-up of 12.1 and 22.8 months, respectively. CONCLUSIONS The treatment efficacy of STER and EFTR for the treatment of gastric fundus SMTs was comparable. However, STER has some advantages over EFTR in terms of suture time, the number of clips required for closure and postoperative hospital stay.
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Affiliation(s)
- Tian-Ying Duan
- Department of Gastroenterology, the Second Xiangya Hospital of Central South University
| | - Yu-Yong Tan
- Department of Gastroenterology, the Second Xiangya Hospital of Central South University
| | - Xue-Hong Wang
- Department of Gastroenterology, the Second Xiangya Hospital of Central South University
| | - Liang Lv
- Department of Gastroenterology, the Second Xiangya Hospital of Central South University
| | - De-Liang Liu
- Gastroenterology, the Second Xiangya Hospital, China
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Endoscopic Full-thickness Resection for Gastric Subepithelial Tumors Originating From the Muscularis Propria: A 69-Case Series. Surg Laparosc Endosc Percutan Tech 2018; 28:e12-e17. [PMID: 29077606 DOI: 10.1097/sle.0000000000000491] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This report describes a mini-invasive technique called endoscopic full-thickness resection (EFR) for the treatment of gastric subepithelial tumors (SETs) originating from the muscularis propria (MP). MATERIALS AND METHODS We retrospectively analyzed 69 patients with gastric SETs originating from the MP at our hospital between September 2009 and July 2016. The data from each patient were reviewed, including patient information, tumor characteristics, procedure-related data, and recurrence rates. RESULTS Successful complete resection by EFR was achieved in 69 cases. The complete resection rate was 100%, and the mean resected tumor size was 2.25±1.40 (range, 0.6 to 6) cm. No residual tumor recurrence was detected during the follow-up period in 57 patients. The other 12 patients were lost to follow-up. CONCLUSIONS EFR seems to be a safe and effective technique for the treatment of patients with gastric SETs originating from the MP.
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Zhang Y, Mao XL, Zhou XB, Yang H, Zhu LH, Chen G, Ye LP. Long-term outcomes of endoscopic resection for small (≤ 4.0 cm) gastric gastrointestinal stromal tumors originating from the muscularis propria layer. World J Gastroenterol 2018; 24:3030-3037. [PMID: 30038470 PMCID: PMC6054947 DOI: 10.3748/wjg.v24.i27.3030] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/15/2018] [Accepted: 06/25/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the long-term efficacy of endoscopic resection (ER) for small (≤ 4.0 cm) gastric gastrointestinal stromal tumors (GISTs) originating from the muscularis propria layer. METHODS Between June 2005 and February 2015, we retrospectively analyzed 229 consecutive patients with gastric MP-GISTs who underwent ER with a follow-up at least 36 mo. The main outcome measurements included complete resection rate, complications, and long-term follow-up outcomes. RESULTS ER included endoscopic muscularis excavation in 179 cases, endoscopic full-thickness resection in 32 cases, and submucosal tunneling endoscopic resection in 18 cases. The median size of GISTs was 1.90 cm. Of the 229 GISTs, 147 were very low risk, 72 were low risk, 8 were intermediate risk, and 2 were high risk. Short-term outcomes showed the complete resection rate was 96.5%, and 8 patients (3.5%) had complications. Of the 8 patients with complications, only one patient required surgical intervention. Long-term outcomes showed 225 patients were actively followed-up until composition of this manuscript. The remaining 4 patients were lost because of unrelated death. During the follow-up period (median, 57 mo), no residual, recurrent lesions, or distant metastasis were detected in any patients. Binary logistic regression analysis showed tumor size was a risk factor associated with a high mitotic index (≥ 5/50 HPF) of GISTs (P = 0.002). CONCLUSION ER seems to be an effective and safe method for gastric MP-GISTs ≤ 4.0 cm, and, for some intermediate or high risk GISTs, adjuvant therapy and/or additional surgery might be required to reduce the risk of recurrence or metastasis.
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Affiliation(s)
- Yu Zhang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Xin-Li Mao
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Xian-Bin Zhou
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Hai Yang
- Department of Radiology, Enze Hospital, Wenzhou Medical University, Taizhou city 318000, Zhejiang Province, China
| | - Lin-Hong Zhu
- Department of Medical Administration, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Guang Chen
- Department of Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Li-Ping Ye
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
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Yoo IK, Choi HS, Chun HJ, Kim SH, Lee JM, Kim ES, Keum B, Lee HS, Jeen YT, Kim CD. A promising Forcep Strip Method for gastrointestinal subepithelial tumors originating from the muscularis propria. Dig Liver Dis 2018; 50:360-365. [PMID: 29398415 DOI: 10.1016/j.dld.2017.12.005] [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: 07/26/2017] [Revised: 11/06/2017] [Accepted: 12/06/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Subepithelial tumors (SETs) originating from the muscularis propria layer are unlikely to be resected completely and safely. We developed the Forcep Strip Method (FSM) for the resection of SETs in the stomach. AIMS This study aimed to evaluate the feasibility and safety of the FSM. METHODS Endoscopic SET resection using electrical forceps was performed in 11 consecutive patients with clinical indications for lesion removal. Following injection around the tumor, the adjacent mucosa or submucosa was grasped with the hot forceps and pulled away to form a "tent". The tumor was dissected from the muscularis propria layer and carefully removed using coagulating forceps. RESULTS The FSM was successful in 10 of the 11 patients in the series; one patient required surgery due to respiratory depression during the procedure. The complete resection rate was 100% and no major complications including bleeding and perforation occurred. Mean procedure time was 39.3 ± 14.7 min, mean hospitalization time was 5.0 ± 1.2 days, and mean tumor size was 17.1 ± 4.7 mm. CONCLUSION FSM was found to be an easy, safe, and effective procedure for the treatment of gastric SETs originating from the muscularis propria layer.
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Affiliation(s)
- In Kyung Yoo
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Republic of Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Republic of Korea.
| | - Seung Han Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Republic of Korea
| | - Jae Min Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Republic of Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Republic of Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Republic of Korea
| | - Hong Sik Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Republic of Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Republic of Korea
| | - Chang Duck Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Republic of Korea
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Cai MY, Martin Carreras-Presas F, Zhou PH. Endoscopic full-thickness resection for gastrointestinal submucosal tumors. Dig Endosc 2018; 30 Suppl 1:17-24. [PMID: 29658639 DOI: 10.1111/den.13003] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/11/2017] [Indexed: 02/06/2023]
Abstract
Endoscopic full-thickness resection (EFTR) is a "changing-concept" endoscopic resection technique, which safely allows resecting deep submucosal tumors (SMTs) in the gastrointestinal (GI) wall. It's a highly promising endoscopic procedure that allows full-thickness excision of a small piece of the complete GI wall by using only a flexible endoscope. EFTR is a meeting point between surgery and endoscopy and probably the onset of many prospective combined minimally invasive therapeutic techniques that science will explore. In this review, use of the EFTR technique for gastrointestinal SMTs is highlighted, focusing on some technical aspects, indications, contraindications and outcomes.
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Affiliation(s)
- Ming-Yan Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, Shanghai, China
| | | | - Ping-Hong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, Shanghai, China
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Hu JW, Ge L, Zhou PH, Li QL, Zhang YQ, Chen WF, Chen T, Yao LQ, Xu MD, Chu Y. A novel grasp-and-loop closure method for defect closure after endoscopic full-thickness resection (with video). Surg Endosc 2017; 31:4275-4282. [PMID: 28374258 DOI: 10.1007/s00464-017-5473-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 02/15/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endoscopic full-thickness resection (EFTR) is a minimally invasive method for en bloc resection of gastrointestinal (GI) lesions originating from the muscularis propria layer. Successful closure of the wall defect is a critical step. OBJECTIVE The aim of this study was to evaluate the feasibility and efficacy of a novel and simplified endoscopic grasp-and-loop (GAL) closure method using an endo-loop assisted with grasping forceps for defect closure. METHODS From January 2015 to March 2016, 13 patients with submucosal tumors (SMTs) originating from the muscularis propria (MP) layer underwent EFTR and were enrolled in this study. After successful tumor resection, an endo-loop was anchored onto the circumferential margin of the gastric defect with grasping forceps assistance and tightened gently. Patient characteristics, tumor size, en bloc resection, and postoperative complications were evaluated. RESULTS Of the 13 lesions in the stomach, two were located in the greater curvature of the mid-upper body, 11 were located in the fundus. The endoscopic GAL closure method was successfully performed after EFTR in all the 13 patients without laparoscopic assistance. The mean procedure time was 43.5 min (range 20-80 min), while the GAL closure procedure took a mean of 9.4 min (range 3-18 min). The mean resected lesion size was 1.5 cm (range 0.5-3.5 cm). Pathological diagnoses of these lesions were 11 gastrointestinal stromal tumors (GISTs) and two leiomyomas. No major adverse events occurred during or after the procedure. All the patients were discharged after a mean time of 2.4 days (range 1-4 days). No residual lesion or tumor recurrence was found during the follow-up period (median, 5 months; range, 1-15 months). CONCLUSIONS The endoscopic GAL closure method is feasible, effective, and safe for closing the gastric defect after EFTR in patients.
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Affiliation(s)
- Jian-Wei Hu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Lei Ge
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital, Xinjiang Medical University, Urumuqi, 830011, People's Republic of China
| | - Ping-Hong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Quan-Lin Li
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Yi-Qun Zhang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Wei-Feng Chen
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Tao Chen
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Li-Qing Yao
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Mei-Dong Xu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
| | - Yuan Chu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
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Al-Bawardy B, Rajan E, Wong Kee Song LM. Over-the-scope clip-assisted endoscopic full-thickness resection of epithelial and subepithelial GI lesions. Gastrointest Endosc 2017; 85:1087-1092. [PMID: 27569858 DOI: 10.1016/j.gie.2016.08.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/17/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Endoscopic full-thickness resection (EFTR) allows for definitive diagnosis and treatment of select subepithelial and epithelial lesions unsuitable to conventional resection techniques. Our aim was to evaluate the efficacy and safety of over-the-scope (OTS) clip-assisted EFTR for these lesions. METHODS Patients who underwent OTS clip-assisted EFTR between June 2014 and October 2015 were analyzed. The procedure involved (1) thermal marking of the periphery of the lesion; (2) lesion suction into the cap of either an OTSC (Ovesco Endoscopy AG, Tübingen, Germany) or Padlock clip (Aponos Medical Corp, Kingston, NH, USA) with or without triprong anchor retraction of the lesion; (3) clip deployment; and (4) en bloc resection of the lesion above the clip using an electrosurgical snare and/or knife. Data were abstracted for demographics, lesion features, histopathologic diagnoses, R0 resection (negative margins) status, and adverse events. RESULTS Nine patients (7 men) with a mean age of 63 ± 9.6 years were identified. The endoscopic findings included subepithelial lesions in the duodenum (n = 4), rectosigmoid colon (n = 2), stomach (n = 1), and postappendectomy appendiceal orifice polyps (n = 2). The mean lesion size was 8 ± 3 mm and the mean procedure time 53 ± 21 minutes. R0 resection was confirmed in all cases. The histopathologic diagnoses included neuroendocrine tumors (n = 6), sessile serrated adenomas (n = 2), and pancreatic heterotopia (n = 1). No adverse events were noted. CONCLUSIONS OTS clip-assisted EFTR is an effective and safe technique for the removal of select subepithelial and epithelial lesions that are not amenable to conventional resection techniques.
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Affiliation(s)
- Badr Al-Bawardy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth Rajan
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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An W, Sun PB, Gao J, Jiang F, Liu F, Chen J, Wang D, Li ZS, Shi XG. Endoscopic submucosal dissection for gastric gastrointestinal stromal tumors: a retrospective cohort study. Surg Endosc 2017; 31:4522-4531. [PMID: 28374257 DOI: 10.1007/s00464-017-5511-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 03/08/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Endoscopic submucosal dissection (ESD) has been used to remove submucosal tumors. However, with regard to the potential malignant behavior of gastrointestinal stromal tumors (GISTs), whether ESD can be recommended for treatment is still controversial. Therefore, we evaluated the efficacy and safety of ESD for removal of GISTs in the muscularis propria (MP) layer and to assess the possible risk factors for a gastric-wall defect (GWD). METHODS For 168 GISTs located in the MP layer from 168 consecutive patients, the baseline information, complications, and therapeutic outcomes were recorded. Subsequently, risk factors for a GWD were analyzed. RESULTS Most GISTs (106/168) were located in the fundus of the stomach. Tumor shapes in 154 patients (91.7%) were regular, and the median size of the tumor was 1.5 (range 0.5-6.0) cm. The en bloc resection rate was 100% and the median procedure time was 46.5 (33-181) min. A GWD was observed in 71 patients (42.3%) and delayed bleeding occurred in 2 patients (1.2%), and they were treated by clips. A total of 117 patients with a GIST were at very low risk, 37 patients were at low risk, and 14 patients were at mild risk. No local recurrences or distant metastases were observed during a median follow-up of 25 (6-67) months. Univariate and multivariate logistic regression analyses identified the tumor type to be an independent risk factor for a GWD during ESD (odds ratio 29.82, 95% confidence interval 10.87-81.80, P < 0.001). CONCLUSION ESD is a safe and feasible method for gastric GISTs, especially for tumor types A and B. Endoscopic ultrasound can aid evaluation of the tumor type before ESD, which is an independent risk factor correlated with a GWD upon ESD.
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Affiliation(s)
- Wei An
- Department of Gastroenterology, Changhai Hospital of Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Ping-Bo Sun
- Information Centre, Changhai Hospital of Second Military Medical University, Shanghai, China
| | - Jie Gao
- Department of Gastroenterology, Changhai Hospital of Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Fei Jiang
- Department of Gastroenterology, Changhai Hospital of Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Feng Liu
- Department of Gastroenterology, Changhai Hospital of Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Jie Chen
- Department of Gastroenterology, Changhai Hospital of Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Dong Wang
- Department of Gastroenterology, Changhai Hospital of Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital of Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Xin-Gang Shi
- Department of Gastroenterology, Changhai Hospital of Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China.
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Zhang Q, Wang F, Wei G, Cai JQ, Zhi FC, Bai Y. Endoscopic resection of gastric submucosal tumors: A comparison of endoscopic nontunneling with tunneling resection and a systematic review. Saudi J Gastroenterol 2017; 23:52-59. [PMID: 28139501 PMCID: PMC5329978 DOI: 10.4103/1319-3767.199116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 08/28/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND/AIM Endoscopic tunneling resection is a relatively novel endoscopic technology for removing gastric submucosal tumors. Our study aimed to compare the differences between tunneling and nontunneling resection for gastric submucosal tumors. MATERIALS AND METHODS Resections of gastric submucosal tumors (n = 97) performed from 2010 to 2015 at our endoscopy center were reviewed, and PubMed was searched for clinical studies on gastric submucosal tumor resection by endoscopic nontunneling and tunneling techniques. RESULTS At our endoscopy center, nontunneling (Group 1) and tunneling resection (Group 2) were performed for 78 and 19 submucosal tumors, respectively; median tumor diameters were 15 and 20 mm (P = 0.086), median procedural times were 50 and 75 min (P = 0.017), successful resection rates were 94.9% (74/78) and 89.5% (17/19) (P = 0.334), and en bloc resection rates were 95.9% (71/74) and 94.1% (16/17) (P = 0.569) in the Groups 1 and 2, respectively. Postoperative fever, delayed hemorrhage and perforation, hospitalization time, and hospitalization expense were statistically similar between the 2 groups. A literature review on gastric submucosal tumor resection suggested that the en bloc resection rates of the two methods for tumors with a median diameter of 15-30 mm were also high, and there were no relapses during the follow-up period. CONCLUSIONS Both endoscopic nontunneling and tunneling resection seem to be effective and safe methods for removing relatively small gastric submucosal tumors. Compared with endoscopic nontunneling, tunneling resection does not seem to have distinct advantages for gastric submucosal tumors, and has a longer mean operative time.
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Affiliation(s)
- Qiang Zhang
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fei Wang
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Gong Wei
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jian-Qun Cai
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fa-Chao Zhi
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yang Bai
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Beduya D, Parasher G. Evaluation and Management of Mucosal and Submucosal Lesions in the Foregut. UPPER ENDOSCOPY FOR GI FELLOWS 2017:139-150. [DOI: 10.1007/978-3-319-49041-0_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Jain D, Mahmood E, Desai A, Singhal S. Endoscopic full thickness resection for gastric tumors originating from muscularis propria. World J Gastrointest Endosc 2016; 8:489-495. [PMID: 27499831 PMCID: PMC4959942 DOI: 10.4253/wjge.v8.i14.489] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 04/28/2016] [Accepted: 06/02/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To do systematic review of current literature for endoscopic full thickness resection (EFTR) technique for gastric tumors originating from muscularis propria.
METHODS: An extensive English literature search was done till December 2015; using PubMed and Google scholar to identify the peer reviewed original and review articles using keywords-EFTR, gastric tumor, muscularis propria. Human only studies were included. The references of pertinent studies were manually searched to identify additional relevant studies. The indications, procedural details, success rates, clinical outcomes, complications and limitations were considered. For the purpose of review, data from individual studies was combined to calculate mean. No other statistical test was applied.
RESULTS: A total of 9 original articles were identified. Four articles were from same institute and the time frames of these studies were overlapping. To avoid duplication of data, only the study with patients over the longest time interval was included and other three were excluded. In total six studies were included in the final review. In our systematic review, the mean success rate for EFTR of gastric tumors originating from muscularis propria was 96.8%. The mean procedure time varied from a minimum of 37 min to a maximum of 105 min. There was no reported mortality from the technique itself. The most common histological diagnosis was gastrointestinal stromal tumors and leiomyoma. Gastric wall defect closure by either metallic clips or over the scope clip (OTSC) had similar outcomes although experience with OTSC was limited to smaller lesions (< 3 cm).
CONCLUSION: EFTR is a minimally invasive technique to resect gastric submucosal tumors originating from muscularis propria with a high success rate and low complication rate.
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36
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Yang D, Draganov PV. Laparoscopic and endoscopic cooperative surgery: Is two always better than one? Gastrointest Endosc 2016; 84:53-5. [PMID: 27315734 DOI: 10.1016/j.gie.2015.11.010] [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] [Received: 11/03/2015] [Accepted: 11/10/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Dennis Yang
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Peter V Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
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Meier B, Schmidt A, Caca K. [Endoscopic full-thickness resection]. Internist (Berl) 2016; 57:755-62. [PMID: 27286839 DOI: 10.1007/s00108-016-0087-x] [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: 11/28/2022]
Abstract
Conventional endoscopic resection techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) are powerful tools for the treatment of gastrointestinal (GI) neoplasms. However, those techniques are limited to the superficial layers of the GI wall (mucosa and submucosa). Lesions without lifting sign (usually arising from deeper layers) or lesions in difficult anatomic positions (appendix, diverticulum) are difficult - if not impossible - to resect using conventional techniques, due to the increased risk of complications. For larger lesions (>2 cm), ESD appears to be superior to the conventional techniques because of the en bloc resection, but the procedure is technically challenging, time consuming, and associated with complications even in experienced hands. Since the development of the over-the-scope clips (OTSC), complications like bleeding or perforation can be endoscopically better managed. In recent years, different endoscopic full-thickness resection techniques came to the focus of interventional endoscopy. Since September 2014, the full-thickness resection device (FTRD) has the CE marking in Europe for full-thickness resection in the lower GI tract. Technically the device is based on the OTSC system and combines OTSC application and snare polypectomy in one step. This study shows all full-thickness resection techniques currently available, but clearly focuses on the experience with the FTRD in the lower GI tract.
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Affiliation(s)
- B Meier
- Medizinische Klinik I, Gastroenterologie und Onkologie, Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Deutschland
| | - A Schmidt
- Medizinische Klinik I, Gastroenterologie und Onkologie, Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Deutschland
| | - K Caca
- Medizinische Klinik I, Gastroenterologie und Onkologie, Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Deutschland.
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38
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Endoscopic Submucosal Dissection (ESD) and Related Techniques as Precursors of "New Notes" Resection Methods for Gastric Neoplasms. Gastrointest Endosc Clin N Am 2016; 26:313-322. [PMID: 27036900 DOI: 10.1016/j.giec.2015.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Endoscopic full-thickness resection for subepithelial tumors is one of the more attractive proposed methods for less-invasive transluminal surgery but remains challenging in terms of safety and feasibility. Currently, laparoscopic endoscopic cooperative surgery is thought to be a more clinically acceptable approach. In targeting cancers, however, more advanced nonexposure techniques are required to avoid the risk of iatrogenic tumor seeding. By combining these techniques with possible regional lymphadenectomy using sentinel node navigation surgery, an ideal minimally invasive, function-preserving gastric resection can be achieved even in possible node-positive cancers. Further development for this type of advanced endoscopic surgery is expected.
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Cai M, Zhou P, Lourenço LC, Zhang D. Endoscopic Full-thickness Resection (EFTR) for Gastrointestinal Subepithelial Tumors. Gastrointest Endosc Clin N Am 2016; 26:283-295. [PMID: 27036898 DOI: 10.1016/j.giec.2015.12.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
There has been booming interest in the endoscopic full-thickness resection (EFTR) technique since it was first described. With the advent of improved and more secure endoscopic closure techniques and devices, such as endoscopic suturing devices, endoscopists are empowered to perform more aggressive procedures than ever. This article focuses on the procedural technique and clinical outcomes of EFTR for gastrointestinal subepithelial tumors.
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Affiliation(s)
- Mingyan Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 20032, China
| | - Pinghong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 20032, China.
| | - Luís Carvalho Lourenço
- Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, IC-19, Venteira, Amadora 2720276, Portugal
| | - Danfeng Zhang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 20032, China
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40
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Angsuwatcharakon P, Rerknimitr R. Endoscopic closure of iatrogenic perforation. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2016. [DOI: 10.18528/gii150009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Phonthep Angsuwatcharakon
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Maehata T, Goto O, Takeuchi H, Kitagawa Y, Yahagi N. Cutting edge of endoscopic full-thickness resection for gastric tumor. World J Gastrointest Endosc 2015; 7:1208-1215. [PMID: 26566427 PMCID: PMC4639742 DOI: 10.4253/wjge.v7.i16.1208] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 08/18/2015] [Accepted: 09/30/2015] [Indexed: 02/05/2023] Open
Abstract
Recently, several studies have reported local full-thickness resection techniques using flexible endoscopy for gastric tumors, such as gastrointestinal stromal tumors, gastric carcinoid tumors, and early gastric cancer (EGC). These techniques have the advantage of allowing precise resection lines to be determined using intraluminal endoscopy. Thus, it is possible to minimize the resection area and subsequent deformity. Some of these methods include: (1) classical laparoscopic and endoscopic cooperative surgery (LECS); (2) inverted LECS; (3) combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique; and (4) non-exposed endoscopic wall-inversion surgery. Furthermore, a recent prospective multicenter trial of the sentinel node navigation surgery (SNNS) for EGC has shown acceptable results in terms of sentinel node detection rate and the accuracy of nodal metastasis. Endoscopic full-thickness resection with SNNS is expected to become a treatment option that bridges the gap between endoscopic submucosal dissection and standard surgery for EGC. In the future, the indications for these procedures for gastric tumors could be expanded.
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42
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Godat S, Robert M, Caillol F, Bories E, Pesenti C, De Cassan C, Ratone JP, Poizat F, Giovannini M. Efficiency and safety of endoscopic resection in the management of subepithelial lesions of the stomach. United European Gastroenterol J 2015; 4:250-6. [PMID: 27087954 DOI: 10.1177/2050640615604774] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/15/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Gastric subepithelial tumors represent a diagnostic and therapeutic challenge, given their histologic heterogeneity and potential malignant behavior. OBJECTIVE The objective of this article is to evaluate the interest, efficiency and safety of endoscopic resection for subepithelial gastric lesions of size <20 mm. METHODS We conducted a single-center retrospective study in a tertiary care center. RESULTS A total of 33 lesions (10 malignant/23 benign lesions) were studied. Mean histological size was 14.5 mm. Nine EMR, 18 ESD and six hybrid resections were performed. A total of 93.9% lesions were resected in one piece. At six months' follow-up, complete and definitive resection was obtained in 96.7% of cases. A vertical resection was insufficient in four cases. One GIST needed a complementary surgical resection, one neuroendocrine tumor was successfully treated by a new ESD session and two pancreatic rests were not additionally treated given the benign character and the absence of residual tissue in endoscopic control after six months. There was only one severe adverse event (2.9%); one pneumoperitoneum with ESD, three bleeding with one ESD and two EMR, always treated conservatively or endoscopically. CONCLUSION Endoscopic resection is safe and should be the procedure of choice for both diagnosis and definitive resection of subepithelial gastric lesions of size under 20 mm.
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Affiliation(s)
- Sébastien Godat
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Maxime Robert
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Fabrice Caillol
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Erwan Bories
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Christian Pesenti
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Chiara De Cassan
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | | | - Flora Poizat
- Division of Pathology, Paoli-Calmettes Institute, Marseille, France
| | - Marc Giovannini
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
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Schmidt A, Meier B, Caca K. Endoscopic full-thickness resection: Current status. World J Gastroenterol 2015; 21:9273-9285. [PMID: 26309354 PMCID: PMC4541380 DOI: 10.3748/wjg.v21.i31.9273] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 05/16/2015] [Accepted: 07/03/2015] [Indexed: 02/06/2023] Open
Abstract
Conventional endoscopic resection techniques such as endoscopic mucosal resection or endoscopic submucosal dissection are powerful tools for treatment of gastrointestinal neoplasms. However, those techniques are restricted to superficial layers of the gastrointestinal wall. Endoscopic full-thickness resection (EFTR) is an evolving technique, which is just about to enter clinical routine. It is not only a powerful tool for diagnostic tissue acquisition but also has the potential to spare surgical therapy in selected patients. This review will give an overview about current EFTR techniques and devices.
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44
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Lee JS, Kim GH, Park DY, Yoon JM, Kim TW, Seo JH, Lee BE, Song GA. Endoscopic Submucosal Dissection for Gastric Subepithelial Tumors: A Single-Center Experience. Gastroenterol Res Pract 2015; 2015:425469. [PMID: 26347772 PMCID: PMC4548140 DOI: 10.1155/2015/425469] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/09/2015] [Accepted: 07/13/2015] [Indexed: 12/11/2022] Open
Abstract
Background and Aims. Endoscopic submucosal dissection (ESD) has been accepted as a treatment modality for gastrointestinal epithelial tumors. Recently, ESD has been applied to resect subepithelial tumors (SETs) in the gastrointestinal tract, but clinical evidence on its efficacy and safety is limited. The aim of this study was to investigate the efficacy and safety of ESD for gastric SETs and to assess possible predictive factors for incomplete resection. Patients and Methods. Between January 2006 and December 2013, a total of 49 patients with gastric SET underwent ESD at our hospital. Clinicopathologic characteristics of patients and SETs, therapeutic outcomes, complications, and follow-up outcomes were evaluated. Results. The overall rates of en bloc resection and complete resection were 88% (43/49) and 84% (43/49), respectively. Complete resection rates in tumors originating from the submucosal layer were significantly higher than those in tumors originating from the muscularis propria layer (90% versus 56%, P = 0.028). In multivariate logistic regression analyses, tumor location (upper third: odds ratio [OR] 12.639, 95% confidence interval [CI] 1.087-146.996, P = 0.043) and layer of tumor origin (muscularis propria: OR 8.174, 95% CI 1.059-63.091, P = 0.044) were independently associated with incomplete resection. Procedure-related bleeding and perforation rates were both 4%. No recurrence was observed in patients with complete resection at a median follow-up period of 29 months (range: 7-83 months). Conclusions. ESD is an effective, safe, and feasible treatment for gastric SETs. The frequency of incomplete resection increases in tumors located in the upper third of the stomach and in those originating from the muscularis propria layer.
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Affiliation(s)
- Jin Sung Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 602-739, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, Republic of Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 602-739, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, Republic of Korea
| | - Do Youn Park
- Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, Republic of Korea
- Department of Pathology, Pusan National University School of Medicine, Busan 602-739, Republic of Korea
| | - Jong Min Yoon
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 602-739, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, Republic of Korea
| | - Tae Wook Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 602-739, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, Republic of Korea
| | - Jong Hun Seo
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 602-739, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, Republic of Korea
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 602-739, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, Republic of Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 602-739, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, Republic of Korea
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