Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 25, 2016; 8(14): 489-495
Published online Jul 25, 2016. doi: 10.4253/wjge.v8.i14.489
Endoscopic full thickness resection for gastric tumors originating from muscularis propria
Deepanshu Jain, Ejaz Mahmood, Aakash Desai, Shashideep Singhal
Deepanshu Jain, Ejaz Mahmood, Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA 19141, United States
Aakash Desai, Shashideep Singhal, Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, Houston, TX 77030, United States
Author contributions: Jain D contributed to literature review, interpretation of data and drafting of the manuscript; Mahmood E contributed in acquisition of data, interpretation of data and drafting of the manuscript; Desai A contributed in acquisition of data; Singhal S contributed to literature review and critical revision of the manuscript for important intellectual content.
Conflict-of-interest statement: None of the authors have any conflicts of interest.
Data sharing statement: Our article is a systematic review and thus it does not apply to our article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shashideep Singhal, MD, Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 4.234, Houston, TX 77030, United States. sdsinghal@gmail.com
Telephone: +1-713-5006677 Fax: +1-713-5006699
Received: March 6, 2016
Peer-review started: March 7, 2016
First decision: April 6, 2016
Revised: May 6, 2016
Accepted: May 31, 2016
Article in press: June 2, 2016
Published online: July 25, 2016
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.

Keywords: Endoscopic full thickness resection, Gastric tumor, Muscularis propria, Over the scope clip

Core tip: Endoscopic submucosal dissection success for gastric submucosal tumors arising from muscularis propria has remained limited. Authors have reported success with endoscopic full thickness resection (EFTR) in achieving complete resection of gastric tumors (as large as 5 cm) originating from musucularis propria in the absence of major complications. EFTR seems to be a reasonable replacement for laparoscopic technique for this subset of patients. Careful selection of candidates by preoperative imaging and endoscopy including endoscopic ultrasound to rule out metastatic disease and to confirm the size and location of lesion remains crucial.