Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2019; 11(11): 1054-1064
Published online Nov 15, 2019. doi: 10.4251/wjgo.v11.i11.1054
Endoscopic full-thickness resection for treating small tumors originating from the muscularis propria in the gastric fundus: An improvement in technique over 15 years
Nan Ge, Jin-Long Hu, Fei Yang, Fan Yang, Si-Yu Sun
Nan Ge, Jin-Long Hu, Fei Yang, Fan Yang, Si-Yu Sun, Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
Author contributions: Ge N and Sun SY contributed to study planning and manuscript drafting; Hu JL and Yang F contributed to data collection; Yang F contributed to data interpretation; all authors read and approved the final draft submitted.
Institutional review board statement: The protocol to perform retrospective revision of the cases was approved by the Medical Ethics Committees of Shengjing Hospital.
Informed consent statement: All patients were informed of the benefits and risks of the procedure; they provided written informed consent prior to each procedure.
Conflict-of-interest statement: All authors declare no conflict of interest.
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/
Corresponding author: Si-Yu Sun, MD, PhD, Professor, Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang 110004, Liaoning Province, China. sunsy@sj-hospital.org
Telephone: +86-24-23892617 Fax: +86-24-23892617
Received: July 2, 2019
Peer-review started: July 12, 2019
First decision: July 31, 2019
Revised: August 31, 2019
Accepted: September 11, 2019
Article in press: September 11, 2019
Published online: November 15, 2019
Processing time: 137 Days and 4.8 Hours
Abstract
BACKGROUND

The fundus of the stomach is regarded as a difficult area for endoscopic resection of small tumors originating from the muscularis propria (MP tumors). Three endoscopic resection techniques have been developed to treat these tumors, including ligation-assisted endoscopic full-thickness resection (L-EFTR), snare-assisted EFTR (S-EFTR), and endoscopic submucosal dissection-assisted EFTR (E-EFTR). To date, no studies have compared these techniques.

AIM

We aimed to evaluate and compare S-EFTR with L-EFTR and E-EFTR for treating small MP tumors in the gastric fundus.

METHODS

We retrospectively reviewed patients with primary small MP tumors in the gastric fundus and treated by these three techniques between January 2016 and December 2018 at Shengjing Hospital, China. Standard demographic and clinicopathologic data, including sex, age, tumor size, surgeon details, and pathological results, were collected. Data regarding operation duration, cost, en-bloc resection, and severe complications were also extracted and compared.

RESULTS

A total of 36 patients (27 women) with a mean age of 55.8 ± 10.20 years were included in this study. The mean tumor size was 9.0 ± 3.98 mm. All the methods showed a 100% en-bloc resection rate and 0% severe complication rate. There was no statistically significant difference among the three groups in the operation duration (P = 0.148). The cost comparison for the whole procedure was as follows: E-EFTR > L-EFTR > S-EFTR (5837.5 ± 7212.96 CNY, 5970.7 ± 3465.27 CNY, 5852.0 ± 6438.25 CNY, respectively, P < 0.001).

CONCLUSION

S-EFTR, L-EFT, and E-EFTR are all effective for resection of small MP tumors in the gastric fundus. S-EFTR is superior in terms of cost-effectiveness.

Keywords: Endoscopic full-thickness resection; Ligation; Muscularis propria; Snare; Endoscopic submucosal dissection; Cost

Core tip: Ligation-assisted endoscopic full-thickness resection (L-EFTR), snare-assisted EFTR (S-EFTR), and endoscopic submucosal dissection-assisted EFTR (E-EFTR) are all effective techniques for resection of small muscularis propria (MP tumors) in the gastric fundus. S-EFTR is superior in terms of cost-effectiveness of the treatment. S-EFTR can become the most efficient resection method for MP tumors in the gastric fundus.