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Alvarado-Fernandez V, Vargas-Madrigal J. Natural orifice transluminal endoscopic surgery to the rescue: retrieval of an extraluminally migrated lumen-apposing metal stent. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2024; 9:478-480. [PMID: 39534568 PMCID: PMC11551506 DOI: 10.1016/j.vgie.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Affiliation(s)
| | - Jorge Vargas-Madrigal
- Department of Gastroenterology, Hospital San Juan de Dios, San José, Costa Rica
- Clínica Equilibrium, San José, Costa Rica
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Sha H, Jiang ZD. Esophageal bronchogenic cyst treated with submucosal tunneling endoscopic resection: two case reports. J Med Case Rep 2024; 18:139. [PMID: 38561839 PMCID: PMC10986053 DOI: 10.1186/s13256-024-04453-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/12/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Although esophageal bronchogenic cysts are benign diseases, they may be accompanied by serious complications and have the possibility of recurrence. Therefore, once confirmed, it is necessary to treat the esophagobronchial cyst when the contraindication is excluded. Endoscopic treatment is usually used for lesions with small diameter and shallow origin, and has the advantages of small surgical trauma and risk, which can reduce the psychological burden of patients to a certain extent, help them to recover quickly, and lower hospital costs. CASE PRESENTATION Case 1 is a 54-year-old Han Chinese man admitted to our hospital who complained of difficulty swallowing in the past 6 months. Case 2 is a 41-year-old Han Chinese man who was hospitalized in the past 3 months due to chest discomfort. Endoscopic ultrasound revealed a hypoechoic cystic lesion arising from the muscularis propria. Submucosal tunneling endoscopic resection was performed using a dual knife, and a cystic mass was observed between the mucosa and the muscular layers of the esophagus. On locating the cyst, an incision was made on the oral side of the lesion for evacuation. The cyst wall was excised using endoscopic argon plasma coagulation. We successfully removed the esophageal bronchogenic cyst lesion in the intrinsic muscle layer using submucosal tunneling endoscopic resection. CONCLUSION Esophageal bronchogenic cysts are rare in clinical practice and lack specificity in clinical manifestations. Multiple methods can be used to determine the location and nature of the lesion and ultimately determine the treatment plan. Surgical resection and endoscopic treatment are two different treatment methods, and appropriate treatment plans need to be selected on the basis of the origin layer, size, and relationship with the esophagus of the lesion to reduce complications and improve prognosis.
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Affiliation(s)
- Hui Sha
- Department of Gastroenterology, The People's Hospital of Yining, Xinjiang, China
| | - Zong-Dan Jiang
- Department of Gastroenterology, The People's Hospital of Yining, Xinjiang, China.
- Department of Gastroenterology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, Jiangsu, China.
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First fully endoscopic metabolic procedure with NOTES gastrojejunostomy, controlled bypass length and duodenal exclusion: a 9-month porcine study. Sci Rep 2022; 12:21. [PMID: 34996894 PMCID: PMC8741923 DOI: 10.1038/s41598-021-02921-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/18/2021] [Indexed: 01/14/2023] Open
Abstract
We conducted a pilot study of a potential endoscopic alternative to bariatric surgery. We developed a Natural Orifice Transluminal Endoscopic Surgery (NOTES) gastric bypass with controlled bypass limb length using four new devices including a dedicated lumen-apposing metal stent (GJ-LAMS) and pyloric duodenal exclusion device (DED). We evaluated procedural technical success, weight change from baseline, and adverse events in growing Landrace/Large-White pigs through 38 weeks after GJ-LAMS placement. Six pigs (age 2.5 months, mean baseline weight 26.1 ± 2.7 kg) had initial GJ-LAMS placement with controlled bypass limb length, followed by DED placement at 2 weeks. Technical success was 100%. GJ-LAMS migrated in 3 of 6, and DED migrated in 3 of 5 surviving pigs after mucosal abrasion. One pig died by Day 94. At 38 weeks, necropsy showed 100–240 cm limb length except for one at 760 cm. Weight gain was significantly lower in the pigs that underwent endoscopic bypass procedures compared to expected weight for age. This first survival study of a fully endoscopic controlled bypass length gastrojejunostomy with duodenal exclusion in a growing porcine model showed high technical success but significant adverse events. Future studies will include procedural and device optimizations and comparison to a control group.
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Wang ZZ, Zhou XB, Wang Y, Mao XL, Ye LP, Yan LL, Chen YH, Song YQ, Cai Y, Xu SW, Li SW. Effectiveness and safety of over-the-scope clip in closing perforations after duodenal surgery. World J Gastroenterol 2021; 27:5958-5966. [PMID: 34629812 PMCID: PMC8475004 DOI: 10.3748/wjg.v27.i35.5958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/08/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic resection of duodenal subepithelial lesions (SELs) is a difficult procedure with a high risk of perforation. At present, dealing with perforation after endoscopic resection of duodenal SELs is still considered a great challenge. AIM To evaluate the effectiveness and safety of an over-the-scope clip (OTSC) in the treatment of perforation post-endoscopic resection of duodenal SELs. METHODS From May 2015 to November 2019, 18 patients with perforation following endoscopic resection of duodenal SELs were treated with OTSCs. Data comprising the rate of complete resection, closure of intraprocedural perforation, delayed bleeding, delayed perforation, and postoperative infection were extracted. RESULTS The rate of complete removal of duodenal SELs and successful closure of the perforation was 100%. The median perforation size was 1 cm in diameter. Seventeen patients had minor intraoperative bleeding, while the remaining 1 patient had considerable amount of bleeding during the procedure. Seven patients had postoperative abdominal infections, of which 1 patient developed an abscess in the right iliac fossa and another patient developed septic shock. All 18 patients recovered and were discharged. No delayed bleeding or perforation was reported. The mean time taken to resume normal diet after the procedure was 6.5 d. The mean postoperative hospital stay was 9.5 d. No residual or recurrent lesions were detected during the follow-up period (15-66 mo). CONCLUSION Closing a perforation after endoscopic resection of duodenal SELs with OTSCs seems to be an effective and reasonably safe therapeutic method.
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Affiliation(s)
- Zhen-Zhen Wang
- Key Laboratory of Minimally Invasive Techniques and Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Xian-Bin Zhou
- Key Laboratory of Minimally Invasive Techniques and Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Yi Wang
- Key Laboratory of Minimally Invasive Techniques and Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Xin-Li Mao
- Key Laboratory of Minimally Invasive Techniques and Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Li-Ping Ye
- Key Laboratory of Minimally Invasive Techniques and Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Ling-Ling Yan
- Key Laboratory of Minimally Invasive Techniques and Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Ya-Hong Chen
- Health Management Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Ya-Qi Song
- Key Laboratory of Minimally Invasive Techniques and Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Yue Cai
- Key Laboratory of Minimally Invasive Techniques and Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Shi-Wen Xu
- Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Shao-Wei Li
- Key Laboratory of Minimally Invasive Techniques and Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
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Yoshida M, Esaki M, Satoh T, Yamakawa S, Nakajima N, Ono H, Gotoda T. Transrectal laparoscopy using flexible endoscopy with a submucosal tunneling method: Porcine survival model. Dig Endosc 2021; 33:133-140. [PMID: 32275783 DOI: 10.1111/den.13683] [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: 02/14/2020] [Revised: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Transrectal laparoscopy (TRLS) using a flexible endoscope was recently proposed for peritoneal observation. Although previous studies have reported its feasibility, follow-up durations were insufficient to ascertain technical safety. Moreover, knowledge about the technical feasibility of collecting peritoneal cytological lavage or ascites during TRLS is limited. Thus, this study aimed to confirm the safety and efficacy of TRLS in a porcine survival model. METHODS After creating artificial ascites in 10 animals, TRLS was performed as follows: submucosal tunnel creation on the anterior wall of the rectum, intentional perforation at the distal end of the tunnel, endoscopic ascites collection and intraperitoneal observation, and clip closure at the mucosal incision site. The pigs were administered antibiotics orally for 7 days after TRLS and killed for histological evaluation and bacterial culture after 28 days of observation. RESULTS The technical success rates of insertion into the abdominal cavity, ascites collection, and clip closure were 100%. All frequent anatomical sites for peritoneal dissemination including the stomach, subdiaphragmatic space, and pelvic space were fully observable without adverse events. The median procedure time was 36.3 min. Full 28-day survival was observed in all cases without any infection. The autopsies showed no infection, including abscess formation. Bacterial cultures of the peritoneal cavity were negative 28 days after TRLS in all cases. CONCLUSIONS Transrectal laparoscopy enabled ascites collection and intraperitoneal observation without adverse events. All animals survived without peritonitis. Therefore, TRLS can be an option for intraperitoneal examination.
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Affiliation(s)
- Masao Yoshida
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Mitsuru Esaki
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Tatsunori Satoh
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shun Yamakawa
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Noriko Nakajima
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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Du Z, Ding W, Chen T. Suitability and efficacy of submucosal tunneling endoscopic resection for the treatment of giant leiomyoma in the middle and lower esophagus. Dis Esophagus 2019; 32:5519689. [PMID: 31206575 DOI: 10.1093/dote/doz059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 04/01/2019] [Indexed: 12/11/2022]
Abstract
Esophageal leiomyoma constitutes the majority of benign esophageal tumors, and detection rates are increasing. Submucosal tunneling endoscopic resection (STER) is a new technique developed to treat patients with esophageal leiomyoma, but the viability of STER for treating giant esophageal leiomyoma (GEL), particularly in the lower esophagus and close to the cardia, requires verification. This retrospective study assessed the efficacy of STER for the treatment of GEL. From January 2016 to April 2018, 10 patients underwent STER and endoscopic ultrasonography at the Endoscopic Center in Jianyang People's Hospital, and were found with histopathologically confirmed esophageal leiomyoma >3 cm. These cases were reviewed for successful excision, postoperative complications, and tumor recurrence. Seven of the 10 patients were men. Diagnoses of esophageal leiomyoma and negative resection margins were postoperatively confirmed in all 10 patients. All GELs were successfully excised. The mean operative time was 70.3 min (range, 28-100 min). The largest resected tumor was 14 cm. No adverse event occurred, and no delayed bleeding or associated infection. The patients were given postoperative conservative treatment and discharged. The mean hospitalization was 5.8 days (range, 3-10 d). During the scheduled follow-ups at 1, 3, 6, and 12 months post-STER, patients reported neither abdominal discomfort nor pain. No recurrent esophageal leiomyoma was detected at the follow-ups 3 months or longer following STER. STER is an effective and safe endoscopic resection technique for treating patients with GEL. Men may be at greater risk than women of developing GEL.
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Affiliation(s)
- Zhiqiang Du
- Department of Gastroenterology, Jianyang People's Hospital, Sichuan, China
| | - Wenjuan Ding
- Department of Gastroenterology, Jianyang People's Hospital, Sichuan, China
| | - Tianming Chen
- Department of Gastroenterology, Jianyang People's Hospital, Sichuan, China
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Xu HW, Zhao Q, Yu SX, Jiang Y, Hao JH, Li B. Comparison of different endoscopic resection techniques for submucosal tumors originating from muscularis propria at the esophagogastric junction. BMC Gastroenterol 2019; 19:174. [PMID: 31694564 PMCID: PMC6833169 DOI: 10.1186/s12876-019-1099-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/24/2019] [Indexed: 12/13/2022] Open
Abstract
Background To compare the outcomes of submucosal tunneling endoscopic resection (STER) and submucosal excavation (ESE) for the treatment of submucosal tumors (SMTs) arising from the muscularis propria (MP) at the esophagogastric junction (EGJ). Methods A retrospective analysis of patients with SMTs at EGJ who underwent STER and ESE from October 2011 to October 2017 was performed. The outcomes evaluated were operation time, complete resection rate, adverse events, and tumor recurrence. Results Ninety patients were included in this study. Complete resection rates in the STER group were higher than those of the ESE group (100 vs. 92%, p < 0.05). For tumors ≤15 mm, both techniques achieved 100% complete resection rate; but for tumors > 15 mm, complete resection rate was higher in the STER group than the ESE group (100% vs. 77.8%, p < 0.05). Subgroup analyses revealed that the operation time of STER for in cardiac-gastric group was longer than that for ESE (145.14 ± 42.43 min vs. 70.32 ± 39.84 min, p < 0.05). The air leakage symptoms were more frequent in STER group (90.9% vs. 50.0%, p < 0.05). No tumor recurrence occurred in both the STER and ESE groups. Conclusions For SMTs ≤15 mm, both STER and ESE have similar satisfactory therapeutic outcomes. However, in the cardiac-gastric subgroup, STER had a longer operative time compared to the ESE procedure. For SMTs > 15 mm, STER is the preferred choice due to its higher complete resection rate.
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Affiliation(s)
- Hong-Wei Xu
- Department of Gastroenterology, Shandong Provincial Hospital affiliated to Shandong University, No. 324, Jingwuweiqi Road, Jinan, Shandong, China
| | - Qi Zhao
- Department of Gastroenterology, Shandong Provincial Hospital affiliated to Shandong University, No. 324, Jingwuweiqi Road, Jinan, Shandong, China
| | - Shu-Xia Yu
- Department of Gastroenterology, Shandong Provincial Hospital affiliated to Shandong University, No. 324, Jingwuweiqi Road, Jinan, Shandong, China
| | - Ying Jiang
- Department of Gastroenterology, Shandong Provincial Hospital affiliated to Shandong University, No. 324, Jingwuweiqi Road, Jinan, Shandong, China
| | - Jing-Hua Hao
- Department of Gastroenterology, Shandong Provincial Hospital affiliated to Shandong University, No. 324, Jingwuweiqi Road, Jinan, Shandong, China
| | - Bin Li
- Department of Gastroenterology, Shandong Provincial Hospital affiliated to Shandong University, No. 324, Jingwuweiqi Road, Jinan, Shandong, China.
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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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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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Rajan E, Wong Kee Song LM. Endoscopic Full Thickness Resection. Gastroenterology 2018; 154:1925-1937.e2. [PMID: 29486198 DOI: 10.1053/j.gastro.2018.02.020] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 02/06/2023]
Abstract
Recent advances in minimally invasive endoscopic approaches have pushed the boundaries of well-established resection techniques for therapeutic and diagnostic applications. Endoscopic full thickness resection techniques are a key development in the management of challenging epithelial and subepithelial lesions that are not amenable to conventional endoscopic resection methods and previously required a surgical approach. Endoscopic full thickness biopsy represents a paradigm shift in tissue acquisition and will enhance our understanding of the pathophysiology, and guide therapy, of gastrointestinal neuromuscular diseases, as well as other inflammatory and neoplastic conditions. This review highlights current tools and techniques available for endoscopic full thickness resection and biopsy, as well as outcomes from such interventions.
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Affiliation(s)
- Elizabeth Rajan
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Feng X, Linghu E, Chai N, Lu Z, Wang X, Tang P, Meng J, Du H, Wang H. Endoscopic Submucosal Tunnel Dissection for Large Gastric Neoplastic Lesions: A Case-Matched Controlled Study. Gastroenterol Res Pract 2018; 2018:1419369. [PMID: 29692806 PMCID: PMC5859796 DOI: 10.1155/2018/1419369] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 02/04/2018] [Indexed: 12/12/2022] Open
Abstract
AIM To evaluate the efficacy and safety of endoscopic submucosal tunnel dissection (ESTD) for resection of large superficial gastric lesions (SGLs). METHODS The clinicopathological records of patients performed with ESTD or endoscopic submucosal dissection (ESD) for SGLs between January 2012 and January 2014 were retrospectively reviewed. 7 cases undergoing ESTD were enrolled to form the ESTD group. The cases were individually matched at a 1 : 1 ratio to other patients performed with ESD according to lesion location, ulcer or scar findings, resected specimen area, operation time and operators, and the matched cases constituting the ESD group. The treatment outcomes were compared between the two groups. RESULTS The mean specimen size was 46 mm. 10 lesions were located in the cardia and 4 lesions in the lesser curvature of the lower gastric body. En bloc resection was achieved for all lesions. The mean ESTD resection time was 69 minutes as against 87.7 minutes for the ESD (P = 0.01). The mean resection speed was faster for ESTD than for ESD (18.86 mm2/min versus 13.76 mm2/min, P = 0.03). There were no significant differences regarding the safety and curability during the endoscopic follow-up (mean 27 months). CONCLUSIONS ESTD is effective and safe for the removal of SGLs and appears to be an optimal option for patients with large SGLs at suitable sites.
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Affiliation(s)
- Xiuxue Feng
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
| | - Enqiang Linghu
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
| | - Ningli Chai
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhongsheng Lu
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiangdong Wang
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
| | - Ping Tang
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
| | - Jiangyun Meng
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
| | - Hong Du
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
| | - Hongbin Wang
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
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Ko WJ, Cho JY. Introduction to Endoscopic Submucosal Surgery. Clin Endosc 2018; 51:8-12. [PMID: 29357614 PMCID: PMC5806918 DOI: 10.5946/ce.2017.154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/30/2017] [Accepted: 12/04/2017] [Indexed: 12/21/2022] Open
Abstract
The concept of using natural orifices to reduce the complications of surgery, Natural Orifices Transluminal Endoscopic Surgery, has also been applied to therapeutic endoscopy. Endoscopic submucosal surgery (ESS) provides more treatment options for various gastrointestinal diseases than traditional therapeutic endoscopy by using the submucosal layer as a working space. ESS has been performed in various fields ranging from transluminal peritoneoscopy to peroral endoscopic myotomy. With further advances in technology, ESS will be increasingly useful for diagnosis and treatment of gastrointestinal diseases.
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Affiliation(s)
- Weon Jin Ko
- Department of Gastroenterology, Cha Kumi Medical Center, Cha University College of Medicine, Gumi, Korea
| | - Joo Young Cho
- Department of Gastroenterology, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam, Korea
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Andalib I, Yeoun D, Reddy R, Xie S, Iqbal S. Endoscopic resection of gastric gastrointestinal stromal tumors originating from the muscularis propria layer in North America: methods and feasibility data. Surg Endosc 2017; 32:1787-1792. [PMID: 28916847 DOI: 10.1007/s00464-017-5862-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/22/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. In recent years, endoscopic procedures such as endoscopic enucleation (EN) and endoscopic full-thickness resection (EFTR) have been used to resect GISTs. This study aimed to investigate the clinical efficacy, safety, and feasibility of endoscopic resection of GISTs in a North American population. METHODS A total of 25 patients with gastric submucosal lesions (SML) underwent endoscopic resection from December 2014 to April 2016. Data from cases with histologically proven GISTs originating from the muscularis propria layer (MP-GIST) were collected. The main outcome measures were complete resection rate, operative time, postoperative complications, length of hospital stay, narcotic analgesic requirement, and follow-up outcomes. Surveillance was performed with CT abdomen, and/or EGD along with oncology follow-up at 6- to 24-month intervals. RESULTS Out of 25 gastric SML, there were 12 histologically proven MP-GIST. Five endophytic MP-GIST were removed by EN, and seven exophytic MP-GIST were removed by EFTR. All lesions were removed en bloc except for one hard to localize exophytic lesion which was completely removed piecemeal. The mean removal time was 79.7 min (range 17-180 min). Nine out of twelve patients required inpatient admission for observation with a mean length of stay of 2.08 days (range 1-4 days). No complications were noted and no narcotic analgesics were required. Pathology reports showed that one GIST was intermediate risk but all others were low-risk lesions. No recurrence has been noted thus far. CONCLUSION Endoscopic removal of MP-GIST by a trained endoscopist appears to be safe and feasible in North American population. Further studies with greater sample size are necessary to compare endoscopic versus surgical resection of MP-GIST. Comparison of outcomes may support wider use of endoscopic techniques for GIST removal.
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Affiliation(s)
- Iman Andalib
- Division of Gastroenterology & Hepatology, SUNY Downstate Medical Center, Brooklyn, NY, USA.
| | - Daniel Yeoun
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Ramesh Reddy
- Department of Surgery, Kings County Hospital Center, Brooklyn, NY, USA
| | - Steve Xie
- Department of Pathology, Kings County Hospital Center, Brooklyn, NY, USA
| | - Shahzad Iqbal
- Division of Gastroenterology & Hepatology, SUNY Downstate Medical Center, Brooklyn, NY, USA
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14
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Maydeo A, Dhir V. Third-space endoscopy: stretching the limits. Gastrointest Endosc 2017; 85:728-729. [PMID: 28317688 DOI: 10.1016/j.gie.2016.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Amit Maydeo
- Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, India
| | - Vinay Dhir
- Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, India
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15
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Mao XL, Ye LP, Zheng HH, Zhou XB, Zhu LH, Zhang Y. Submucosal tunneling endoscopic resection using methylene-blue guidance for cardial subepithelial tumors originating from the muscularis propria layer. Dis Esophagus 2017; 30:1-7. [PMID: 28375471 DOI: 10.1093/dote/dow023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Indexed: 12/11/2022]
Abstract
Submucosal tunneling endoscopic resection (STER) of subepithelial tumors (SETs) originating from the muscularis propria (MP) layer in the cardia is rarely performed due to the difficulty of creating a submucosal tunnel for resection. The aim of this study is to evaluate the feasibility of STER using methylene-blue guidance for SETs originating from the MP layer in the cardia. From January 2012 to December 2014, 56 patients with SETs originating from the MP layer in the cardia were treated with STER using methylene-blue guidance. The complete resection rate and adverse event rate were the main outcome measurements. Successful complete resection by STER was achieved in all 56 cases (100%). The median size of the tumor was 1.8 cm. Nine patients (15.3%) had adverse events including subcutaneous emphysema, pneumoperitoneum, pneumothorax, and pleural effusion. These nine patients recovered successfully after conservative treatment without endoscopic or surgical intervention. No residual or recurrent tumors were detected in any patient during the follow-up period (median, 25 months). The adverse event rate was significantly higher for tumors originating in the deeper MP layers (46.7%) than in the superficial MP layers (4.9%) (P < 0.05), differed significantly according to tumor size (5.4% for tumors < 2.0 cm vs. 36.8% for tumors ≥ 2.0 cm; P < 0.05), and also differed significantly in relation to the tumor growth pattern (4.1% for the intraluminal growth vs. 100% for the extraluminal growth; P < 0.001). STER using methylene-blue guidance appears to be a feasible method for removing SETs originating from the MP layer in the cardia.
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Affiliation(s)
- X-L Mao
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, Zhejiang Province, China
| | - L-P Ye
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, Zhejiang Province, China
| | - H-H Zheng
- Department of Pathology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, Zhejiang Province, China
| | - X-B Zhou
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, Zhejiang Province, China
| | - L-H Zhu
- Department of Medical Administration, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, Zhejiang Province, China
| | - Y Zhang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, Zhejiang Province, China
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16
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Jain D, Desai A, Mahmood E, Singhal S. Submucosal tunneling endoscopic resection of upper gastrointestinal tract tumors arising from muscularis propria. Ann Gastroenterol 2017; 30:262-272. [PMID: 28469356 PMCID: PMC5411376 DOI: 10.20524/aog.2017.0128] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/18/2016] [Indexed: 12/17/2022] Open
Abstract
The management of incidentally discovered small upper gastrointestinal (GI) tract submucosal tumors (SMT) remains debatable. In this review, we summarize the evolving experience with submucosal tunneling endoscopic resection (STER) of upper GI SMTs originating from the muscularis propria. From 16 original studies, we reviewed a total of 703 patients with 736 lesions. Of these, 436 were located in the esophagus, 146 in the esophagogastric junction (EGJ) and 154 in the stomach. The composite complete resection rate (CRR) for STER of upper GI tumors arising from the muscularis propria layer was 99.8% (445/446). The composite CRR for STER of esophageal, EGJ and gastric SMTs arising from the muscularis propria layer was 100% (208/208),100% (78/78)and 100% (115/115), respectively. The composite en bloc resection rate (EBRR) for STER of upper GI tumors arising from the muscularis propria layer was 94.6% (679/718). The composite EBRR for STER of esophageal, EGJ and gastric SMTs arising from the muscularis propria layer was 98.6% (205/208), 96.2% (75/78) and 97.9% (95/97), respectively. Tumor recurrence rate was 0%. The reported complication rate for STER was high but the majority responded to conservative management. STER is a minimally invasive and efficacious alternative to surgery, especially for patients with small tumors (<3 cm). Careful selection of candidates remains crucial for excluding potentially malignant tumors.
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Affiliation(s)
- Deepanshu Jain
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA (Deepanshu Jain, Ejaz Mahmood)
| | - Aakash Desai
- Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, Houston, Texas (Aakash Desai, Shashideep Singhal), USA
| | - Ejaz Mahmood
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA (Deepanshu Jain, Ejaz Mahmood)
| | - Shashideep Singhal
- Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, Houston, Texas (Aakash Desai, Shashideep Singhal), USA
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17
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Mao XL, Ye LP, Zheng HH, Zhou XB, Zhu LH, Zhang Y. Submucosal tunneling endoscopic resection using methylene-blue guidance for cardial subepithelial tumors originating from the muscularis propria layer. Dis Esophagus 2017; 30:1-7. [PMID: 27671744 DOI: 10.1111/dote.12536] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Submucosal tunneling endoscopic resection (STER) of subepithelial tumors (SETs) originating from the muscularis propria (MP) layer in the cardia is rarely performed due to the difficulty of creating a submucosal tunnel for resection. The aim of this study was to evaluate the feasibility of STER using methylene-blue guidance for SETs originating from the MP layer in the cardia. From January 2012 to December 2014, 56 patients with SETs originating from the MP layer in the cardia were treated with STER using methylene-blue guidance. The complete resection rate and adverse event rate were the main outcome measurements. Successful complete resection by STER was achieved in all 56 cases (100%). The median size of the tumor was 1.8 cm. Nine patients (15.3%) had adverse events including subcutaneous emphysema, pneumoperitoneum, pneumothorax, and pleural effusion. These nine patients recovered successfully after conservative treatment without endoscopic or surgical intervention. No residual or recurrent tumors were detected in any patient during the follow-up period (median, 25 months). The adverse event rate was significantly higher for tumors originating in the deeper MP layers (46.7%) than in the superficial MP layers (4.9%) (P < 0.05), differed significantly according to tumor size (5.4% for tumors < 2.0 cm vs. 36.8% for tumors ≥ 2.0 cm; P < 0.05), and also differed significantly in relation to the tumor growth pattern (4.1% for the intraluminal growth vs. 100% for the extraluminal growth; P < 0.001). STER using methylene-blue guidance appears to be a feasible method for removing SETs originating from the MP layer in the cardia.
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Affiliation(s)
- Xin-Li Mao
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - Li-Ping Ye
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - Hai-Hong Zheng
- Department of Pathology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - Xian-Bin Zhou
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - Lin-Hong Zhu
- Department of Medical Administration, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - Yu Zhang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
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18
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Ye LP, Zhang Y, Luo DH, Mao XL, Zheng HH, Zhou XB, Zhu LH. Safety of Endoscopic Resection for Upper Gastrointestinal Subepithelial Tumors Originating from the Muscularis Propria Layer: An Analysis of 733 Tumors. Am J Gastroenterol 2016; 111:788-796. [PMID: 26782819 DOI: 10.1038/ajg.2015.426] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/07/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Although endoscopic resection is an accepted technique for upper gastrointestinal subepithelial tumors (SETs) originating from the muscularis propria (MP) layer, published data regarding its complications are highly variable and limited to small data series. This study aimed to analyze the safety of endoscopic resection in a large case series. METHODS A total of 726 consecutive patients with 733 upper gastrointestinal SETs originating from the MP layer underwent endoscopic resection from June 2005 to December 2014. The complete resection rate, perioperative perforation rate, and perioperative bleeding rate were the main outcome measurements. RESULTS The complete resection rate was 97.1%. Ninety-four patients had complications (12.9%), including 88 with perioperative perforations (12.1%), 13 with perioperative bleeding (1.8%), 5 with localized peritonitis (0.7%), and one with delayed bleeding (0.1%). Eleven patients required surgery; the others were treated endoscopically. Risk factors for incomplete resection were extensive connection of the tumor to the MP layer (P=0.007) and extraluminal growth (P=0.048). Risk factors for perioperative perforation were larger tumor size (≤2.0 cm vs. 2.1-3.0 cm vs. >3.0 cm, P=0.021), extraluminal growth (P=0.046), and extensive connection (P<0.001). A risk factor for perioperative bleeding was larger tumor size (P=0.045). No residual or recurrent lesions were detected during the follow-up period (median: 28 months). CONCLUSIONS Endoscopic resection is an effective and reasonably safe therapeutic method for treating/removing upper gastrointestinal SETs originating from the MP layer when managed by an experienced endoscopic team.
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Affiliation(s)
- Li-Ping Ye
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - Yu Zhang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - Ding-Hai Luo
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - Xin-Li Mao
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - Hai-Hong Zheng
- Department of Pathology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - Xian-Bin Zhou
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - Lin-Hong Zhu
- Department of Medical Administration, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
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19
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Li B, Liu J, Lu Y, Hao J, Liu H, Jiang J, Jiang Y, Qin C, Xu H. Submucosal tunneling endoscopic resection for tumors of the esophagogastric junction. MINIM INVASIV THER 2016; 25:141-7. [PMID: 27049345 DOI: 10.3109/13645706.2016.1167085] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND For submucosal tumors (SMTs) originating from the muscularis propria (MP) layer of the esophagogastric junction (EGJ), submucosal tunneling endoscopic resection (STER) is now widely used, and it shows promise in overcoming the limitations of endoscopic submucosal dissection. AIMS This study aimed to evaluate the efficacy and safety of the STER technique for treating SMTs of the EGJ originating from the MP layer. MATERIAL AND METHODS From October 2011 to February 2014, 20 patients were enrolled for STER surgery. RESULTS The patients were categorized into three groups according to the tumor location. The esophagocardiac group had a lower complication rate (0/7) compared with the cardiac group (3/6) and the gastrocardiac group (3/7). The mean operation time in the esophagocardiac (83 ± 24 min) and cardiac (83 ± 55 min) groups was significantly shorter than that of the gastrocardiac group (145 ± 44 min) (P < 0.05). The en bloc resection rate was 100%, with no severe complications and no recurrence during the follow-up period. CONCLUSIONS The STER technique appears to be a feasible and safe minimally invasive approach for SMTs originating from the MP layer of the EGJ, with satisfying en bloc resection, a short operation time, and low rates of severe complications.
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Affiliation(s)
- Bin Li
- a Department of Gastroenterology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China
| | - Juan Liu
- a Department of Gastroenterology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China
| | - Yingju Lu
- a Department of Gastroenterology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China
| | - Jinghua Hao
- a Department of Gastroenterology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China
| | - Hui Liu
- a Department of Gastroenterology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China
| | - Junmei Jiang
- a Department of Gastroenterology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China
| | - Ying Jiang
- a Department of Gastroenterology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China
| | - Chengyong Qin
- a Department of Gastroenterology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China
| | - Hongwei Xu
- a Department of Gastroenterology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China
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20
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Liu BR, Song JT. Submucosal Tunneling Endoscopic Resection (STER) and Other Novel Applications of Submucosal Tunneling in Humans. Gastrointest Endosc Clin N Am 2016; 26:271-282. [PMID: 27036897 DOI: 10.1016/j.giec.2015.12.003] [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: 02/06/2023]
Abstract
The submucosal tunneling technique was originally developed to provide safe access to the peritoneal cavity for natural orifice transluminal endoscopic surgery procedures. With this technique, the submucosal tunnel becomes the working space for partial myotomy and tumor resection. The submucosal space has come to represent the "third space" distinguished from gastrointestinal lumen (first space) and peritoneal cavity (second space). New applications continue to be developed and further clinical applications in the future are anticipated. This article summarizes the current applications of submucosal tunneling endoscopic resection for subepithelial tumors and describes other related uses of submucosal tunneling.
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Affiliation(s)
- Bing-Rong Liu
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Nangang District, Harbin 150086, People's Republic of China.
| | - Ji-Tao Song
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Nangang District, Harbin 150086, People's Republic of China
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21
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Ye LP, Zheng HH, Mao XL, Zhang Y, Zhou XB, Zhu LH. Complete circular endoscopic resection using submucosal tunnel technique combined with esophageal stent placement for circumferential superficial esophageal lesions. Surg Endosc 2016; 30:1078-1085. [PMID: 26092023 DOI: 10.1007/s00464-015-4301-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 06/03/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS At present, removing a circumferential superficial esophageal lesion (SEL) via en bloc resection is still a great challenge. Based on the previous success of submucosal tunneling endoscopic resection, this study aimed to evaluate the safety and effectiveness of complete circular endoscopic resection (CER) using a submucosal tunnel technique combined with esophageal stent placement for patients with circumferential SELs. METHODS From August 2012 to June 2014, 23 patients with circumferential SELs were treated by CER using a submucosal tunnel technique combined with esophageal stent placement. The following steps were performed: (1) circular mucosa incisions were made at the anal and oral side of the lesion after marking the margin, (2) two submucosal tunnels were created from the oral to anal side using a hybrid knife, which was followed by submucosal dissection, and (3) following the completion of CER, a retrievable esophageal stent was placed to prevent postoperative stricture. RESULTS CER using the submucosal tunnel technique combined with esophageal stent placement was successfully performed for all 23 cases. The complete resection and success rate were 100%, while the mean longitudinal diameter of the lesions was 65 mm. Mediastinal emphysema, pneumothorax, and postoperative stenosis were detected in 8.7% (2/23), 4.3% (1/23), and 17.4% (4/23) of the cases, respectively. Pathological diagnoses of the lesions included carcinomas (13/23) and high-grade intraepithelial neoplasias (10/23). No residual or recurrent tumors were detected in any patient during the follow-up period. CONCLUSIONS CER using the submucosal tunnel technique combined with esophageal stent placement seems to be a safe and effective procedure for treating patients with SELs that result in a higher en bloc resection rate with fewer or minor complications.
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Affiliation(s)
- Li-Ping Ye
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang Province, China
| | - Hai-Hong Zheng
- Department of Pathology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - Xin-Li Mao
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang Province, China
| | - Yu Zhang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang Province, China.
| | - Xian-Bin Zhou
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang Province, China
| | - Lin-Hong Zhu
- Department of Medical Administration, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
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Gomercic C, Vanbiervliet G, Gonzalez JM, Saint-Paul MC, Garcès-Duran R, Garnier E, Hébuterne X, Berdah S, Barthet M. Prospective randomized comparison of endoscopic submucosal tunnel dissection and conventional submucosal dissection in the resection of superficial esophageal/gastric lesions in a living porcine model. Endosc Int Open 2015; 3:E577-83. [PMID: 26716116 PMCID: PMC4683130 DOI: 10.1055/s-0034-1393084] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND STUDY AIMS To assess experimentally endoscopic submucosal tunnel dissection (ESTD) as an alternative technique of endoscopic submucosal resection. PATIENTS AND METHODS This was a prospective, randomized, comparative experimental animal study carried out over a period of 9 months at the surgical research and teaching center of Aix-Marseille University, France. Virtual esophageal and gastric lesions measuring 3 cm in diameter were resected in pigs weighing 25 to 30 kg. The primary aim was to evaluate ESTD's efficacy compared with endoscopic submucosal dissection (ESD). The secondary aims were to determine complication rates as well as to assess procedure time and procedure speed, histologic quality of the resected specimen, and procedure cost. RESULTS Eighteen procedures (9 ESD and 9 ESTD) were performed in nine pigs. The technical success rate was 88.9 % for both techniques, with one single failure in each. The en bloc resection rate was 100 % for ESTD and 88.9 % for ESD (one failure). The complication rate (22 %) and median procedure time were similar but dissection speed was quicker with ESTD in the esophagus (P = 0.03). Median procedure cost (728 Euros for ESD and ESTD) did not differ. On histologic examination, the lateral margins were healthy in 100 % of ESTD and in 88.9 % of ESD (P = 0.49). Deep resection margins were of better quality in ESTD (median submucosal thickness: 1307.1 µm vs. 884.7 µm; P = 0.039). CONCLUSIONS ESTD is feasible and safe but not superior in the treatment of superficial esophageal/gastric lesions in porcine models compared with ESD. Nevertheless it provides a better quality histologic specimen.
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Affiliation(s)
- Cécile Gomercic
- Endoscopie digestive, Hôpital L’Archet 2, Centre Hospitalier Universitaire, Nice, F-06202 Cedex 3, France,CERC, LBA UMRT24, Université Aix-Marseille, Faculté de médecine, Marseille, F-13916 Cedex20, France
| | - Geoffroy Vanbiervliet
- Endoscopie digestive, Hôpital L’Archet 2, Centre Hospitalier Universitaire, Nice, F-06202 Cedex 3, France,CERC, LBA UMRT24, Université Aix-Marseille, Faculté de médecine, Marseille, F-13916 Cedex20, France,Corresponding author Geoffroy Vanbiervliet, MD, MSc Endoscopy unit, GastroenterologyL’Archet 2 Hospital151 Route de Saint Antoine de GinestièreCS 2307906202 Nice cedex 3France00 33 (0)4 92 03 63 8500 33 (0)4 92 03 59 28
| | - Jean-Michel Gonzalez
- CERC, LBA UMRT24, Université Aix-Marseille, Faculté de médecine, Marseille, F-13916 Cedex20, France,Gastro entérologie, Hôpital Nord, Assistance Publique des hôpitaux de Marseille, Marseille, F-13915 Cedex20, France
| | - Marie-Christine Saint-Paul
- Département d’anatomo-pathologie, Hôpital Pasteur, Centre Hospitalier Universitaire, Nice, F-06000, France
| | - Rodrigo Garcès-Duran
- CERC, LBA UMRT24, Université Aix-Marseille, Faculté de médecine, Marseille, F-13916 Cedex20, France,Gastro entérologie, Hôpital Nord, Assistance Publique des hôpitaux de Marseille, Marseille, F-13915 Cedex20, France
| | - Emmanuelle Garnier
- CERC, LBA UMRT24, Université Aix-Marseille, Faculté de médecine, Marseille, F-13916 Cedex20, France
| | - Xavier Hébuterne
- Endoscopie digestive, Hôpital L’Archet 2, Centre Hospitalier Universitaire, Nice, F-06202 Cedex 3, France
| | - Stéphane Berdah
- CERC, LBA UMRT24, Université Aix-Marseille, Faculté de médecine, Marseille, F-13916 Cedex20, France,Chirurgie Digestive, Hôpital Nord, Assistance Publique des hôpitaux de Marseille, Marseille, F-13915 Cedex20, France
| | - Marc Barthet
- CERC, LBA UMRT24, Université Aix-Marseille, Faculté de médecine, Marseille, F-13916 Cedex20, France,Gastro entérologie, Hôpital Nord, Assistance Publique des hôpitaux de Marseille, Marseille, F-13915 Cedex20, France
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Lee DJK, Tan KY. Endoscopic surgery - exploring the modalities. World J Gastrointest Surg 2015; 7:326-334. [PMID: 26649156 PMCID: PMC4663387 DOI: 10.4240/wjgs.v7.i11.326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 09/14/2015] [Accepted: 10/01/2015] [Indexed: 02/07/2023] Open
Abstract
The adoption of endoscopic surgery continues to expand in clinical situations with the recent natural orifice transluminal endoscopic surgery technique enabling abdominal organ resection to be performed without necessitating any skin incision. In recent years, the development of numerous devices and platforms have allowed for such procedures to be carried out in a safer and more efficient manner, and in some ways to better simulate triangulation and surgical tasks (e.g., suturing and dissection). Furthermore, new novel techniques such as submucosal tunneling, endoscopic full-thickness resection and hybrid endo-laparoscopic approaches have further widened its use in more advanced diseases. Nevertheless, many of these new innovations are still at their pre-clinical stage. This review focuses on the various innovations in endoscopic surgery, with emphasis on devices and techniques that are currently in human use.
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Liu BR, Song JT, Kong LJ, Ma X, Liu JY, Cui GX. Esophago-Cardial-Gastric Tunneling Peritoneoscopy: In Vivo Dog Survival Study. J Laparoendosc Adv Surg Tech A 2015; 25:920-5. [PMID: 26402572 DOI: 10.1089/lap.2015.0275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Bing-Rong Liu
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Ji-Tao Song
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Ling-Jian Kong
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Xiao Ma
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Jing-Yang Liu
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Guang-Xing Cui
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
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Wang YN, Li YM, Lu XF. Value of submucosal tunneling endoscopic resection in treatment of upper gastrointestinal muscularis propria tumors. Shijie Huaren Xiaohua Zazhi 2015; 23:793-799. [DOI: 10.11569/wcjd.v23.i5.793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the feasibility and safety of submucosal tunneling endoscopic resection (STER) in the treatment of upper gastrointestinal muscularis propria tumors, and the value of endoscopic ultrasonography (EUS) in pre-therapy detection of these tumors.
METHODS: All patients with muscularis propria tumors were diagnosed by EUS. Twenty-four patients were treated by STER, and the other 15 patients treated by surgery were used as controls. Clinical effects were compared for the two groups.
RESULTS: In the STER group, three patients were found to have tumors located in the muscularis mucosa and converted to other forms of treatment during operation. For the other cases, the average diameter of resected tumors was similar to that in the control group (P > 0.05). The treatment time for esophagus tumors had no significant difference between the two groups (P > 0.05). However, for stomach tumors, STER was faster than surgery (P < 0.01). Patients in the STER group needed shorter hospitalizing time (P < 0.01) and less cost (P < 0.05) compared with controls. Postoperative pathological examination demonstrated that the rate of correct preoperative diagnosis by EUS was 92.3%.
CONCLUSION: STER is safe and efficient in the treatment of upper gastrointestinal muscularis propria tumors. EUS is important in determining the tumor location and treatment manner.
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Gonzalez JM, Saito K, Kang C, Gromski M, Sawhney M, Chuttani R, Matthes K. Prospective randomized comparison of gastrotomy closure associating tunnel access and over-the-scope clip (OTSC) with two other methods in an experimental ex vivo setting. Endosc Int Open 2015; 3:E83-9. [PMID: 26134780 PMCID: PMC4423288 DOI: 10.1055/s-0034-1390794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 08/26/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Safe transgastric natural orifice transluminal endoscopic surgery (NOTES) procedures require a reliable closure of the gastrotomy. Recently a novel peritoneal access method via a submucosal tunnel has been described with encouraging preliminary results. AIM The aim is to compare a submucosal tunnel access plus over-the-scope clip (OTSC) system for closure with two other closure modalities. PATIENTS AND METHODS This is a prospective ex vivo study conducted on 42 porcine stomach models equally randomized into three groups in an academic medical center. The procedures performed in each group included: (1) Tunnel (6 cm) + endoclips; (2) Knife + balloon dilation access + OTSC; and (3) Tunnel + OTSC. A pressurized air-leak test was performed to evaluate the strength of the closure. Stomach volumes, procedure times, number of clips, and incision sizes were also registered. RESULTS The mean air-leak pressure was statistically higher in Group 3 than in Groups 1 and 2-95.2 ± 19.3 mmHg versus 72.5 ± 35.2 and 79.0 ± 24.5 mmHg (P < 0.05). The gastrotomy creation times for Groups 1, 2, and 3 were 28.0 ± 10.1, 4.3 ± 1.4, and 20.1 ± 10.6 minutes, respectively, with significantly lower time in Group 2 (P < 0.001). The closure times were 16.1 ± 6.1, 6.5 ± 1.2, and 5.3 ± 3.0 minutes, respectively, and significantly longer in the endoclip group (P < 0.001). There were no differences in the volumes and the incision sizes among the three groups. CONCLUSION The combination of a submucosal tunnel access and OTSC offers a stronger closure than the other methods studied.
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Affiliation(s)
- Jean-Michel Gonzalez
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA,Corresponding author Jean-Michel Gonzalez, MD Dana 506Division of GastroenterologyBeth Israel Deaconess Medical CenterHarvard Medical School330 Brookline Ave.Boston, MA 02215USA
| | - Kayoko Saito
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Changdon Kang
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mark Gromski
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mandeep Sawhney
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ram Chuttani
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kai Matthes
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA,Department of Anesthesiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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A new technique for performing endoscopic pyloromyotomy by gastric submucosal tunnel dissection. Surg Laparosc Endosc Percutan Tech 2015; 24:e92-4. [PMID: 24887546 DOI: 10.1097/sle.0b013e31829cec0e] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM To investigate the feasibility of a new endoscopic pyloromyotomy technique. MATERIALS AND METHODS Endoscopic pyloromyotomy through a gastric submucosal tunnel was performed in 6 pigs. At the greater curvature, 2 cm proximal to the pylorus, we incised the mucosa and dissected the submucosal tunnel up to the pyloric ring. The pyloric muscular ring was sectioned, and then the gastric mucosal incision was closed with metallic clips. The pigs were then euthanized and necropsies were performed. RESULTS Section of the pyloric ring was successful in all 6 pigs. Small perforations occurred in 2 of the pigs, and there was limited bleeding in 1 pig. Necropsy and histologic evaluation confirmed the pyloric section. CONCLUSIONS This technique is feasible, easy to perform, and maybe alternative to pyloroplasty in selected cases. Experimental comparative studies with other techniques still must be performed.
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Chen H, Xu Z, Huo J, Liu D. Submucosal tunneling endoscopic resection for simultaneous esophageal and cardia submucosal tumors originating from the muscularis propria layer (with video). Dig Endosc 2015; 27:155-158. [PMID: 24444087 DOI: 10.1111/den.12227] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 12/09/2013] [Indexed: 12/21/2022]
Abstract
Submucosal tunneling endoscopic resection (STER) is a new treatment technique for upper gastrointestinal submucosal tumors (SMT) originating from the muscularis propria (MP) layer. In contrast to conventional endoscopic resection, the new therapy can maintain the mucosal integrity of the digestive tract, which effectively prevents mediastinitis and peritonitis. STER, although a known method, has not been widely adopted because of technical difficulties. Here, we describe the case of a 30-year-old patient presenting with two separate SMT originating from the esophageal and cardia MP layer. A 2-cm longitudinal mucosal incision was made approximately 5 cm proximal to the esophageal SMT, and the esophageal and cardia SMT were dissected successively in the same submucosal tunnel. In the relevant literature, this is the first case of STER for resecting esophageal and cardia SMT using the same submucosal tunnel.
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Affiliation(s)
- Hui Chen
- Department of Gastroenterology, Second Xiangya Hospital of Central South University, Changsha, China
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29
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Ye LP, Yu Z, Mao XL, Zhu LH, Zhou XB. Endoscopic full-thickness resection with defect closure using clips and an endoloop for gastric subepithelial tumors arising from the muscularis propria. Surg Endosc 2014; 28:1978-1983. [PMID: 24619327 DOI: 10.1007/s00464-014-3421-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 01/03/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS This retrospective study evaluated the safety and efficacy of endoscopic full-thickness resection (eFTR) with defect closure using clips and an endoloop for the treatment of gastric subepithelial tumors (SETs) arising from the muscularis propria (MP). METHODS From January 2009 to December 2012, 51 patients with gastric SETs arising from the MP underwent eFTR with defect closure using clips and an endoloop. The key steps were (1) several milliliters of mixture solution was injected into the submucosa after dots were marked around the tumor; (2) a cross incision was made in the mucosa to reveal the tumor; (3) subsequently, circumferential excavation was performed as deep as the muscularis propria, and full-thickness resection of the tumor was performed with an insulated-tip knife, including its underlying MP and serosa; (4) the gastric wall defect was closed with clips and an endoloop was then placed to fix and tighten all of the clips together. RESULTS Successful complete resection by eFTR was achieved in 50 cases (98.0%). One case failed and was converted into a laparoscopic resection due to the tumor falling into the peritoneal cavity during the procedure. The mean procedure time was 52 min. No patients had severe complications, such as massive bleeding, delayed bleeding, peritonitis, or gastrointestinal tract leakage. The mean tumor length was 2.4 cm. Pathological diagnoses of the tumors were leiomyomas (21/51) and gastrointestinal stromal tumors (30/51). The median follow-up period after the procedure was 22.4 months (range 1-48 months), and no residual tumor or tumor recurrence was detected during the follow-up period. CONCLUSIONS eFTR with defect closure with clips and an endoloop appears to be a safe and effective technique for the treatment of patients with gastric SETs originating from the MP, especially for those with extraluminal growth or adhesions to the MP.
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Affiliation(s)
- Li-Ping Ye
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang, China
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Kobara H, Mori H, Rafiq K, Fujihara S, Nishiyama N, Ayaki M, Yachida T, Matsunaga T, Tani J, Miyoshi H, Yoneyama H, Morishita A, Oryu M, Iwama H, Masaki T. Submucosal tunneling techniques: current perspectives. Clin Exp Gastroenterol 2014; 7:67-74. [PMID: 24741323 PMCID: PMC3982978 DOI: 10.2147/ceg.s43139] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Advances in endoscopic submucosal dissection include a submucosal tunneling technique, involving the introduction of tunnels into the submucosa. These tunnels permit safer offset entry into the peritoneal cavity for natural orifice transluminal endoscopic surgery. Technical advantages include the visual identification of the layers of the gut, blood vessels, and subepithelial tumors. The creation of a mucosal flap that minimizes air and fluid leakage into the extraluminal cavity can enhance the safety and efficacy of surgery. This submucosal tunneling technique was adapted for esophageal myotomy, culminating in its application to patients with achalasia. This method, known as per oral endoscopic myotomy, has opened up the new discipline of submucosal endoscopic surgery. Other clinical applications of the submucosal tunneling technique include its use in the removal of gastrointestinal subepithelial tumors and endomicroscopy for the diagnosis of functional and motility disorders. This review suggests that the submucosal tunneling technique, involving a mucosal safety flap, can have potential values for future endoscopic developments.
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Affiliation(s)
- Hideki Kobara
- Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan
| | - Hirohito Mori
- Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan
| | - Kazi Rafiq
- Department of Pharmacology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan
| | - Shintaro Fujihara
- Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan
| | - Noriko Nishiyama
- Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan
| | - Maki Ayaki
- Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan
| | - Tatsuo Yachida
- Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan
| | - Tae Matsunaga
- Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan
| | - Johji Tani
- Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan
| | - Hisaaki Miyoshi
- Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan
| | - Hirohito Yoneyama
- Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan
| | - Asahiro Morishita
- Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan
| | - Makoto Oryu
- Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan
| | - Hisakazu Iwama
- Life Science Research Center, Faculty of Medicine, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan
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Kim CG. Natural orifice transluminal endoscopic surgery and upper gastrointestinal tract. J Gastric Cancer 2013; 13:199-206. [PMID: 24511415 PMCID: PMC3915181 DOI: 10.5230/jgc.2013.13.4.199] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 12/18/2022] Open
Abstract
Since the first transgastric natural orifice transluminal endoscopic surgery was described, various applications and modified procedures have been investigated. Transgastric natural orifice transluminal endoscopic surgery for periotoneoscopy, cholecystectomy, and appendectomy all seem viable in humans, but additional studies are required to demonstrate their benefits and roles in clinical practice. The submucosal tunneling method enhances the safety of peritoneal access and gastric closure and minimizes the risk of intraperitoneal leakage of gastric air and juice. Submucosal tunneling involves submucosal tumor resection and peroral endoscopic myotomy. Peroral endoscopic myotomy is a safe and effective treatment option for achalasia, and the most promising natural orifice transluminal endoscopic surgery procedure. Endoscopic full-thickness resection is a rapidly developing natural orifice transluminal endoscopic surgery procedure for the upper gastrointestinal tract and can be performed with a hybrid natural orifice transluminal endoscopic surgery technique (combining a laparoscopic approach) to overcome some limitations of pure natural orifice transluminal endoscopic surgery. Studies to identify the most appropriate role of endoscopic full-thickness resection are anticipated. In this article, I review the procedures of natural orifice transluminal endoscopic surgery associated with the upper gastrointestinal tract.
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Affiliation(s)
- Chan Gyoo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
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Rezende M, Montero EFDS, Salomão R, Brunialti M, Rodrigues R, Gomes G, Libera AD, Ferrari A, Libera ED. Acute inflammatory response to transgastric natural orifice transluminal endoscopic surgery peritoneoscopy: an experimental study in swine. Clinics (Sao Paulo) 2013; 68:1433-9. [PMID: 24270956 PMCID: PMC3812549 DOI: 10.6061/clinics/2013(11)09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 05/19/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the impact of transgastric peritoneal access on plasma biomarkers of acute inflammatory response in comparison to laparoscopy. METHODS This was a prospective and comparative study in a porcine model. Transgastric peritoneal access performed by natural orifice transluminal endoscopic surgery was compared with laparoscopy. Laparotomy and sham groups were used as positive and negative controls, respectively. Thirty-four pigs were assigned to receive transgastric natural orifice transluminal endoscopic surgery (n = 12), laparoscopy (n = 8), laparotomy (n = 8) or a sham procedure involving only anesthesia (n = 6). In the natural orifice transluminal endoscopic surgery group, peritoneoscopy was performed with a gastroscope via transgastric access. Blood samples were collected at baseline and 1, 3, 6, 9 and 24 h after the surgical procedure for measurement of interleukins 1β, 6 and 10 and tumor necrosis factor-α. A complete blood count was performed, and C-reactive protein levels were measured at baseline and at 24 h. RESULTS All surgical and endoscopic procedures were performed without major complications. Peritoneal cavity inventory showed no signs of peritonitis in any animal. Interleukin 1β, interleukin 10 and tumor necrosis factor-α levels were below the threshold of detection. The mean level of interleukin 6 was statistically significantly higher in the laparotomy group than in the other groups (p<0.05), with no significant differences among the sham, laparoscopy and natural orifice transluminal endoscopic surgery groups (p>0.05). C-reactive protein analysis indicated significant increases in all groups, with no differences among the groups. Complete blood count analysis showed no differences among the groups. CONCLUSIONS Based on the observed interleukin 6 patterns, the systemic inflammatory response resulting from transgastric peritoneal access by natural orifice transluminal endoscopic surgery is similar in intensity to the response that occurs after laparoscopy.
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Affiliation(s)
- Marcelo Rezende
- Gastroenterology Division, São Paulo Federal University (UNIFESP), São PauloSP, Brazil
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Chiu PW, Ho LK, Reddy N, Seo DW, Tajiri H. Asia Pacific NOTES: Where are we? GASTROINTESTINAL INTERVENTION 2013. [DOI: 10.1016/j.gii.2013.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Teoh AYB, Chiu PWY, Chan SM, Wong TCL, Lau JYW, Ng EKW. Direct incision versus submucosal tunneling as a method of creating transgastric accesses for natural orifice transluminal endoscopic surgery (NOTES) peritoneoscopy: randomized controlled trial. Dig Endosc 2013; 25:281-7. [PMID: 23368513 DOI: 10.1111/j.1443-1661.2012.01390.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 08/27/2012] [Indexed: 02/08/2023]
Abstract
AIM The optimal approach for creating accesses for transgastric peritoneoscopy is still uncertain. The present study aims to assess the feasibility of carrying out transgastric submucosal tunnel (SMT) peritoneoscopy and to determine whether this approach improves or restricts access to various sectors within the peritoneal cavity. METHODS This was a randomized comparative study carried out in an in-vivo survival porcine model. Sixty-six beads in six swine were visualized and touched via gastrotomies created by either direct incision (DI) or SMT. The influence of the type of gastrotomy on improving or restricting access to particular sites within the peritoneal cavity for natural orifice transluminal endoscopic surgery (NOTES) peritoneoscopy was compared. The main outcome measurements were localization score of beads, overall procedural time, morbidities and mortalities. RESULTS A significantly higher mean (SD) localization score was observed in peritoneoscopies carried out in the DI group (P < 0.001). Both the visualization and the touching scores were significantly better with the DI technique, and the overall yield of NOTES peritoneoscopy with DI and SMT were 72.73% and 60.6%, respectively (P = 0.043). Significantly more beads that were not touched in the SMT group were located in the sub-phrenic area (P = 0.013). The overall procedural time was significantly shorter in the DI group (P = 0.004). No major morbidities or mortalities occurred in any procedures. CONCLUSIONS SMT resulted in lower visualization and touching scores for transgastric NOTES peritoneoscopy. Alternate methods to improve the diagnostic yield to the sub-phrenic area are required.
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Affiliation(s)
- Anthony Yuen Bun Teoh
- Division of Upper Gastrointestinal Surgery, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
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Lee SH, Kim SJ, Lee TH, Chung IK, Park SH, Kim EO, Lee HJ, Cho HD. Human applications of submucosal endoscopy under conscious sedation for pure natural orifice transluminal endoscopic surgery. Surg Endosc 2013; 27:3016-20. [PMID: 23397506 DOI: 10.1007/s00464-013-2844-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 01/04/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND The submucosal endoscopy provide not only a reliable methods of access and closure for peritoneoscopy, but also an endoscopic working space for full-thickness resection. The aim of this study was to report the clinical outcome of submucosal endoscopy for pure natural orifice transluminal endoscopic surgery. METHODS We prospectively evaluated 10 patients who received submucosal endoscopies. The indications of submucosal endoscopy were transgastric peritoneoscopy (TGP) and endoscopic full-thickness resection (EFTR) of a gastric subepithelial tumor. All procedures were performed with a standard gastroscope under conscious sedation with the balanced propofol method in the endoscopic unit. After a 40 mm submucosal tunnel was created using an endoscopic submucosal dissection technique, (1) in TGP, balloon dilation of a serosal puncture and intraperitoneal exploration was performed; (2) in EFTR, a full-thickness incision and snaring resection was performed. Closure of the mucosal incision was performed by endoclips. RESULTS All cases were technically feasible. The mean times for creating the submucosal tunnel, main procedure (peritoneal exploration or resection), and closure were acceptable (10.44 ± 2.42 minutes, 18.80 ± 9.41 minutes, and 5.63 ± 2.17 minutes, respectively). The mean hospital stay was 3.8 ± 1.48 days. All TGPs were diagnostic (4 peritoneal carcinomatosis and 1 tuberculosis). En bloc and complete resections were possible in all EFTRs (3 gastrointestinal stromal tumors and 2 schwannomas; mean tumor size, 20.8 ± 3.27 mm). There were no procedure-related complications, such as significant bleeding or peritonitis. CONCLUSIONS Human applications of submucosal endoscopy under conscious sedation for pure NOTES were feasible and safe.
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Affiliation(s)
- Suck-Ho Lee
- Department of Internal Medicine, Division of Gastroenterology, Cheonan Hospital, Soonchunhyang University College of Medicine, 23-20 Bongmyung-dong, Choongnam, Cheonan 330-721, Korea.
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Ye LP, Zhang Y, Mao XL, Zhu LH, Zhou XB, He SQ, Chen JY, Jin X. Submucosal tunnelling endoscopic resection for the treatment of esophageal submucosal tumours originating from the muscularis propria layer: an analysis of 15 cases. Dig Liver Dis 2013; 45:119-123. [PMID: 22989470 DOI: 10.1016/j.dld.2012.08.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 08/13/2012] [Accepted: 08/15/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The aim of this prospective study was to evaluate the feasibility of submucosal tunnelling endoscopic resection of esophageal tumours originating from the muscularis propria layer. METHODS Fifteen patients with esophageal submucosal tumours originating from the muscularis propria layer underwent submucosal tunnelling endoscopic resection between August 2011 and February 2012. The key steps were: (1) creating a submucosal tunnel from 5 cm above the tumour between the submucosal and muscular layers with a hook knife or hybrid knife; (2) dissecting the tumour by the technique of endoscopic submucosal dissection; (3) closing the mucosal incision site with clips after the tumour was removed. RESULTS Submucosal tunnelling endoscopic resection was successfully performed in all cases. The en bloc resection rate was 100%. The average tumour diameter was 1.8 cm (range 1.0-3.0 cm). During the procedure, perforation occurred in 3 patients, who recovered after conservative treatment. No residual tumour or tumour recurrence was detected during the follow-up period (mean: 3.5 months, range: 1-9 months). Pathological diagnoses of these tumours were leiomyomas (12/15) and gastrointestinal stromal tumours (3/15). CONCLUSIONS Submucosal tunnelling endoscopic resection is a feasible method for the treatment of small esophageal submucosal tumours originating from the muscularis propria layer.
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Affiliation(s)
- Li-Ping Ye
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, Zhejiang Province, China
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Ciocirlan M, Ionescu ME, Diculescu MM. Endoscopic knot tying: In vitro assessment in a porcine stomach model. World J Gastrointest Endosc 2013; 5:29-33. [PMID: 23330051 PMCID: PMC3547117 DOI: 10.4253/wjge.v5.i1.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 10/02/2012] [Accepted: 11/02/2012] [Indexed: 02/05/2023] Open
Abstract
AIM To determine if surgical knotting performed via endoscopy is an effective closure method for natural orifice translumenal endoscopic surgery. METHODS The proposed method was tested on an in vitro pig stomach model using standard endoscopy suite materials. A single use laparoscopy trocar (Versaport Plus manufactured by Tyco Healthcare) was fixed onto a plastic rectangular box in a horizontal position. A fresh pig stomach was tightly attached via its esophageal end to the trocar opening on the inner side of the box. The stomach cavity was closed at the duodenal end with Kocher forceps. A standard upper gastrointestinal endoscope fitted at its tip with a transparent plastic cap was introduced into the stomach through the outer trocar opening, so that the passage of the surgical trocar would mimic the passage of an esophagus. The stomach was subsequently inflated, followed by irrigation and washing. A neutral electrode of an electrocautery unit was placed inside the plastic box, underneath the pig stomach. The stomach's outer surface was kept moist using normal saline in order to maintain the natural elasticity and to ensure good contact with the electrode. RESULTS The submucosal space on the anterior face of the stomach was accessed using the technique of endoscopic submucosal dissection. First, a site on the anterior face of the stomach was chosen, near the angle. Then, saline was injected into the submucosa with a standard endoscopic needle, so as to create a 20 mm diameter elevation. A linear 15 mm vertical incision was created at its center using a Dual Knife (KD650U manufactured by Olympus). This incision was used to access the submucosal space, and about 10 mm was dissected on both sides of the incision. The endoscope was then pushed through to the outside of the stomach after dilating a small puncture made by the Dual Knife in the muscularis propria, which simulated the peritoneoscopy procedure. Then, a 0.025" guidewire (Jagwire/450 cm manufactured by Boston Scientific) was inserted into the puncture, followed by a dilating balloon (Quantum TT manufactured by Cook Medical) that was used to enlarge the aperture orifice. After withdrawing the scope back into the stomach, the procedure continued with guidewires being passed from the submucosal space into the gastric lumen through small orifices on the left and right sides of the mucosal opening. These orifices were made with the Dual Knife, and the guidewires were inserted via a guiding catheter (HGC-6 manufactured by Cook Medical). As the guidewires were pulled outside of the stomach, they were replaced with a single surgical suture that had been initially attached to their tip and was now untied. Finally, one loop of this surgical suture was formed on the exterior. One loop end was fixed while the opposite suture end was pulled by biopsy forceps through the endoscope channel as the scope was inserted into the stomach. The loop was advanced until it approached and fixed the two mucosal incision margins. Three alternating loops were made in this manner to create a genuine tight surgical knot. CONCLUSION Endoscopic knotting of the gastric wall is feasible, but an in vitro survival study is necessary to validate clinical significance.
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Kobara H, Mori H, Fujihara S, Nishiyama N, Kobayashi M, Kamata H, Masaki T. Bloc biopsy by using submucosal endoscopy with a mucosal flap method for gastric subepithelial tumor tissue sampling (with video). Gastrointest Endosc 2013; 77:141-5. [PMID: 23021164 DOI: 10.1016/j.gie.2012.08.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 08/07/2012] [Indexed: 12/17/2022]
Affiliation(s)
- Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
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Córdova H, Estépar RSJ, Rodríguez-D’Jesús A, Martínez-Pallí G, Arguis P, de Miguel CR, Navarro-Ripoll R, Perdomo JM, Cuatrecasas M, Llach J, Vosburgh KG, Fernández-Esparrach G. Comparative study of NOTES alone versus NOTES guided by a new image registration system for navigation in the mediastinum: a study in a porcine model. Gastrointest Endosc 2013; 77:102-7. [PMID: 23261099 PMCID: PMC3684696 DOI: 10.1016/j.gie.2012.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 09/07/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery (NOTES) mediastinoscopy (MED) through the esophagus has proved to be feasible in the animal model. However, injury of the adjacent pleura and pneumothorax has been reported as a frequent adverse event when using a blind access. OBJECTIVE To assess the utility and safety of a CT-based image registration system (IRS) for navigation in the mediastinum. DESIGN Prospective, randomized, controlled trial in 30 Yorkshire pigs. Thirty-minute MEDs were performed: 15 MEDs were performed with IRS guidance (MED-IRS), and 15 MEDs were performed with a blind access. SETTING Animal research laboratory. INTERVENTIONS In both groups, the mediastinum was accessed through a 10-cm submucosal tunnel in the esophageal wall. Timed exploration was performed with identification of 8 mediastinal structures. MAIN OUTCOME MEASUREMENTS Technical feasibility, adverse events, and the number of mediastinal structures identified. RESULTS Thirty animals weighing 31.5 ± 3.5 kg were included in this study. MED was not possible in 2 animals in the "MED with blind access" group but was possible in all MEDs performed with IRS. The mean number of identified organs was slightly higher in "with IRS-MED" (6.13 ± 1.3) than with MED with blind access (4.7 ± 2.3; P = .066). Moreover, the right atrium and vena cava were identified in more cases with IRS-MED than in MED with blind access (13 vs 3 and 15 vs 11, P = .000 and P = .03, respectively). There were 3 (23%) adverse events with IRS-MED and 4 (27%) with "MED with blind access" (P = not significant), with pneumothorax being the most frequent (2 and 3, respectively). LIMITATIONS Nonsurvival animal study. CONCLUSIONS This study demonstrates that the IRS system appears feasible in natural orifice transluminal endoscopic surgery MED and suggests that IRS guidance might be useful for selected procedures.
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Affiliation(s)
- Henry Córdova
- Department of Gastroenterology, CDB, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain
| | | | | | - Graciela Martínez-Pallí
- ICMDiM, Department of Anesthesiology, CDB, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Pedro Arguis
- ICMDiM, Department of Radiology, CDB, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain
| | | | - Ricard Navarro-Ripoll
- ICMDiM, Department of Anesthesiology, CDB, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Juan M. Perdomo
- ICMDiM, Department of Anesthesiology, CDB, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Miriam Cuatrecasas
- ICMDiM, Department of Pathology, CDB, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Josep Llach
- Department of Gastroenterology, CDB, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Kirby G. Vosburgh
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Rodrigues R, Rezende M, Gomes G, Souza F, Blagitz M, Libera AD, Taha M, Ferrari A, Libera ED. Effect of transgastric peritoneal access on peritoneal innate cellular immunity: experimental study in swine. Surg Endosc 2012; 27:964-70. [PMID: 23239288 DOI: 10.1007/s00464-012-2541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 08/04/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND One of the main concerns of natural orifice surgery is the local and systemic impact on physiology. Few studies have compared natural orifice transluminal endoscopic surgery (NOTES) with other surgical modalities. Most studies are based on systemic variables such as postoperative serum cytokines, with conflicting results. Surgical trauma induces an early inflammatory response, release of cytokines, and local leukocyte activation and oxidative burst. Major surgical trauma is related to impairment of phagocytic function and an increase in production of active oxygen species by phagocytes. The aim of this study was to evaluate the impact of transgastric peritoneoscopy on peritoneal innate immune response compared with laparoscopy and laparotomy in swine. METHODS Thirty-four male Sus scrofa domesticus swine were assigned to four groups: transgastric peritoneoscopy (13), laparoscopy (7), laparotomy (7), and sham procedure (7). Twenty-four hours after the procedure, peritoneal fluid cells were harvested by peritoneal washing after necropsy. Flow cytometry analysis of labeled S. aureus and E. coli phagocytosis by peritoneal neutrophils and macrophages was blindly performed. Oxidative burst activity measured by H(2)O(2) production under different challenges was also evaluated. RESULTS Total operative time varied between all groups. The transgastric, laparoscopy, and laparotomy groups required 56, 17.2, and 40.3 min of mean operative time, respectively (p < 0.05). Even though the mean percentage and intensity of phagocytosis by peritoneal phagocytes were higher in the sham, transgastric, and laparoscopy groups, there was no significant difference between these groups and laparotomy. Macrophage production of H(2)O(2) has been shown to be similar among the transgastric, laparoscopy, and sham groups, and smaller than that in laparotomy (p < 0.05), either under basal conditions, while performing E. coli phagocytosis, or challenged by the presence of E. coli membrane lipopolysaccharide. CONCLUSION Under the conditions of this study, transgastric peritoneoscopy has been shown to have minimal impact on peritoneal innate immune response.
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Affiliation(s)
- Rodrigo Rodrigues
- Clinical Gastroenterology Division, Department of Medicine, São Paulo Federal University, São Paulo, Brazil,
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The rise of tunnel endoscopic surgery: a case report and literature review. Case Rep Gastrointest Med 2012; 2012:847640. [PMID: 22988531 PMCID: PMC3439945 DOI: 10.1155/2012/847640] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 08/05/2012] [Indexed: 12/21/2022] Open
Abstract
There has been booming interest in natural orifice transluminal surgery since it was first described. Several techniques first developed for the safe transluminal access now derive into independent endoscopic surgical procedures. In this paper, we describe a case treated by a novel procedure by submucosal tunnelling technique and provide a literature review of the rise of tunnel endoscopic surgery.
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Banerjee S, Barth BA, Bhat YM, Desilets DJ, Gottlieb KT, Maple JT, Pfau PR, Pleskow DK, Siddiqui UD, Tokar JL, Wang A, Song LMWK, Rodriguez SA. Endoscopic closure devices. Gastrointest Endosc 2012; 76:244-51. [PMID: 22658920 DOI: 10.1016/j.gie.2012.02.028] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 02/17/2012] [Indexed: 02/08/2023]
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Kono Y, Yasuda K, Hiroishi K, Akagi T, Kawaguchi K, Suzuki K, Yoshizumi F, Inomata M, Shiraishi N, Kitano S. Transrectal peritoneal access with the submucosal tunnel technique in NOTES: a porcine survival study. Surg Endosc 2012; 27:278-85. [DOI: 10.1007/s00464-012-2441-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 06/05/2012] [Indexed: 11/29/2022]
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Wang J, Zhang L, Wu W. Current progress on natural orifice transluminal endoscopic surgery (NOTES). Front Med 2012; 6:187-94. [PMID: 22570129 DOI: 10.1007/s11684-012-0198-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 03/26/2012] [Indexed: 12/21/2022]
Abstract
Natural orifice transluminal endoscopic surgery (NOTES) has received considerable interest in recent years as a novel surgical technique. Here, we aim to review the current progress on NOTES, particularly focusing on the advantages and complications related to NOTES, the recent advances of surgical approaches, new instruments for closure of the natural orifice incision, and the newly developed platform for NOTES. Finally, we make a prediction of the conceivable applications of NOTES on human subjects.
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Affiliation(s)
- Junqing Wang
- Department of General Surgery, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
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Lee SH, Cho WY, Cho JY. Submucosal endoscopy, a new era of pure natural orifice translumenal endoscopic surgery (NOTES). Clin Endosc 2012; 45:4-10. [PMID: 22741129 PMCID: PMC3363116 DOI: 10.5946/ce.2012.45.1.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 11/28/2011] [Accepted: 12/29/2011] [Indexed: 12/21/2022] Open
Abstract
Natural orifice translumenal endoscopic surgery (NOTES) involves the intentional perforation of the viscera with an endoscope to access the abdominal cavity and perform an intraabdominal operation. In a brief time period, NOTES has been shown to be feasible in laboratory animal and human studies. Easy access to the peritoneal cavity and complete gastric closure should be secured before NOTES can be recommended as an acceptable alternative in clinical practice. The concept of submucosal endoscopy has been introduced as a solution to overcome these two primary barriers to human NOTES application. Its offset entry/exit access method effectively prevents contamination and allows the rapid closure of the entry site with a simple mucosal apposition. In addition, it could be used as an endoscopic working space for various submucosal conditions. Herein, the detailed procedures, laboratory results and human application of the submucosal endoscopy will be reviewed.
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Affiliation(s)
- Suck-Ho Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
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Akagi T, Yasuda K, Kono Y, Suzuki K, Kawaguchi K, Yoshizumi F, Inomata M, Shiraishi N, Kitano S. Safety and Efficacy of the Submucosal Tunnel Without Mucosal Closure for the Transgastric Approach in a Porcine Survival Model. Surg Innov 2012; 19:415-20. [DOI: 10.1177/1553350611432721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction. Usefulness of submucosal tunneling for transgastric approach with clip closure of the mucosal incision in natural orifice translumenal endoscopic surgery (NOTES) has been described. Although the narrow longitudinal submucosal tunnel itself is considered good for wound approximation and healing, no reports have evaluated the sealing effect in this technique. This study was aimed at evaluating the technical feasibility of a submucosal tunnel technique for transgastric peritoneal access without mucosal closure. Methods. Transgastric peritoneoscopy using submucosal tunneling with endoscopic submucosal dissection without mucosal closure was performed on six 40- to 45-kg female pigs. Measures included ( a) evaluation of technical feasibility, ( b) clinical monitoring for 7 days, ( c) necropsy findings, and ( d) pathological examination. Results. NOTES transgastric peritoneoscopy was successfully performed in all pigs, and all recovered well clinically. Necropsy findings revealed no peritonitis, confirming completeness of gastric closure in 5 of the 6 pigs. One pig in which the submucosal layer of the tunnel was injured during dissection from the muscular layer showed local peritonitis. Pathological examination at the submucosal site tunnel showed wound healing with focal transmural fibrosis and inflammatory cell infiltration in 5 pigs, whereas the pig with peritonitis had a large mucosal defect with necrotic tissue, abscess formation, and focal transmural fibrosis. Conclusions. The submucosal tunnel technique without mucosal closure is safe and effective for transgastric peritoneal access and subsequent closure, when the endoscopists’ learning curve is accomplished and the submucosal tunnel is produced without damaging of mucosa. It is necessary to use devices such as mucosal clips or tissue anchors in order to achieve adequate healing of mucosal defect.
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Xu MD, Cai MY, Zhou PH, Qin XY, Zhong YS, Chen WF, Hu JW, Zhang YQ, Ma LL, Qin WZ, Yao LQ. Submucosal tunneling endoscopic resection: a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer (with videos). Gastrointest Endosc 2012; 75:195-9. [PMID: 22056087 DOI: 10.1016/j.gie.2011.08.018] [Citation(s) in RCA: 231] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 08/11/2011] [Indexed: 12/12/2022]
Affiliation(s)
- Mei-Dong Xu
- Endoscopy center and Endoscopy Research Institute, Fudan University, Shanghai, China
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Auyang ED, Santos BF, Enter DH, Hungness ES, Soper NJ. Natural orifice translumenal endoscopic surgery (NOTES(®)): a technical review. Surg Endosc 2011; 25:3135-48. [PMID: 21553172 DOI: 10.1007/s00464-011-1718-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 03/11/2011] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The clinical NOTES literature continues to grow. This review quantifies the published human NOTES experience to date, examines instrument use in detail, and compiles available perioperative outcomes data. METHODS A PubMed search for all articles describing human NOTES cases was performed. All articles providing a technical description of procedures, excluding cases limited to diagnostic procedures, specimen extraction, fluid drainage or gynecological procedures, were reviewed. Two reviewers systematically cataloged the technical details of each procedure and performed a frequency analysis of instrument use in each type of case. Available outcomes data were also compiled. RESULTS Forty-three discrete articles were reviewed in detail, describing a total of 432 operations consisting of transvaginal (n = 355), transgastric (n = 58), transesophageal (n = 17), and transrectal (n = 2) procedures, with 90% of cases performed in hybrid fashion with laparoscopic assistance. Cholecystectomy (84% of cases) was the most common procedure. Analysis of key steps included choice of endoscope, establishment of peritoneal access, dissection, specimen extraction, and closure of the access site. Analysis of instrument use during transvaginal cholecystectomy revealed variation in the choice of endoscope and the technique for establishment of access. A majority of these procedures relied heavily on the use of rigid and transabdominal instrumentation. Closure of the vaginotomy site was found to be well standardized, performed with an open suturing technique. Similar analysis for transgastric procedures revealed consistency in the choice of flexible endoscope as well as access and closure techniques. Perioperative outcomes from NOTES procedures were reported, but the data are currently limited due to small case numbers. CONCLUSIONS NOTES is most commonly performed using a hybrid, transvaginal approach. Although some aspects of these procedures appear to be well standardized, there is still significant variability in technique. More outcomes data with standardized reporting are needed to determine the actual risks and benefits of NOTES.
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Affiliation(s)
- Edward D Auyang
- Department of Surgery, Northwestern University, Chicago, IL 60611, USA
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Abstract
INTRODUCTION The clinical NOTES literature continues to grow. This review quantifies the published human NOTES experience to date, examines instrument use in detail, and compiles available perioperative outcomes data. METHODS A PubMed search for all articles describing human NOTES cases was performed. All articles providing a technical description of procedures, excluding cases limited to diagnostic procedures, specimen extraction, fluid drainage or gynecological procedures, were reviewed. Two reviewers systematically cataloged the technical details of each procedure and performed a frequency analysis of instrument use in each type of case. Available outcomes data were also compiled. RESULTS Forty-three discrete articles were reviewed in detail, describing a total of 432 operations consisting of transvaginal (n = 355), transgastric (n = 58), transesophageal (n = 17), and transrectal (n = 2) procedures, with 90% of cases performed in hybrid fashion with laparoscopic assistance. Cholecystectomy (84% of cases) was the most common procedure. Analysis of key steps included choice of endoscope, establishment of peritoneal access, dissection, specimen extraction, and closure of the access site. Analysis of instrument use during transvaginal cholecystectomy revealed variation in the choice of endoscope and the technique for establishment of access. A majority of these procedures relied heavily on the use of rigid and transabdominal instrumentation. Closure of the vaginotomy site was found to be well standardized, performed with an open suturing technique. Similar analysis for transgastric procedures revealed consistency in the choice of flexible endoscope as well as access and closure techniques. Perioperative outcomes from NOTES procedures were reported, but the data are currently limited due to small case numbers. CONCLUSIONS NOTES is most commonly performed using a hybrid, transvaginal approach. Although some aspects of these procedures appear to be well standardized, there is still significant variability in technique. More outcomes data with standardized reporting are needed to determine the actual risks and benefits of NOTES.
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Teoh AYB, Chiu PWY, Lau JYW, Ng EKW. Randomized comparative trial of a novel one-step needle sphincterotome versus direct incision and balloon dilation used to create gastrotomies for natural orifice translumenal endoscopic surgery (NOTES) in the porcine model. Surg Endosc 2011; 25:3116-21. [PMID: 21487882 DOI: 10.1007/s00464-011-1653-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 02/20/2011] [Indexed: 01/09/2023]
Affiliation(s)
- Anthony Yuen Bun Teoh
- Division of Upper Gastrointestinal Surgery, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
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