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Shichijo S, Uedo N, Sawada A, Hirasawa K, Takeuchi H, Abe N, Miyaoka M, Yao K, Dobashi A, Sumiyama K, Ishida T, Morita Y, Ono H. Endoscopic full-thickness resection for gastric submucosal tumors: Japanese multicenter prospective study. Dig Endosc 2024; 36:811-821. [PMID: 37914400 DOI: 10.1111/den.14717] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/30/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES Early gastric cancer endoscopic resection (ER) is prominent in Japan. However, evidence regarding ER of gastric submucosal tumors (SMT) is limited. This prospective multicenter phase II study investigated the efficacy and safety of endoscopic full-thickness resection (EFTR) for gastric SMT. METHODS Endoscopic full-thickness resection indication for gastric SMT was 11-30 mm, histologically proven or clinically suspicious (irregular margin, increasing size, or internal heterogeneity) gastrointestinal stromal tumors (GIST), with no ulceration and intraluminal growth type. The primary end-point was the complete ER (ER0) rate, with a sample size of 42. RESULTS We enrolled 46 patients with 46 lesions between September 2020 and May 2023 at seven Japanese institutions. The mean ± SD (range) endoscopic tumor size was 18.8 ± 4.5 (11-28) mm. The tumor resection and defect closure times were 54 ± 26 (22-125) min and 33 ± 28 (12-186) min, respectively. A 100% ER0 was achieved in all 46 patients. The EFTR procedure was accomplished in all patients without surgical intervention. One patient had delayed perforation and was managed endoscopically. GIST accounted for 76% (n = 35) of the cases. R0, R1, and RX rates were 33 (77%), 3 (6.5%), and 7 (15%), respectively. CONCLUSION Endoscopic full-thickness resection for gastric SMT of 11-30 mm is efficacious. It warrants further validation in a large-scale cohort study to determine the long-term outcome of this treatment for patients with gastric GIST.
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Affiliation(s)
- Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Atsushi Sawada
- Endoscopy Division, Yokohama City University Medical Center, Kanagawa, Japan
| | - Kingo Hirasawa
- Endoscopy Division, Yokohama City University Medical Center, Kanagawa, Japan
| | - Hirohisa Takeuchi
- Department of Gastroenterological and General Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Nobutsugu Abe
- Department of Gastroenterological and General Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Masaki Miyaoka
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Akira Dobashi
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuki Sumiyama
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Tsukasa Ishida
- Department of Gastroenterology, Akashi Medical Center, Hyogo, Japan
| | - Yoshinori Morita
- Department of Gastroenterology, Kobe University International Clinical Cancer Research Center, Kobe, Japan
| | - Hiroyuki Ono
- Endoscopy Division, Shizuoka Cancer Center, Shizuoka, Japan
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Shimamura Y, Inoue H, Yamamoto K, Owada K, Tanaka I. Advancements in minimally invasive endoscopic treatment: Navigating deeper layers for upper gastrointestinal lesion. Dig Endosc 2024. [PMID: 38867345 DOI: 10.1111/den.14828] [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: 01/14/2024] [Accepted: 05/07/2024] [Indexed: 06/14/2024]
Abstract
The field of minimally invasive endoscopic treatment has seen a continual progression, marked by significant advancements in treatment devices and the refinement of endoscopic techniques. While endoscopic resection has become the standard for treating superficial gastrointestinal neoplasms, a proactive approach becomes imperative when dealing with lesions that extend beyond the submucosal layer and deeper into the muscularis propria. The ongoing evolution of endoscopic closure techniques has facilitated the introduction of advanced procedures such as endoscopic muscularis dissection, endoscopic subserosal dissection, and endoscopic full-thickness resection. This evolution is achieved by the commitment to improve the efficacy and precision in treating challenging lesions. Nevertheless, there is currently a lack of definitive guidelines or consensus regarding the specifics of deeper layer dissection. Drawing from prior research and clinical insights, this review discusses indications, techniques, clinical outcomes, and future perspectives of deeper layer dissection.
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Affiliation(s)
- Yuto Shimamura
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Haruhiro Inoue
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Kazuki Yamamoto
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Kaori Owada
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Ippei Tanaka
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
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Nomura T, Sugimoto S, Fujimura Y, Ito K, Katsumine Y, Uedo N. Full-thickness defect closure using the reopenable clip over-the-line method with omental patch. Endoscopy 2023; 55:E969-E970. [PMID: 37604446 PMCID: PMC10442211 DOI: 10.1055/a-2133-6266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Tatsuma Nomura
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Mie, Japan
- Department of Gastroenterology, Mie Prefectural Shima Hospital, Shima, Mie, Japan
| | - Shinya Sugimoto
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Yu Fujimura
- Department of Surgery, Mie Prefectural Shima Hospital, Shima, Mie, Japan
| | - Keiichi Ito
- Department of Gastroenterology, Mie Prefectural Shima Hospital, Shima, Mie, Japan
| | - Yasuo Katsumine
- Department of Surgery, Mie Prefectural Shima Hospital, Shima, Mie, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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Cai Q, Fu H, Zhang L, Shen M, Yi S, Xie R, Lan W, Dong W, Chen X, Zhang J, Hou X, He Y, Yang D. Twin-grasper assisted mucosal inverted closure achieves complete healing of large perforations after gastric endoscopic full-thickness resection. Dig Endosc 2023; 35:736-744. [PMID: 36567663 DOI: 10.1111/den.14507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/22/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES This study aimed to demonstrate the feasibility and safety of a novel twin-grasper assisted mucosal inverted closure (TAMIC) technique for large perforations after gastric endoscopic full-thickness resection (EFTR) in a porcine model. METHODS Iatrogenic large perforations of the stomach were created and closed by an experienced endoscopist using the TAMIC technique in 12 pigs. Repeat gastroscopy was performed in 4 weeks after surgery to examine the wound sites and then the animals were killed. The primary outcomes were the successful TAMIC closure rate and the complete healing rate. Secondary end points included procedure time of TAMIC, complete inverted healing rate, delayed bleeding rate, and postsurgery perforation. Histologies of the wounds were analyzed by hematoxylin-eosin, Masson trichrome, and immunohistochemistry staining. RESULTS The median size of the defects was 3.5 (range 2.5-4.5) cm. TAMIC was successfully performed in all the 12 pigs. Complete healing was achieved in 11 pigs 4 weeks after operation as one pig died postsurgery due to severe pneumonia. The median procedure time for TAMIC was 39 (range 23-81) min. The complete inverted healing rate was 45.5% (5/11). No delayed bleeding or postsurgery perforation was observed. Histologic analyses showed that both the epithelium and muscularis mucosae layers were appropriately connected under inverted healing. CONCLUSIONS Twin-grasper assisted mucosal inverted closure is feasible and safe for closure of large perforations after gastric EFTR and could be a propagable and promising technique for clinical practice.
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Affiliation(s)
- Qinbo Cai
- Center for Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Laboratory of General Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Research Center for Diagnosis and Treatment of Gastric Cancer, Sun Yat-sen University, Guangzhou, China
| | - Huafeng Fu
- Center for Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Laboratory of General Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Research Center for Diagnosis and Treatment of Gastric Cancer, Sun Yat-sen University, Guangzhou, China
| | - Lele Zhang
- Center for Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Laboratory of General Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Research Center for Diagnosis and Treatment of Gastric Cancer, Sun Yat-sen University, Guangzhou, China
| | - Minxuan Shen
- Center for Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Laboratory of General Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Research Center for Diagnosis and Treatment of Gastric Cancer, Sun Yat-sen University, Guangzhou, China
| | - Shaoxiong Yi
- Center for Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Laboratory of General Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Research Center for Diagnosis and Treatment of Gastric Cancer, Sun Yat-sen University, Guangzhou, China
| | - Rongman Xie
- Center for Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Laboratory of General Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Research Center for Diagnosis and Treatment of Gastric Cancer, Sun Yat-sen University, Guangzhou, China
| | - Wentong Lan
- Department of Endoscopy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenqing Dong
- Center for Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Endoscopy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Research Center for Diagnosis and Treatment of Gastric Cancer, Sun Yat-sen University, Guangzhou, China
| | - Xiaolian Chen
- Silver Snake (Guang Zhou) Medical Technology Co., Ltd, Guangzhou, China
| | - Jie Zhang
- Center for Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Laboratory of General Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Research Center for Diagnosis and Treatment of Gastric Cancer, Sun Yat-sen University, Guangzhou, China
| | - Xun Hou
- Center for Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Research Center for Diagnosis and Treatment of Gastric Cancer, Sun Yat-sen University, Guangzhou, China
| | - Yulong He
- Center for Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Research Center for Diagnosis and Treatment of Gastric Cancer, Sun Yat-sen University, Guangzhou, China
- Digestive Medicine Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Digestive Cancer Research, Shenzhen, China
| | - Dongjie Yang
- Center for Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Research Center for Diagnosis and Treatment of Gastric Cancer, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Digestive Cancer Research, Shenzhen, China
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Nomura T, Sugimoto S, Temma T, Oyamada J, Ito K, Kamei A. Reopenable clip-over-the-line method for closing large mucosal defects following colorectal endoscopic submucosal dissection: A feasibility study. Endosc Int Open 2023; 11:E697-E702. [PMID: 37564328 PMCID: PMC10411209 DOI: 10.1055/a-2095-0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/09/2023] [Indexed: 08/12/2023] Open
Abstract
Background and study aims Complete closure of large defects after colorectal endoscopic submucosal dissection (ESD) can be problematic, especially in challenging areas or lesions larger than half the lumen circumference. We report a reopenable clip-over-the-line method for such defects and aim to investigate its feasibility through a case series. Patients and methods We retrospectively evaluated data from 30 consecutive patients who underwent ESD with defect closure using the reopenable clip-over-the-line method between October 2020 and September 2022. This method requires the first clip-with-line grasp of the oral side's defect edge and muscle layer. The next reopenable clip (with a line fed through a hole in the reopenable clip tooth) is placed on the opposing mucosal defect edge and muscle layer. This process is repeated until complete closure. The primary study outcome was the rate of complete mucosal defect closure. We also reported post-procedure bleeding or perforation. Results The median dimensions of the resected specimens were 45 mm (range, 35-70) by 39 mm (range, 29-60). Complete closure was achieved for all defects, including nine rectal defects, of which three bordered the anal verge. Of the 30 defects included in this study, nine were larger than half the lumen circumference. The median closure time was 25 minutes (range, 14-52), and the median clip number was 17 (range, 9-42). No post-procedure bleeding or perforation occurred. Conclusions The reopenable clip-over-the-line method is a feasible technique for the complete closure of large colorectal defects after endoscopic submucosal dissection, regardless of location.
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Affiliation(s)
- Tatsuma Nomura
- Gastroenterology, Ise Red Cross Hospital, Ise-shi, Japan
- Gastroenterology, Mie Prefectural Shima Hospital, Shima-shi, Japan
| | | | - Taishi Temma
- Gastroenterology, Ise Red Cross Hospital, Ise-shi, Japan
| | - Jun Oyamada
- Gastroenterology, Ise Red Cross Hospital, Ise-shi, Japan
| | - Keiichi Ito
- Gastroenterology, Mie Prefectural Shima Hospital, Shima-shi, Japan
| | - Akira Kamei
- Gastroenterology, Ise Red Cross Hospital, Ise-shi, Japan
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Nomura T, Sugimoto S, Temma T, Oyamada J, Ito K, Kamei A. Full-thickness resection closure using reopenable-clip over-the-line method inside a submucosal pocket. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:217-219. [PMID: 37303704 PMCID: PMC10251675 DOI: 10.1016/j.vgie.2023.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Video 1Full-thickness defect resection closure using the reopenable-clip over-the-line method inside a submucosal pocket in the porcine stomach.
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Affiliation(s)
- Tatsuma Nomura
- Department of Gastroenterology, Mie Prefectural Shima Hospital, Shima, Mie, Japan
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Shinya Sugimoto
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Taishi Temma
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Jun Oyamada
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Keichi Ito
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Akira Kamei
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Mie, Japan
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7
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Nomura T, Sugimoto S, Oyamada J, Suzuki H, Ito K, Nemoto A. Gastric endoscopic muscularis dissection using a partial intramuscular injection technique. Endoscopy 2022; 55:E209-E210. [PMID: 36400049 PMCID: PMC9829966 DOI: 10.1055/a-1965-3654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Tatsuma Nomura
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Mie, Japan,Department of Gastroenterology, Mie Prefectural Shima Hospital, Shima, Mie, Japan
| | - Shinya Sugimoto
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Jun Oyamada
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Hiroto Suzuki
- Department of Gastroenterology, Mie Prefectural Shima Hospital, Shima, Mie, Japan,Department of Gastroenterology and Hepatology, Mie University Hospital, Tsu, Japan
| | - Keiichi Ito
- Department of Gastroenterology, Mie Prefectural Shima Hospital, Shima, Mie, Japan
| | - Akiyoshi Nemoto
- Department of Surgery, Mie Prefectural Shima Hospital, Shima, Mie, Japan
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