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Tanaka I, Shimamura Y, Inoue H, Azuma D, Ushikubo K, Yamamoto K, Okada H, Nishikawa Y, Tanabe M, Onimaru M. Endoscopic resection for gastric submucosal tumors: A single-center experience in Japan. DEN OPEN 2025; 5:e402. [PMID: 39011512 PMCID: PMC11249007 DOI: 10.1002/deo2.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/22/2024] [Accepted: 06/21/2024] [Indexed: 07/17/2024]
Abstract
Objectives Endoscopic resection (ER) for gastric submucosal tumors (SMTs) has gained prominence in recent years, with studies emerging from various countries. However, there is a paucity of reports from Japan. We aimed to elucidate the efficacy and safety of ER for gastric SMT in Japan. Methods In this retrospective observational study, we investigated the outcomes of consecutive patients who underwent ER for gastric SMT from January 2017 to May 2023. The outcome variables assessed included the complete resection rate, procedure time, closure-related outcomes, and the incidence of adverse events. Results A total of 13 patients were included in the analysis. The median procedure time was 163 (55-283) min. Complete full-thickness resection was performed in seven cases, while in four cases, the serosa remained, and in two cases, the outer layer of the muscularis propria remained. In two cases where the SMT was located on the anterior side, conversion to laparoscopic surgery became necessary, resulting in a procedural success rate of 84.6% (11/13). Excluding these two cases, endoscopic closure of the defect was successfully accomplished in the remaining 11 cases. R0 resection was achieved in 12 out of 13 cases (92.3%). Although one patient had peritonitis, which was successfully treated conservatively, no other treatment-related adverse events were encountered. Conclusions Although ER for SMT on the anterior side may be challenging, our experience revealed that ER is a safe and efficacious approach for gastric SMT.
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Affiliation(s)
- Ippei Tanaka
- Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan
| | - Yuto Shimamura
- Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan
| | - Haruhiro Inoue
- Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan
| | - Daisuke Azuma
- Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan
| | - Kei Ushikubo
- Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan
| | - Kazuki Yamamoto
- Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan
| | - Hiroki Okada
- Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan
| | - Yohei Nishikawa
- Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan
| | - Mayo Tanabe
- Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan
| | - Manabu Onimaru
- Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan
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2
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Goto O, Iwakiri K. Excision and closure: Challenge to surgery by endoscopists. Dig Endosc 2024; 36:822-824. [PMID: 38380544 DOI: 10.1111/den.14766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/21/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Osamu Goto
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
- Endoscopy Center, Nippon Medical School Hospital, Tokyo, Japan
| | - Katsuhiko Iwakiri
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
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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: 4] [Impact Index Per Article: 4.0] [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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4
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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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Nabi Z, Reddy DN. Endoscopic full thickness resection: techniques, applications, outcomes. Expert Rev Gastroenterol Hepatol 2024; 18:257-269. [PMID: 38779710 DOI: 10.1080/17474124.2024.2357611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Endoscopic full-thickness resection (EFTR) represents a pivotal advancement in the minimally invasive treatment of gastrointestinal lesions, offering a novel approach for the management of lesions previously deemed challenging or unreachable through conventional endoscopic techniques. AREAS COVERED This review discusses the development, methodologies, applications, and clinical outcomes associated with EFTR, including exposed and device-assisted EFTR, the integration of endoscopic mucosal resection with EFTR in hybrid techniques, and the collaborative approach between laparoscopic and endoscopic surgery (LECS). It encapsulates a comprehensive analysis of the various EFTR techniques tailored to specific lesion characteristics and anatomical locations, underscoring the significance of technique selection based on the lesion's nature and situational context. EXPERT OPINION/COMMENTARY The review underscores EFTR's transformative role in expanding therapeutic horizons for gastrointestinal tumors, emphasizing the importance of technique selection tailored to the unique attributes of each lesion. It highlights EFTR's capacity to facilitate organ-preserving interventions, thereby significantly enhancing patient outcomes and reducing procedural complications. EFTR is a cornerstone in the evolution of gastrointestinal surgery, marking a significant leap forward in the pursuit of precision, safety, and efficacy in tumor management.
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Affiliation(s)
- Zaheer Nabi
- Department of Gastroenterology, Asian institute of Gastroenterology, Hyderabad, India
| | - D Nageshwar Reddy
- Department of Gastroenterology, Asian institute of Gastroenterology, Hyderabad, India
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Ueda S, Kawata N, Ono H. Closing the defect after gastric endoscopic full-thickness resection with a novel closure device. Dig Endosc 2024; 36:742-743. [PMID: 38558088 DOI: 10.1111/den.14802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
Watch a video of this article.
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Affiliation(s)
- Shunsuke Ueda
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
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Moreels TG. How to implement adverse events as a quality indicator in gastrointestinal endoscopy. Dig Endosc 2024; 36:89-96. [PMID: 37485844 DOI: 10.1111/den.14641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/20/2023] [Indexed: 07/25/2023]
Abstract
Quality improvement through the registration of endoscopy-related adverse events (AEs) has been recognized by major international endoscopy societies as an important quality indicator. The theory behind this is easier to approve than its implementation in daily practice. The results of many valuable attempts have been published in the literature, mainly highlighting the diverse hurdles trying to capture events related to endoscopy and the sedation used for endoscopic procedures. The current review discusses the difficulties encountered attempting to register AEs and incidents related to endoscopic procedures. Government-driven and financed health-care databases with automated coupling of specific data seem the only efficient way to implement endoscopy-related AEs and outcomes on a prospective and complete basis. This will not only allow continuous confidential feedback to endoscopists in relation to the pooled national benchmark data, but also follow-up in time through data-driven credentialing aiming to progressively optimize these benchmark data.
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Affiliation(s)
- Tom G Moreels
- Department of Gastroenterology and Hepatology, University Hospital Saint-Luc, Brussels, Belgium
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Matsumoto H, Yamashina T, Shimatani M, Orino M, Kano M, Yuba T, Naganuma M. Endoscopic resection of a gastric gastrointestinal stromal tumor without perforation using a detachable snare. Endoscopy 2023; 55:E549-E550. [PMID: 36931304 PMCID: PMC10023245 DOI: 10.1055/a-2040-3802] [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: 03/19/2023]
Affiliation(s)
- Hironao Matsumoto
- Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Moriguchi, Osaka, Japan
| | - Takeshi Yamashina
- Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Moriguchi, Osaka, Japan
| | - Masaaki Shimatani
- Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Moriguchi, Osaka, Japan
| | - Masahiro Orino
- Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Moriguchi, Osaka, Japan
| | - Masataka Kano
- Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Moriguchi, Osaka, Japan
| | - Takafumi Yuba
- Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Moriguchi, Osaka, Japan
| | - Makoto Naganuma
- Third Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
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Yamashina T, Shimatani M, Matsumoto H, Orino M, Kano M, Kasai T, Saito N, Horitani S, Mitsuyama T, Sumimoto K, Takeo M, Yuba T, Naganuma M. Perforation-free removal of gastric gastrointestinal stromal tumors: Endoscopic inversion and strangulation of muscle layer and resection (EISMR). Endosc Int Open 2023; 11:E800-E804. [PMID: 37664786 PMCID: PMC10473888 DOI: 10.1055/a-2112-5210] [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: 04/05/2023] [Accepted: 06/15/2023] [Indexed: 09/05/2023] Open
Abstract
Endoscopic resection for GIST has become more widespread in recent years because it is less invasive than surgery. However, when endoscopic resection is performed, a full-layer resection of the gastric wall is often necessary, and extensive suturing is required if perforation occurs, which is a technically challenging procedure. Recently, we reported a new method called endoscopic inversion and strangulation of the muscle layer and resection (EISMR), which consists of endoscopically inverting the muscle layer into the gastric lumen and strangulating the muscle layer with a detachable snare, followed by resection. The study comprised five consecutive patients with gastric GIST ≤50 mm in diameter who underwent EISMR procedures. The main outcomes of the study were en bloc resection rate, R0 resection rate, procedure time, and complications. The results showed that all five patients successfully underwent complete resection without perforation, and the en bloc resection and R0 resection rates were 100%. The median procedure time was 93 min (range, 58-120 min), and there were no major complications. We concluded that EISMR would be a safe and effective technique for endoscopic resection of gastric GISTs and may be an alternative to surgery or endoscopic submucosal dissection.
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Affiliation(s)
- Takeshi Yamashina
- Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Moriguchi, Japan
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Masaaki Shimatani
- Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Hironao Matsumoto
- Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Masahiro Orino
- Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Masataka Kano
- Third Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
| | - Takeshi Kasai
- Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Natsuko Saito
- Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Shunsuke Horitani
- Third Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
| | - Toshiyuki Mitsuyama
- Third Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
| | - Kimi Sumimoto
- Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Masahiro Takeo
- Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Takafumi Yuba
- Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Makoto Naganuma
- Third Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
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Sun Y, Liu L, Shi D, Ma C, Xu X. Assessment of a Real-world Learning Curve for the Endoscopic Resection of Gastric Gastrointestinal Stromal Tumors. J Int Med Res 2023; 51:3000605231194448. [PMID: 37646636 PMCID: PMC10469254 DOI: 10.1177/03000605231194448] [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: 05/14/2023] [Accepted: 07/27/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Endoscopic resection (ER) is a proven treatment for gastric gastrointestinal stromal tumors (gGISTs). We aimed to assess the learning curve (LC) associated with ER for gGISTs and identify determinants. METHODS We conducted an analysis of 289 patients who underwent the ER of gGISTs by an experienced endoscopist. To characterize the LC, we employed cumulative sum analysis of the duration of surgery. The participants were divided into an early phase (cases 1-50) and a later phase (case 51-289), which were compared. Furthermore, we identified risk factors for the conversion from endoscopic to laparoscopic resection (LR). RESULTS The durations of surgery and hospitalization were shorter, and there were fewer complications and fasting days in the later phase. The conversion rates to LR were 6.0% and 2.5% in the early and later phases, respectively. The tumor diameter (≥3.0 cm) and invasion beyond the muscularis propria were significant risk factors for conversion to LR (odds ratio 17.92, 95% confidence interval 2.66-120.87; and 58.03, 6.40-525.84; respectively). CONCLUSIONS The LC for ER of gGISTs lasts for approximately 50 cases. In addition, tumors ≥3.0 cm in diameter and those that invade beyond the muscularis propria are more likely to require conversion to LR.
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Affiliation(s)
- Ying Sun
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
| | - Luojie Liu
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
- Department of Gastroenterology, the First Affiliated Hospital of Soochow University. Suzhou, China
| | - Dongtao Shi
- Department of Gastroenterology, the First Affiliated Hospital of Soochow University. Suzhou, China
| | - Chao Ma
- Department of Gastroenterology, the First Affiliated Hospital of Soochow University. Suzhou, China
| | - Xiaodan Xu
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
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