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Ao J, Huang S, Liao S, Huang L, Zhong E, Zhao P, Wang D. Guidewire-assisted piecemeal resection of a giant gastric tumor. Endoscopy 2024; 56:E13-E14. [PMID: 38194981 PMCID: PMC10776273 DOI: 10.1055/a-2218-3297] [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: 01/11/2024]
Affiliation(s)
- Jixiang Ao
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Silin Huang
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Suhuan Liao
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Longbin Huang
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Erzhen Zhong
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Pengcheng Zhao
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Dongfang Wang
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
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Lin XM, Liu J, Xi CH, Wang J, Yang GD, Wang XF, Yuan C. Compression from a retroperitoneal schwannoma presenting as a subepithelial lesion of the gastric fundus. Endoscopy 2024; 56:E236-E237. [PMID: 38467351 PMCID: PMC10927355 DOI: 10.1055/a-2271-4028] [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: 03/13/2024]
Affiliation(s)
- Xue-Mei Lin
- Department of Pathology, Institute of Basic Medicine and Forensic Medicine, North Sichuan Medical College, Nanchong, China
- Department of Pathology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Juan Liu
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Digestive Endoscopy Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Chun-Hui Xi
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Digestive Endoscopy Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jun Wang
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Digestive Endoscopy Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Guo-Dong Yang
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Digestive Endoscopy Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xian-Fei Wang
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Digestive Endoscopy Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Cong Yuan
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Digestive Endoscopy Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Dong Z, Zhao X, Zheng H, Zheng H, Chen D, Cao J, Xiao Z, Sun Y, Zhuang Q, Wu S, Xia J, Ning M, Qin B, Zhou H, Bao J, Wan X. Efficacy of real-time artificial intelligence-aid endoscopic ultrasonography diagnostic system in discriminating gastrointestinal stromal tumors and leiomyomas: a multicenter diagnostic study. EClinicalMedicine 2024; 73:102656. [PMID: 38828130 PMCID: PMC11137341 DOI: 10.1016/j.eclinm.2024.102656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 06/05/2024] Open
Abstract
Background Gastrointestinal stromal tumors (GISTs) represent the most prevalent type of subepithelial lesions (SELs) with malignant potential. Current imaging tools struggle to differentiate GISTs from leiomyomas. This study aimed to create and assess a real-time artificial intelligence (AI) system using endoscopic ultrasonography (EUS) images to differentiate between GISTs and leiomyomas. Methods The AI system underwent development and evaluation using EUS images from 5 endoscopic centers in China between January 2020 and August 2023. EUS images of 1101 participants with SELs were retrospectively collected for AI system development. A cohort of 241 participants with SELs was recruited for external AI system evaluation. Another cohort of 59 participants with SELs was prospectively enrolled to assess the real-time clinical application of the AI system. The AI system's performance was compared to that of endoscopists. This study is registered with Chictr.org.cn, Number ChiCT2000035787. Findings The AI system displayed an area under the curve (AUC) of 0.948 (95% CI: 0.921-0.969) for discriminating GISTs and leiomyomas. The AI system's accuracy (ACC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) reached 91.7% (95% CI 87.5%-94.6%), 90.3% (95% CI 83.4%-94.5%), 93.0% (95% CI 87.2%-96.3%), 91.9% (95% CI 85.3%-95.7%), and 91.5% (95% CI 85.5%-95.2%), respectively. Moreover, the AI system exhibited excellent performance in diagnosing ≤20 mm SELs (ACC 93.5%, 95% CI 0.900-0.969). In a prospective real-time clinical application trial, the AI system achieved an AUC of 0.865 (95% CI 0.764-0.966) and 0.864 (95% CI 0.762-0.966) for GISTs and leiomyomas diagnosis, respectively, markedly surpassing endoscopists [AUC 0.698 (95% CI 0.562-0.834) for GISTs and AUC 0.695 (95% CI 0.546-0.825) for leiomyomas]. Interpretation We successfully developed a real-time AI-assisted EUS diagnostic system. The incorporation of the real-time AI system during EUS examinations can assist endoscopists in rapidly and accurately differentiating various types of SELs in clinical practice, facilitating improved diagnostic and therapeutic decision-making. Funding Science and Technology Commission Foundation of Shanghai Municipality, Science and Technology Commission Foundation of the Xuhui District, the Interdisciplinary Program of Shanghai Jiao Tong University and the Research Funds of Shanghai Sixth people's Hospital.
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Affiliation(s)
- Zhixia Dong
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangyun Zhao
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hangbin Zheng
- College of Mechanical Engineering, Dong Hua University, Shanghai, China
| | - HanYao Zheng
- College of Mechanical Engineering, Dong Hua University, Shanghai, China
| | - Dafan Chen
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Cao
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zili Xiao
- Digestive Endoscopic Department, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yunwei Sun
- Department of Gastroenterology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Zhuang
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shan Wu
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Xia
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Ning
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Binjie Qin
- School of Biomedical Engineering, Shanghai Jiao Tong University, China
| | - Hui Zhou
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinsong Bao
- College of Mechanical Engineering, Dong Hua University, Shanghai, China
| | - Xinjian Wan
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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4
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Chantarojanasiri T, Sonthalia N, Lui RN. Small gastric subepithelial lesions: A sand in the eye. J Gastroenterol Hepatol 2024. [PMID: 38859657 DOI: 10.1111/jgh.16647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 05/25/2024] [Indexed: 06/12/2024]
Affiliation(s)
- Tanyaporn Chantarojanasiri
- Division of Gastroenterology, Department of Medicine, Rajavithi hospital, Ministry of Public Health, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Nikhil Sonthalia
- Institute of Gastrosciences and Liver Transplant, Apollo Multispecialty Hospitals, Kolkata, West Bengal, India
| | - Rashid N Lui
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, Chinese University of HongKong, Hong Kong, China
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5
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Impellizzeri G, Donato G, De Angelis C, Pagano N. Diagnostic Endoscopic Ultrasound (EUS) of the Luminal Gastrointestinal Tract. Diagnostics (Basel) 2024; 14:996. [PMID: 38786295 PMCID: PMC11120241 DOI: 10.3390/diagnostics14100996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/05/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
The purpose of this review is to focus on the diagnostic endoscopic ultrasound of the gastrointestinal tract. In the last decades, EUS has gained a central role in the staging of epithelial and sub-epithelial lesions of the gastrointestinal tract. With the evolution of imaging, the position of EUS in the diagnostic work-up and the staging flow-chart has continuously changed with two extreme positions: some gastroenterologists think that EUS is absolutely indispensable, and some think it is utterly useless. The truth is, as always, somewhere in between the two extremes. Analyzing the most up-to-date and strong evidence, we will try to give EUS the correct position in our daily practice.
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Affiliation(s)
| | | | | | - Nico Pagano
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy; (G.I.); (C.D.A.)
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6
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Cai M, Song B, Deng Y, Gao P, Cai S, Yalikong A, Xu E, Zhong Y, Yu J, Zhou P. Automatically optimized radiomics modeling system for small gastric submucosal tumor (<2 cm) discrimination based on EUS images. Gastrointest Endosc 2024; 99:537-547.e4. [PMID: 37956896 DOI: 10.1016/j.gie.2023.11.006] [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: 05/20/2023] [Revised: 10/14/2023] [Accepted: 11/06/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND AND AIMS The clinical management of small gastric submucosal tumors (SMTs) (<2 cm) faces a non-negligible challenge because of the lack of guideline consensus and effective diagnostic tools. This article develops an automatically optimized radiomics modeling system (AORMS) based on EUS images to diagnose and evaluate SMTs. METHODS A total of 205 patients with EUS images of small gastric SMTs (<2 cm) were retrospectively enrolled in the development phase of AORMS for the diagnosis and the risk stratification of GI stromal tumor (GIST). A total of 178 patients with images from different centers were prospectively enrolled in the independent testing phase. The performance of AORMS was compared to that of endoscopists in the development set and evaluated in the independent testing set. RESULTS AORMS demonstrated an area under the curve (AUC) of 0.762 for the diagnosis of GIST and 0.734 for the risk stratification of GIST, respectively. In the independent testing set, AORMS achieved an AUC of 0.770 and 0.750 for the diagnosis and risk stratification of small GISTs, respectively. In comparison, the AUCs of 5 experienced endoscopists ranged from 0.501 to 0.608 for diagnosing GIST and from 0.562 to 0.748 for risk stratification. AORMS outperformed experienced endoscopists by more than 20% in diagnosing GIST. CONCLUSIONS AORMS implements automatic parameter selection, which enhances its robustness and clinical applicability. It has demonstrated good performance in the diagnosis and risk stratification of GISTs, which could aid endoscopists in the diagnosis of small gastric SMTs (<2 cm).
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Affiliation(s)
- Mingyan Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
| | - Baohui Song
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
| | - Yinhui Deng
- MingGe Research, Fudan University Science Park, Shanghai, China; Biomedical Engineering Center, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Pingting Gao
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
| | - Shilun Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
| | - Ayimukedisi Yalikong
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
| | - Enpan Xu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
| | - Yunshi Zhong
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China; Department of Endoscopy, Zhongshan Hospital Xuhui Branch, Fudan University, Shanghai, China.
| | - Jinhua Yu
- Biomedical Engineering Center, School of Information Science and Technology, Fudan University, Shanghai, China.
| | - Pinghong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China.
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Yamamoto M, Nishida T, Uema R, Kanesaka T, Ogawa H, Kitamura S, Iijima H, Nagai K, Tsutsui S, Komori M, Yamamoto K, Tsujii Y, Hayashi Y, Takehara T. Utility and advantage of the unroofing technique for gastrointestinal subepithelial tumors: A multicenter retrospective cohort study. DEN OPEN 2024; 4:e332. [PMID: 38250518 PMCID: PMC10797821 DOI: 10.1002/deo2.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/14/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024]
Abstract
Background and aim Various techniques for direct biopsy from gastrointestinal subepithelial tumors (SETs) have been reported, although no standard method has been established. A common feature of these techniques is the removal of overlaying mucosa to enable direct biopsies from the SETs. These methods have been synthesized under the collective term "unroofing technique". We conducted a multicenter retrospective study to assess its efficacy and identify potential complications. Methods This study was conducted in 10 hospitals and involved all eligible patients who underwent unroofing techniques to obtain biopsies for gastrointestinal SETs between April 2015 and March 2021. The primary endpoint was the diagnostic accuracy of the unroofing technique, and the secondary endpoints were the incidence of adverse events and the factors contributing to the accurate diagnosis. Results The study included 61 patients with 61 gastrointestinal SETs. The median tumor size was 20 mm, and the median procedure time was 38 min, with 82% successful tumor exposure. The rate of pathological diagnosis was 72.1%. In 44 patients with a pathological diagnosis, two showed discrepancies with the postresection pathological diagnosis. No factors, including facility experience, organ, tumor size, or tumor exposure, significantly affected the diagnostic accuracy. There was one case of delayed bleeding and two cases of perforation. Conclusion The diagnostic yield of the unroofing technique was acceptable. The unroofing technique was beneficial regardless of institutional experience, organ, tumor size, or actual tumor exposure.
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Affiliation(s)
- Masashi Yamamoto
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
| | - Tsutomu Nishida
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
| | - Ryotaro Uema
- Department of Gastroenterology and HepatologyOsaka University Graduate School of MedicineOsakaJapan
| | - Takashi Kanesaka
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Hiroyuki Ogawa
- Department of GastroenterologyNishinomiya Municipal Central HospitalHyogoJapan
| | - Shinji Kitamura
- Department of GastroenterologySakai City Medical CenterOsakaJapan
| | - Hideki Iijima
- Department of GastroenterologyOsaka Police HospitalOsakaJapan
| | - Kengo Nagai
- Department of GastroenterologySuita Municipal HospitalOsakaJapan
| | - Shusaku Tsutsui
- Departments of Gastroenterology and HepatologyItami City HospitalHyogoJapan
| | - Masato Komori
- Department of GastroenterologyHyogo Prefectural Nishinomiya HospitalHyogoJapan
| | - Katsumi Yamamoto
- Department of GastroenterologyJapan Community Healthcare Organization Osaka HospitalOsakaJapan
| | - Yoshiki Tsujii
- Department of Gastroenterology and HepatologyOsaka University Graduate School of MedicineOsakaJapan
| | - Yoshito Hayashi
- Department of Gastroenterology and HepatologyOsaka University Graduate School of MedicineOsakaJapan
| | - Tetsuo Takehara
- Department of Gastroenterology and HepatologyOsaka University Graduate School of MedicineOsakaJapan
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Park K, Ahn JY, Na HK, Jung KW, Lee JH, Kim DH, Choi KD, Song HJ, Lee GH, Jung HY. Natural history of gastric leiomyoma. Surg Endosc 2024:10.1007/s00464-024-10782-2. [PMID: 38532051 DOI: 10.1007/s00464-024-10782-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/07/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Most gastric leiomyomas are asymptomatic and benign subepithelial tumors (SETs); however, some may increase in size or become symptomatic. Understanding their natural history is therefore important to their management. We investigated the natural history of histologically proven gastric leiomyomas. METHODS We retrospectively reviewed histologically proven gastric leiomyoma cases at a tertiary center. The baseline characteristics of these cases were analyzed, and those with a follow-up period of at least 12 months without immediate resection were evaluated. The primary outcome was the frequency of size increase of more than 25% during the follow-up period, and the secondary outcome was the histopathologic results in cases that underwent resection. RESULTS Among the 231 patients with histologically proven gastric leiomyomas, the most frequent location was the cardia (77.1%), and the median size was 3 cm (IQR 2-4 cm). Eighty-four cases were followed up over a median period of 50.8 months (IQR 27.2-91.3 months). During the follow-up period, tumor size increased in two cases (2.4%). Surgical results showed that one case was leiomyoma, and the other was leiomyosarcoma. Among the remaining cases without change in size, 15 underwent surgical resection (n = 10) or endoscopic resection (n = 5), and all cases were confirmed as leiomyoma. CONCLUSIONS Most gastric leiomyomas are benign SETs, and an increase in size is not frequent, even in large-sized cases. Close monitoring with routine follow-up without resection may be sufficient in cases of histologically proven gastric leiomyoma. However, in cases of ulceration or size increase, resection may be beneficial.
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Affiliation(s)
- Kwangbeom Park
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hwwon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
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Xiang AY, Wang KH, Su W, Tan T, Qu YF, Li XQ, Wang Y, Cai MY, Li QL, Zhang YQ, Hu H, Zhou PH. Endoscopic resection of giant esophageal subepithelial lesions: experience from a large tertiary center. Gastrointest Endosc 2024; 99:358-370.e11. [PMID: 37852331 DOI: 10.1016/j.gie.2023.10.032] [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: 06/01/2023] [Revised: 08/28/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND AND AIMS Increased reports on endoscopic resection (ER) of esophageal giant subepithelial lesions (g-SELs) have emerged in recent years. The aim of this study was to evaluate the efficacy, technical difficulty, and safety through our single-center experience. METHODS Seventy-five patients with g-SELs undergoing endoscopic resection were included in the training set. Clinicopathologic features, procedure-related characteristics, postprocedural outcomes, and follow-up data were analyzed. A predictive nomogram model for procedural difficulty was proposed based on the multivariable logistic regression analysis. Internal and external validations were conducted to verify the model performance. RESULTS The overall en bloc resection rate was 93.3%. Intraoperative and postoperative adverse events occurred in 7 (9.3%) and 13 (17.3%) patients, respectively. No recurrence or metastasis was observed. Thirty-two (42.7%) patients underwent a difficult procedure. Age (adjusted odds ratio [aOR], .915; P = .004), maximal tumor diameter ≥8 cm (aOR, 9.896; P = .009), irregular shape (aOR, 4.081; P = .053), extraluminal growth pattern (aOR, 5.419; P = .011), and submucosal tunneling endoscopic resection (aOR, .109; P = .042) were found to be statistically or clinically significant factors for predicting endoscopic resection difficulty, based on which a nomogram model was developed. Internal and external validations of the nomogram via receiver-operating characteristic curves and calibration curves achieved favorable results. CONCLUSIONS Endoscopic resection serves as a promising therapeutic option for esophageal g-SELs. A younger patient age, large tumor size, irregular shape, and extraluminal growth may indicate increased endoscopic resection difficulty, whereas a submucosal tunneling endoscopic resection procedure tends to be of lower difficulty. Our nomogram model performs well for predicting endoscopic resection difficulty for esophageal g-SELs.
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Affiliation(s)
- An-Yi Xiang
- Endoscopy Center and Endoscopy Research Institute, Shanghai Collaborative Innovation Center of Endoscopy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ke-Hao Wang
- Endoscopy Center and Endoscopy Research Institute, Shanghai Collaborative Innovation Center of Endoscopy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Su
- Endoscopy Center and Endoscopy Research Institute, Shanghai Collaborative Innovation Center of Endoscopy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Tan
- Endoscopy Center and Endoscopy Research Institute, Shanghai Collaborative Innovation Center of Endoscopy, Zhongshan Hospital, Fudan University, Shanghai, China; School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Yi-Fan Qu
- Endoscopy Center and Endoscopy Research Institute, Shanghai Collaborative Innovation Center of Endoscopy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao-Qing Li
- Endoscopy Center and Endoscopy Research Institute, Shanghai Collaborative Innovation Center of Endoscopy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yun Wang
- Endoscopy Center and Endoscopy Research Institute, Shanghai Collaborative Innovation Center of Endoscopy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ming-Yan Cai
- Endoscopy Center and Endoscopy Research Institute, Shanghai Collaborative Innovation Center of Endoscopy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Quan-Lin Li
- Endoscopy Center and Endoscopy Research Institute, Shanghai Collaborative Innovation Center of Endoscopy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi-Qun Zhang
- Endoscopy Center and Endoscopy Research Institute, Shanghai Collaborative Innovation Center of Endoscopy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hao Hu
- Endoscopy Center and Endoscopy Research Institute, Shanghai Collaborative Innovation Center of Endoscopy, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Ping-Hong Zhou
- Endoscopy Center and Endoscopy Research Institute, Shanghai Collaborative Innovation Center of Endoscopy, Zhongshan Hospital, Fudan University, Shanghai, China.
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10
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Lee E, Lim D, Kang SH, Hwang D, Yoo M, Park YS, Ahn SH, Suh YS, Kim HH. Single-port intragastric wedge resection using the tunnel method: a novel surgical approach for treating endophytic gastric subepithelial tumors. Surg Endosc 2024; 38:1106-1112. [PMID: 38110795 DOI: 10.1007/s00464-023-10583-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/04/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Intragastric wedge resection is an effective method for treating endophytic gastric subepithelial tumors (SETs). However, retracting the stomach wall to the umbilicus is difficult in certain patients. In response, we developed a novel surgical technique for single-port intragastric wedge resection, which we termed the "tunnel method." METHODS A transumbilical incision is made, and a wound retractor is applied. After diagnostic laparoscopy, a gastrostomy is made on the greater curvature, lower body. Another small wound retractor is inserted into the gastrostomy, and extracted through the transumbilical incision, creating a tunnel from the gastrostomy site to the umbilicus. Articulating laparoscopic instruments are inserted via the tunnel, and intragastric wedge resection is performed. We collected and analyzed the clinicopathologic and operative data of patients who underwent intragastric wedge resection via the tunnel method. RESULTS Twenty-seven patients who underwent single-port intragastric wedge resection via the tunnel method in a single tertiary referral hospital were included in this study. The mean age of the patients was 54.6 ± 11.4 years, body mass index was 26.5 ± 3.4 kg/m2. Twenty-four (88.9%) patients had tumors located in the upper third of the stomach. The average operative time was 65.0 ± 24.2 min. None of the patients experienced Clavien-Dindo grade IIIa or higher postoperative complications. The average postoperative hospital stay length was 2.5 ± 0.8 days. Thirteen gastrointestinal stromal tumors, nine leiomyomas, and one neuroendocrine carcinoma, schwannoma, lipoma, spindle cell proliferative lesion, and fibrotic lesion were pathologically diagnosed. The average tumor size was 2.6 ± 1.3 cm. All cases had negative resection margins. CONCLUSIONS Single-port intragastric wedge resection by the tunnel method is a feasible and safe approach for treating endophytic gastric SETs.
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Affiliation(s)
- Eunju Lee
- Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea
| | - Donghyun Lim
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - So Hyun Kang
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Duyeong Hwang
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Mira Yoo
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Ho Kim
- Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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11
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D'Souza LS, Yang D, Diehl D. AGA Clinical Practice Update on Endoscopic Full-Thickness Resection for the Management of Gastrointestinal Subepithelial Lesions: Commentary. Gastroenterology 2024; 166:345-349. [PMID: 38108671 DOI: 10.1053/j.gastro.2023.11.016] [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: 07/14/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023]
Abstract
DESCRIPTION Subepithelial lesions of the gastrointestinal tract are not encountered uncommonly during routine endoscopy. There has been remarkable progress in the development of endoscopic options for the resection of subepithelial lesions, including full-thickness resection. The purpose of this American Gastroenterological Association (AGA) Clinical Practice Update (CPU) is to describe the various techniques for endoscopic full-thickness resection and to facilitate their appropriate application in the management of subepithelial lesions. METHODS This CPU was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPUC and external peer review through standard procedures of Gastroenterology.
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Affiliation(s)
- Lionel S D'Souza
- Department of Gastroenterology and Hepatology, Stony Brook University Hospital, Stony Brook, New York.
| | - Dennis Yang
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida
| | - David Diehl
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania
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12
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Yoshinaga S. Endoscopic ultrasound-based application for determining the management of subepithelial lesions: Do androids dream of endoscopic ultrasound? Dig Endosc 2024; 36:152-153. [PMID: 37469303 DOI: 10.1111/den.14629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023]
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13
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Kim CG. Endoscopic Treatment for Gastric Subepithelial Tumor. J Gastric Cancer 2024; 24:122-134. [PMID: 38225771 PMCID: PMC10774759 DOI: 10.5230/jgc.2024.24.e11] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/17/2024] Open
Abstract
Most gastric subepithelial tumors (SETs) are asymptomatic and are often incidentally discovered during endoscopic procedures conducted for unrelated reasons. Although surveillance is sufficient for the majority of gastric SETs, certain cases necessitate proactive management. Laparoscopic wedge resection, although a viable treatment option, has its limitations, particularly in cases where SETs (especially those with intraluminal growth) are not visualized on the peritoneal side. Recent advances in endoscopic instruments and technology have paved the way for the feasibility of endoscopic resection of SETs. Several promising endoscopic techniques have emerged for gastric SET resection, including submucosal tunneling endoscopic resection, endoscopic full-thickness resection (EFTR), laparoscopic and endoscopic cooperative surgery (LECS), and non-exposure EFTR (non-exposed endoscopic wall-inversion surgery and non-exposure simple suturing EFTR). This study aimed to discuss the indications, methods, and outcomes of endoscopic therapy for gastric SETs. In addition, a simplified diagram of the category of SETs according to the therapeutic indications and an algorithm for the endoscopic management of SET is suggested.
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Affiliation(s)
- Chan Gyoo Kim
- National Cancer Center, Center for Gastric Cancer, Goyang, Korea.
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14
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Wang J, Liu Y, Wu C, Fan J, Jin Z, Wang K. Diagnosis by Endoscopic Ultrasonography-Guided Sampling through the Lower Gastrointestinal Tract. Diagnostics (Basel) 2023; 14:64. [PMID: 38201373 PMCID: PMC10795674 DOI: 10.3390/diagnostics14010064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/FNB) is very safe and has a high diagnostic rate for upper gastrointestinal lesions, especially pancreatic lesions, but its application in the lower gastrointestinal tract has rarely been reported. Due to the tortuous course of the colorectum, with the sigmoid colon particularly prone to perforation, most endoscopists are reluctant to perform lateral-sector endoscopic ultrasound scanning without a water-bag protection for the puncture. The ultrasonic endoscopy and flexible puncture needle techniques recently introduced into clinical practice have made ultrasound-guided puncture safer and more convenient. In addition, endoscopists have carefully tested various protective measures to improve the safety of the lower gastrointestinal puncture, substantially increasing its clinical feasibility. In this article, we review the iterations of endoscopic ultrasound equipment introduced in recent years and the many ingenious ideas proposed by endoscopists regarding lower gastrointestinal puncture.
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Affiliation(s)
| | | | | | | | - Zhendong Jin
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (J.W.); (Y.L.); (C.W.); (J.F.)
| | - Kaixuan Wang
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (J.W.); (Y.L.); (C.W.); (J.F.)
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15
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Medas R, Gauci JL, Kerrison C, Mandarino FV, Whitfield A, Burgess NG, Bourke MJ. Omental patch-assisted endoscopic closure of the transmural defect after endoscopic removal of a 40-mm gastric gastrointestinal stromal tumor. Endoscopy 2023; 55:E1262-E1263. [PMID: 38128595 PMCID: PMC10737082 DOI: 10.1055/a-2218-2416] [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: 12/23/2023]
Affiliation(s)
- Renato Medas
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, Porto, Portugal
- University of Porto Faculty of Medicine, Porto, Portugal
| | - Julia L. Gauci
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
| | - Clarence Kerrison
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
- The University of Sydney Sydney Medical School, Sydney, Australia
| | | | - Anthony Whitfield
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
- The University of Sydney Sydney Medical School, Sydney, Australia
| | - Nicholas G. Burgess
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
- The University of Sydney Sydney Medical School, Sydney, Australia
| | - Michael J. Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
- The University of Sydney Sydney Medical School, Sydney, Australia
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16
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Liao S, Qiao W, Huang S, Yang G, Zhang R, Wu W, Bai X. Diagnosis of a giant gastric subepithelial lesion using a dual-frequency ultrasonic miniprobe. Endoscopy 2023; 55:E1174-E1175. [PMID: 37984394 PMCID: PMC10659829 DOI: 10.1055/a-2192-0277] [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: 11/22/2023]
Affiliation(s)
- Suhuan Liao
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Weiguang Qiao
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Silin Huang
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Guang Yang
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Ronggang Zhang
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Weiwen Wu
- InnerMedical Co., Ltd., Shenzhen, China
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17
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Jacobson BC, Shami VM. Guidelines in Practice: The Diagnosis and Management of Gastrointestinal Subepithelial Lesions. Am J Gastroenterol 2023:00000434-990000000-00886. [PMID: 37782289 DOI: 10.14309/ajg.0000000000002530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Brian C Jacobson
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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18
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Vasilakis T, Ziogas D, Tziatzios G, Gkolfakis P, Koukoulioti E, Kapizioni C, Triantafyllou K, Facciorusso A, Papanikolaou IS. EUS-Guided Diagnosis of Gastric Subepithelial Lesions, What Is New? Diagnostics (Basel) 2023; 13:2176. [PMID: 37443568 DOI: 10.3390/diagnostics13132176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/18/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
Gastric subepithelial lesions (SELs) are intramural lesions that arise underneath the gastric mucosa. SELs can be benign, but can also be malignant or have malignant potential. Therefore, correct diagnosis is crucial. Endosonography has been established as the diagnostic gold standard. Although the identification of some of these lesions can be carried out immediately, solely based on their echo characteristics, for certain lesions histological examination is necessary. Sometimes histology can be inconclusive, especially for smaller lesions. Therefore, new methods have been developed in recent years to assist decision making, such as contrast enhanced endosonography, EUS elastography, and artificial intelligence systems. In this narrative review we provide a complete overview of the gastric SELs and summarize the new data of the last ten years concerning the diagnostic advances of endosonography on this topic.
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Affiliation(s)
- Thomas Vasilakis
- Hepatology and Gastroenterology Clinic, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Dimitrios Ziogas
- 1st Department of Internal Medicine, 251 Hellenic Air Force & VA General Hospital, 3 Kanellopoulou Str., 11525 Athens, Greece
| | - Georgios Tziatzios
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital, 3-5, Theodorou Konstantopoulou Str., Nea Ionia, 14233 Athens, Greece
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital, 3-5, Theodorou Konstantopoulou Str., Nea Ionia, 14233 Athens, Greece
| | - Eleni Koukoulioti
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Christina Kapizioni
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Antonio Facciorusso
- Department of Medical Sciences, University of Foggia, Section of Gastroenterology, 71122 Foggia, Italy
| | - Ioannis S Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
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19
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Aydin S, Elgamal M, Aydin Y. Successful Resection of Gastric Subepithelial Lipoma Using the Bite-on-Bite Approach: Reviving Old Techniques in a Peripheral Hospital. Cureus 2023; 15:e40151. [PMID: 37425504 PMCID: PMC10329538 DOI: 10.7759/cureus.40151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
Subepithelial lesions (SELs) are common findings in the gastrointestinal (GI) tract. They are often benign and asymptomatic but can cause symptoms in some cases. The approach to endoscopic management of these lesions depends on various factors, including associated symptoms, location, available equipment, and operator expertise. In this case report, we present a 50-year-old male with long-standing dyspepsia who was found to have a submucosal lesion in the stomach. The lesion was successfully treated using the bite-on-bite method with cold biopsy forceps. This report aims to discuss gastric subepithelial lesions and current management options, and highlight an old technique for endoscopists in the era of advanced endoscopy.
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Affiliation(s)
| | | | - Yucel Aydin
- Department of Medicine, St. Mary's Hospital, Waterbury, USA
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20
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Mohamed WT, Jahagirdar V, Jaber F, Ahmed M, Fatima I, Chhabra R, Tawfik O. Glomus Tumor of the Stomach Presenting With Upper Gastrointestinal Bleeding: A Case Report. J Investig Med High Impact Case Rep 2023; 11:23247096231192891. [PMID: 37565695 PMCID: PMC10422895 DOI: 10.1177/23247096231192891] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023] Open
Abstract
Gastric glomus tumor is a rare mesenchymal tumor of the gastrointestinal tract, accounting for approximately 1% of all gastrointestinal soft tissue tumors. We describe a unique case of a 27-year-old female patient who presented with recurrent episodes of overt gastrointestinal bleeding requiring multiple blood transfusions. The patient was diagnosed with a gastric ulcer detected on esophagogastroduodenoscopy (EGD), which was grossly suggestive of an ulcerated gastrointestinal stromal tumor (GIST). Preoperative diagnosis was difficult, requiring laparoscopic robotic-assisted local wedge resection of the gastric mass. Pathological diagnosis and immunohistochemical (IHC) studies were consistent with a glomus tumor. We emphasize that the gastric glomus tumor might present with life-threatening recurrent gastrointestinal hemorrhage. In addition, it might mimic GIST and require surgical resection. Pathological diagnosis and IHC studies are needed to confirm the diagnosis.
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