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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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Kormann S, Semadeni GM, Weber M, Brand S, Borovicka J, Frei R. Combining Endoscopic Submucosa Dissection and Endoscopic Full-Thickness Resection for Resection of a Gastric Schwannoma Mimicking Gastrointestinal Stroma Tumor. ACG Case Rep J 2024; 11:e01440. [PMID: 39040957 PMCID: PMC11262815 DOI: 10.14309/crj.0000000000001440] [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: 04/04/2024] [Accepted: 06/14/2024] [Indexed: 07/24/2024] Open
Abstract
Subepithelial gastric tumors are a diagnostic challenge. Endoscopic ultrasound allows differentiation. Lesions originating from the submucosal layer can be resected using endoscopic submucosal dissection (ESD). Surgery or endoscopic full-thickness resection (EFTR) techniques are alternatives. We present a patient with an 11 × 8 mm submucosal tumor in the gastric antrum suggestive of a gastrointestinal stromal tumor, originating from the muscularis propria. Eventually endoscopic resection was performed, combining ESD and EFTR (hybrid ESD-EFTR). Contrary to expectations, histology revealed a gastric schwannoma. This case illustrates an efficient and safe endoscopic hybrid technique for the removal of submucosal gastric lesions.
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Affiliation(s)
- Stefan Kormann
- Department of Gastroenterology / Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Gian-Marco Semadeni
- Department of Gastroenterology / Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Matthias Weber
- Department of Pathology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Stephan Brand
- Department of Gastroenterology / Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jan Borovicka
- Department of Gastroenterology / Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Remus Frei
- Department of Gastroenterology / Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Li J, Xu D, Huang WF, Hong SK, Zhang JY. Efficacy and Safety of Endoscopic Resection for Gastric Gastrointestinal Stromal Tumors Originating from the Muscularis Propria. Dig Dis Sci 2024; 69:2184-2192. [PMID: 38653945 DOI: 10.1007/s10620-024-08359-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/13/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND The role of endoscopic resection (ER) in gastric gastrointestinal stromal tumors (GISTs) has not been fully elucidated. AIMS The purpose of this work was to evaluate the clinical effectiveness and safety of ER in patients with GISTs originating from the muscularis propria (MP). METHODS A total of 233 consecutive patients with gastric GISTs originating from the MP layer, who underwent ER between February 2012 and May 2023, were included in this study. Clinical characteristics, tumor features, and outcomes were recorded and compared between patients who underwent en bloc resection and piecemeal resection. RESULTS Among the 233 patients, the median size of GISTs was 12 mm (range 5-60 mm). Risk assessment categorized 190 patients as very low risk, 26 as low risk, 10 as moderate risk, and 7 as high risk. The procedures performed included endoscopic submucosal excavation (127 cases), endoscopic full-thickness resection (103 cases), and submucosal tunneling endoscopic resection (3 cases). The complete and R0 resection rate was 93.1%. Complications occurred in 4.7% of cases (perioperative perforations 1.7%, perioperative bleeding 1.3%, both 0.9%), resulting in conversion to surgery in 1.3% of cases. Risk factors associated with piecemeal resection were tumor size [odds ratio (OR) 0.402, 95% confidence interval (CI) 0.207-0.783; P = 0.007] and shape (OR 0.045, 95% CI 0.009-0.235; P < 0.001). CONCLUSIONS ER is proven to be an effective and reasonably safe approach for gastric GISTs originating from the MP. Notably, larger tumor size and irregular shape are identified as risk factors for piecemeal resection during ER procedures.
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Affiliation(s)
- Ji Li
- Department of Gastroenterology and Hepatology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China
| | - Dong Xu
- Department of Gastroenterology and Hepatology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China
| | - Wei-Feng Huang
- Department of Gastroenterology and Hepatology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China
| | - Shao-Kun Hong
- Department of General Surgery, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China
| | - Jin-Yan Zhang
- Department of Gastroenterology and Hepatology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China.
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
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Akahoshi K, Tamura S, Akahoshi K, Shiratsuchi Y, Koga H, Oya M, Ohishi Y, Koga T. Efficacy and histologic frequencies of endoscopic ultrasonography-guided tissue acquisition using conventional fine-needle aspiration needles for gastric subepithelial hypoechoic mass. Australas J Ultrasound Med 2024; 27:89-96. [PMID: 38784701 PMCID: PMC11109998 DOI: 10.1002/ajum.12382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Introduction/Purpose For gastric subepithelial lesions (GSELs) showing a hypoechoic mass (HM) on endoscopic ultrasonography (EUS) imaging, the utility of EUS-guided tissue acquisition using conventional fine-needle aspiration needles (EUS-TA-CFNAN) and the frequency of histological types remain unclear. This study aimed to examine this issue. Methods This prospective observational study enrolled 291 consecutive patients who underwent EUS-TA-CFNAN for GSELs showing an HM (GSELHM) on EUS imaging. Immunohistochemical analysis was performed for all EUS-TA-CFNAN and surgically resected specimens. The main outcome measures were the technical results of EUS-TA-CFNAN and the frequency of histological types in GSELHM. Results The endoscopic ultrasound-guided tissue acquisition using conventional fine-needle aspiration needle diagnosis rate for GSELHM was 80.1% (95% confidence interval [CI]: 75.0-84.5, 233/291). It was significantly lower for antrum (P = 0.004) and lesions smaller than 2 cm (P = 0.003). There were no adverse events. The immunohistochemical diagnoses of EUS-TA-CFNAN included 149 cases of gastrointestinal stromal tumour (GIST) (51.2%), 48 cases of leiomyoma (16.5%), 11 cases of schwannoma (3.8%), 8 cases of the ectopic pancreas (2.7%), 5 cases of subepithelial lesion like cancer (1.7%), 12 cases of other lesions (4.1%), and 58 cases of undiagnosable lesions (19.9%). The frequency of malignant or potentially malignant tumour in GSELHM was 55.0% (95% CI: 49.1-60.8, 160/291). Surgery was performed in 149 patients according to the conclusive EUS-TA-CFNAN results, in which the diagnostic accuracy of EUS-TA-CFNAN was 97.3% (95% CI: 94.7-99.9, 145/149). Conclusion The use of EUS-TA-CFNAN for GSELHMs is safe and accurate. Gastric subepithelial lesions showing a hypoechoic mass have a reasonably high possibility of containing malignant or potentially malignant tumours, including GISTs.
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Affiliation(s)
| | | | | | | | - Hidenobu Koga
- Clinical Research Support OfficeAso Iizuka HospitalIizukaJapan
| | - Masafumi Oya
- Department of PathologyAso Iizuka HospitalIizukaJapan
| | | | - Tadashi Koga
- Department of SurgeryAso Iizuka HospitalIizukaJapan
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Wen XP, Wan QQ. Nomogram to predict gas-related complications during transoral endoscopic resection of upper gastrointestinal submucosal lesions: Clinical significance. World J Gastrointest Endosc 2024; 16:5-10. [PMID: 38313461 PMCID: PMC10835473 DOI: 10.4253/wjge.v16.i1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/13/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024] Open
Abstract
Transoral endoscopic resections in treating upper gastrointestinal submucosal lesions have the advantages of maintaining the integrity of the gastrointestinal lumen, avoiding perforation and reducing gastrointestinal fistulae. They are becoming more widely used in clinical practice, but, they may also present a variety of complications. Gas-related complications are one of the most common, which can be left untreated if the symptoms are mild, but in severe cases, they can lead to rapid changes in the respiratory and circulatory systems in a short period, which can be life-threatening. Therefore, it is important to predict the occurrence of gas-related complications early and take preventive measures actively. Based on the authors' results in the prepublication of the article "Nomogram to predict gas-related complications during transoral endoscopic resection of upper gastrointestinal submucosal lesions," and in conjunction with our evaluation and additions to the relevant content, radiographs may help screen patients at high risk for gas-related complications. Controlling blood glucose levels, shortening the duration of surgery, and choosing the most appropriate surgical resection may positively impact the prognosis of patients at high risk for gas-related complications during transoral endoscopic resection of upper gastrointestinal submucosal lesions.
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Affiliation(s)
- Xu-Peng Wen
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Qi-Quan Wan
- Department of Transplant Surgery, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
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Novel Sequence of Endoscopic Therapy for the Management of Colonic Adenocarcinoma and Surrounding Adenoma. ACG Case Rep J 2023; 10:e01008. [PMID: 36891183 PMCID: PMC9988281 DOI: 10.14309/crj.0000000000001008] [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: 08/23/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
An 80-year-old man with a history of an orthotopic heart transplant was found to have a 25 × 40 mm centrally ulcerated mass at the hepatic flexure during evaluation of anemia. Owing to comorbidities, the patient was deemed to be a poor surgical candidate and was referred to the advanced endoscopy team to explore palliative and potentially curative options. We present a novel sequence of intervention involving full-thickness resection with subsequent morcellation clean-up to achieve complete endoscopic removal of a neoplastic lesion.
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Wu ZW, Ding CH, Song YD, Cui ZC, Bi XQ, Cheng B. Colon Sparing Endoscopic Full-Thickness Resection for Advanced Colorectal Lesions: Is It Time for Global Adoption? Front Oncol 2022; 12:967100. [PMID: 35912240 PMCID: PMC9327091 DOI: 10.3389/fonc.2022.967100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
The majority of colon lesions are <10 mm in size and are easily resected by endoscopists with appropriate basic training. Lesions ≥10 mm in size are difficult to remove technically and are associated with higher rates of incomplete resection. Currently, the main endoscopic approaches include endoscopic mucosal resection (EMR) for lesions without submucosal invasion, and endoscopic submucosal dissection (ESD) for relatively larger lesions involving the superficial submucosal layer. Both of these approaches have limitations, EMR cannot reliably ensure complete resection for larger tumors and recurrence is a key limitation. ESD reliably provides complete resection and an accurate pathological diagnosis but is associated with risk such as perforation or bleeding. In addition, both EMR and ESD may be ineffective in treating subepithelial lesions that extend beyond the submucosa. Endoscopic full-thickness resection (EFTR) is an emerging innovative endoscopic therapy which was developed to overcome the limitations of EMR and ESD. Advantages include enabling a transmural resection, complete resection of complex colorectal lesions involving the mucosa to the muscularis propria. Recent studies comparing EFTR with current resection techniques and radical surgery for relatively complicated and larger lesion have provided promising results. If the current trajectory of research and development is maintained, EFTR will likely to become a strong contender as an alternative standard of care for advanced colonic lesions. In the current study we aimed to address this need, and highlighted the areas of future research, while stressing the need for multinational collaboration provide the steppingstone(s) needed to bring EFTR to the mainstream.
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Affiliation(s)
- Zhong-Wei Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chao-Hui Ding
- Department of Emergency Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yao-Dong Song
- Department of Emergency Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zong-Chao Cui
- Department of Emergency Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiu-Qian Bi
- Department of Emergency Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo Cheng
- Department of Emergency Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Bo Cheng,
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