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Li CY, Wang YF, Luo LK, Yang XJ. Present situation of minimally invasive surgical treatment for early gastric cancer. World J Gastrointest Oncol 2024; 16:1154-1165. [PMID: 38660633 PMCID: PMC11037069 DOI: 10.4251/wjgo.v16.i4.1154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/05/2023] [Accepted: 02/02/2024] [Indexed: 04/10/2024] Open
Abstract
Minimally invasive surgery is a kind of surgical operation, which is performed by using professional surgical instruments and equipment to inactivate, resect, repair or reconstruct the pathological changes, deformities and wounds in human body through micro-trauma or micro-approach, in order to achieve the goal of treatment, its surgical effect is equivalent to the traditional open surgery, while avoiding the morbidity of conventional surgical wounds. In addition, it also has the advantages of less trauma, less blood loss during operation, less psychological burden and quick recovery on patients, and these minimally invasive techniques provide unique value for the examination and treatment of gastric cancer patients. Surgical minimally invasive surgical techniques have developed rapidly and offer numerous options for the treatment of early gastric cancer (EGC): endoscopic mucosal resection (EMR), underwater EMR (UEMR), endoscopic submucosal dissection (ESD), endoscopic full-thickness resection (EFTR), endoscopic submucosal excavation (ESE), submucosal tunnel endoscopic resection), laparoscopic and endoscopic cooperative surgery (LECS); Among them, EMR, EFTR and LECS technologies have a wide range of applications and different modifications have been derived from their respective surgical operations, such as band-assisted EMR (BA-EMR), conventional EMR (CEMR), over-the-scope clip-assisted EFTR, no-touch EFTR, the inverted LECS, closed LECS, and so on. These new and improved minimally invasive surgeries are more precise, specific and effective in treating different types of EGC.
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Affiliation(s)
- Chun-Yan Li
- The First Clinical Medical School, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Yi-Feng Wang
- The First Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
| | - Li-Kang Luo
- The First Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
| | - Xiao-Jun Yang
- The First Clinical Medical School, Lanzhou University, Lanzhou 730000, Gansu Province, China
- General Surgery Clinical Centre, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- The Second Department of General Surgery, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- Lanzhou University People's Clinical Hospital, Lanzhou 730000, Gansu Province, China
- Gansu Research Center of Prevention and Control Project for Digestive Oncology, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- Gansu Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
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Ichimasa K, Kudo SE, Tan KK, Lee JWJ, Yeoh KG. Challenges in Implementing Endoscopic Resection for T2 Colorectal Cancer. Gut Liver 2024; 18:218-221. [PMID: 37842729 PMCID: PMC10938148 DOI: 10.5009/gnl230125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/06/2023] [Accepted: 08/15/2023] [Indexed: 10/17/2023] Open
Abstract
The current standard treatment for muscularis propria-invasive (T2) colorectal cancer is surgical colectomy with lymph node dissection. With the advent of new endoscopic resection techniques, such as endoscopic full-thickness resection or endoscopic intermuscular dissection, T2 colorectal cancer, with metastasis to 20%-25% of the dissected lymph nodes, may be the next candidate for endoscopic resection following submucosal-invasive (T1) colorectal cancer. We present a novel endoscopic treatment strategy for T2 colorectal cancer and suggest further study to establish evidence on oncologic and endoscopic technical safety for its clinical implementation.
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Affiliation(s)
- Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shin-ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Ker-Kan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Surgery, National University Hospital, Singapore
| | - Jonathan Wei Jie Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Khay Guan Yeoh
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Wang SS, Ji MY, Huang X, Li YX, Yu SJ, Zhao Y, Shen L. Double-nylon purse-string suture in closing postoperative wounds following endoscopic resection of large (≥ 3 cm) gastric submucosal tumors. World J Gastroenterol 2024; 30:1143-1153. [PMID: 38577185 PMCID: PMC10989488 DOI: 10.3748/wjg.v30.i9.1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/04/2024] [Accepted: 02/02/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Endoscopic full-thickness resection (EFTR) of gastric submucosal tumors (SMTs) is safe and effective; however, postoperative wound management is equally important. Literature on suturing following EFTR for large (≥ 3 cm) SMTs is scarce and limited. AIM To evaluate the efficacy and clinical value of double-nylon purse-string suture in closing postoperative wounds following EFTR of large (≥ 3 cm) SMTs. METHODS We retrospectively analyzed the data of 85 patients with gastric SMTs in the fundus of the stomach or in the lesser curvature of the gastric body whose wounds were treated with double-nylon purse-string sutures after successful tumor resection at the Endoscopy Center of Renmin Hospital of Wuhan University. The operative, postoperative, and follow-up conditions of the patients were evaluated. RESULTS All tumors were completely resected using EFTR. 36 (42.35%) patients had tumors located in the fundus of the stomach, and 49 (57.65%) had tumors located in the body of the stomach. All patients underwent suturing with double-nylon sutures after EFTR without laparoscopic assistance or further surgical treatment. Postoperative fever and stomach pain were reported in 13 (15.29%) and 14 (16.47%) patients, respectively. No serious adverse events occurred during the intraoperative or postoperative periods. A postoperative review of all patients revealed no residual or recurrent lesions. CONCLUSION Double-nylon purse-string sutures can be used to successfully close wounds that cannot be completely closed with a single nylon suture, especially for large (≥ 3 cm) EFTR wounds in SMTs.
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Affiliation(s)
- Shan-Shan Wang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei province, China
| | - Meng-Yao Ji
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei province, China
| | - Xu Huang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei province, China
| | - Yan-Xia Li
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei province, China
| | - Shi-Jie Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei province, China
| | - Yu Zhao
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei province, China
| | - Lei Shen
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei province, China
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Gu L, Wang X, Ouyang M, Li F, Wu Y, Liu X. Facilitating endoscopic full-thickness resection for gastric submucosal tumors with a novel snare traction method (with video). J Gastroenterol Hepatol 2024; 39:535-543. [PMID: 38011894 DOI: 10.1111/jgh.16428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 10/08/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND AIM Endoscopic full-thickness resection (EFTR) is a promising technique in treating gastric submucosal tumors originating from the muscularis propria (SMT-MPs). However, it is challenging without counter-traction. METHODS A snare was inserted through the forceps channel to grasp the part of the tumor or the mucosa connected to the tumor. The outer sheath and inner wire of snare in vitro were fixed by a pair of hemostatic forceps. The handle of snare was cut off, and the endoscope was pulled out without affecting the traction state of snare. Snare-assisted EFTR (EFTR-S) was then performed with counter-traction. One hundred and four patients with gastric SMT-MPs who received the procedure of EFTR with or without snare traction method were retrospectively analyzed using univariate and multiple regressions, and covariates were adjusted in the multiple analysis. RESULTS Compared with EFTR group (n = 36), EFTR-S group (n = 68) showed a higher operative success rate (95.6% vs 72.2%, P = 0.001), a lower incidence of intraoperative hemorrhage (4.4% vs 16.7%, P = 0.038) and shorter operative time among operative successes (53.6 ± 16.6 min vs 67.7 ± 33.4 min, P < 0.001). Univariate logistic analysis showed that snare traction represented a significant factor, which could improve operative successful rate (odds ratio, 8.3; 95% confidence interval, 2.1 to 32.7; P = 0.002). Postoperative outcomes and adverse events among operative successes were similar between the two groups. CONCLUSIONS This novel snare traction method may provide an effective counter-traction and reduce the difficulty of EFTR for gastric SMT-MPs.
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Affiliation(s)
- Lei Gu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaotong Wang
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Miao Ouyang
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Fujun Li
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Yu Wu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease (2020CB1004), Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaowei Liu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease (2020CB1004), Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Kim Y, Ahn JY, Jung HY, Kang S, Song HJ, Choi KD, Kim DH, Lee JH, Na HK, Park YS. Endoscopic resection of gastric gastrointestinal stromal tumor using clip-and-cut endoscopic full-thickness resection: a single-center, retrospective cohort in Korea. Clin Endosc 2024:ce.2023.144. [PMID: 38356170 DOI: 10.5946/ce.2023.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/19/2023] [Indexed: 02/16/2024] Open
Abstract
Background/Aims To overcome the technical limitations of classic endoscopic resection for gastric gastrointestinal stromal tumors (GISTs), various methods have been developed. In this study, we examined the role and feasibility of clip-and-cut procedures (clip-and-cut endoscopic full-thickness resection [cc-EFTR]) for gastric GISTs. Methods Medical records of 83 patients diagnosed with GISTs after endoscopic resection between 2005 and 2021 were retrospectively reviewed. Moreover, clinical characteristics and outcomes were analyzed. Results Endoscopic submucosal dissection (ESD) and cc-EFTR were performed in 51 and 32 patients, respectively. The GISTs were detected in the upper third of the stomach for ESD (52.9%) and cc-EFTR (90.6%). Within the cc-EFTR group, a majority of GISTs were located in the deep muscularis propria or serosal layer, accounting for 96.9%, as opposed to those in the ESD group (45.1%). The R0 resection rates were 51.0% and 84.4% in the ESD and cc-EFTR groups, respectively. Seven (8.4%) patients required surgical treatment (six patients underwent ESD and one underwent cc-EFTR,) due to residual tumor (n=5) and post-procedure adverse events (n=2). Patients undergoing R0 or R1 resection experienced recurrence during a median 14-month follow-up period, except for one patient in the ESD group. Conclusions Cc-EFTR displayed high R0 resection rates as the procedure safely and successfully removed small gastric GISTs.
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Affiliation(s)
- Yuri Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seokin Kang
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Soo Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kouladouros K, Centner M, Reissfelder C, Belle S, Kähler G. The role of the multidisciplinary tumor board after endoscopic resection of malignant tumors: is it worth it? Surg Endosc 2024; 38:607-613. [PMID: 37991571 PMCID: PMC10830656 DOI: 10.1007/s00464-023-10555-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/20/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES The value of multidisciplinary tumor boards (MTBs) in the treatment of gastrointestinal cancer patients is well known. Most of the current evidence focuses on advanced cancer cases, whereas little is known about the effect of MTBs on early tumors, especially after endoscopic resection. The aim of our study is to evaluate the value of the MTB after endoscopic resection of malignant tumors of the gastrointestinal tract. METHODS We retrospectively analyzed all endoscopically resected malignant tumors in our department between 2011 and 2019, focusing on the existence of an MDT recommendation after endoscopic resection, the MDT adherence to the current guidelines, and the implementation of the recommendation by the patients. RESULTS We identified 198 patients fulfilling our inclusion criteria, of whom 168 (85%) were discussed in the MDT after endoscopic resection. In total, 155 of the recommendations (92%) were in accordance with the current guidelines, and 147 (88%) of them were implemented by the patients. The MDT discussion itself did not influence the overall survival, whereas the implementation of the MTB recommendation was associated with a significantly better prognosis. Deviations of the MDT recommendation from the guidelines had no effect on the overall survival. CONCLUSIONS The discussion of endoscopically resected malignant tumors in the MTB is crucial for the treatment of patients with this type of cancer, since the implementation of the MTB recommendation, even if it deviates from the current guidelines, improves the prognosis.
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Affiliation(s)
- Konstantinos Kouladouros
- Central Interdisciplinary Endoscopy Department, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Maximilian Centner
- Central Interdisciplinary Endoscopy Department, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christoph Reissfelder
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Sebastian Belle
- Central Interdisciplinary Endoscopy Department, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- Department of Internal Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Georg Kähler
- Central Interdisciplinary Endoscopy Department, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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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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Xu EP, Qi ZP, Li B, Ren Z, Cai MY, Cai SL, Lyv ZT, Chen ZH, Liu JY, Shi Q, Zhong YS. The efficacy of full-thickness endoscopic resection of subepithelial tumors in the gastric cardia. World J Gastrointest Oncol 2023; 15:2111-2119. [PMID: 38173428 PMCID: PMC10758656 DOI: 10.4251/wjgo.v15.i12.2111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/18/2023] [Accepted: 10/30/2023] [Indexed: 12/14/2023] Open
Abstract
BACKGROUND Gastric subepithelial tumors (SETs) may harbor potential malignancy. Although it is well recognized that large SETs should be resected, the precise treatment strategy remains controversial. Compared to surgical resection, endoscopic resection (ER) has many advantages; however, ER of SETs in the cardia is challenging. AIM To evaluate the safety and efficacy of endoscopic full-thickness resection (EFTR) for the treatment of gastric cardia SETs. METHODS We retrospectively reviewed data from all patients with SETs originating from the muscularis propria layer in the gastric cardia that were treated by EFTR or submucosal tunneling ER (STER) at Zhongshan Hospital Fudan University between November 2014 and May 2022. Baseline characteristics and clinical outcomes, including procedure times and complications rates, were compared between groups of patients receiving EFTR and STER. RESULTS A total of 171 tumors were successfully removed [71 (41.5%) tumors in the EFTR and 100 (58.5%) tumors in the STER group]. Gastrointestinal stromal tumors (GISTs) were the most common SET. The en bloc resection rate was 100% in the EFTR group vs 97.0% in STER group (P > 0.05). Overall, the EFTR group had a higher complete resection rate than the STER group (98.6% vs 91.0%, P < 0.05). The procedure time was also shorter in the EFTR group (44.63 ± 28.66 min vs 53.36 ± 27.34, P < 0.05). The most common major complication in both groups was electrocoagulation syndrome. There was no significant difference in total complications between the two groups (21.1% vs 22.0%, P = 0.89). CONCLUSION EFTR of gastric cardia SETs is a very promising method to facilitate complete resection with similar complications and reduced operative times compared to STER. In cases of suspected GISTs or an unclear diagnosis, EFTR should be recommended to ensure complete resection.
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Affiliation(s)
- En-Pan Xu
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Zhi-Peng Qi
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Bing Li
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Zhong Ren
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Ming-Yan Cai
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Shi-Lun Cai
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Zhen-Tao Lyv
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Zhang-Han Chen
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Jing-Yi Liu
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Qiang Shi
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Yun-Shi Zhong
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
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Sawada A, Hirasawa K, Sato C, Sato S, Sato T, Sugimori K, Kunisaki C, Maeda S. Endoscopic Resection with One-Port Placement: A Newly Developed Technique for the Safe Management of Advanced Endoscopic Resection for Gastric Gastrointestinal Stromal Tumors. Digestion 2023; 104:460-467. [PMID: 37647880 DOI: 10.1159/000532012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 07/05/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Endoscopic full-thickness resection (EFTR) without laparoscopic assistance (pure EFTR) is an emerging, less invasive treatment for gastrointestinal stromal tumors (GISTs). However, the technique has seldom been performed outside China because of concerns regarding pneumoperitoneum, maintenance of endoscopic view, and endoscopic suturing. This study aimed to evaluate the efficacy and safety of endoscopic resection with one-port placement (EROPP) for gastric GISTs. METHODS This retrospective study included 17 patients with gastric GISTs originating from the muscularis propria who underwent EROPP between 2019 and 2022. One camera port was inserted in the umbilicus before initiating the endoscopic procedure to maintain intra-abdominal pressure, which was monitored and adjusted via this port. While allowing for conversion to laparoscopic surgery if needed, EFTR was performed as follows: (1) circumferential incision of the mucosal and submucosal layers around the lesion was performed by typical endoscopic submucosal dissection; (2) an intentional perforation and subsequent seromuscular resection was made using dental floss and an endo-clip for traction; and (3) closure of the gastric full-thickness defect was performed with an over-the-scope clip (OTSC) after peroral retrieval of the specimen. We retrospectively assessed the short-term outcomes and safety. RESULTS All procedures were completed successfully without conversion to laparoscopic surgery. The median size of the resected tumors was 23 mm (range, 8-35 mm), the median resection time was 36 min (range, 22-95 min), and closure time was 18 min (range, 10-45 min). The rates of en bloc and complete resection were 100% and 88%, respectively. In 2 cases, another port was added to aspirate the leaking fluid or check the condition of the endoscopic closure. All gastric defects were endoscopically closed, mainly using OTSCs. The recovery course for all patients was uneventful, and no adverse events were reported. CONCLUSIONS EROPP is a safe and minimally invasive treatment for gastric GISTs and appears to be suitable for introducing EFTR procedures.
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Affiliation(s)
- Atsushi Sawada
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Sho Sato
- Department of Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Tsutomu Sato
- Department of Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuya Sugimori
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Chikara Kunisaki
- Department of Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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10
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Mun EJ, Wagh MS. Recent advances and current challenges in endoscopic resection with the full-thickness resection device. World J Gastroenterol 2023; 29:4009-4020. [PMID: 37476589 PMCID: PMC10354579 DOI: 10.3748/wjg.v29.i25.4009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/27/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Endoscopic full-thickness resection (EFTR) has emerged as a viable technique in the management of mucosal and subepithelial lesions of the gastrointestinal tract (GIT) not amenable to conventional therapeutic approaches. While various devices and techniques have been described for EFTR, a single, combined full-thickness resection and closure device (full-thickness resection device, FTRD system, Ovesco Endoscopy AG, Tuebingen, Germany) has become commercially available in recent years. Initially, the FTRD system was limited to use in the colorectum only. Recently, a modified version of the FTRD has been released for EFTR in the upper GIT as well. This review provides a broad summary of the FTRD, highlighting recent advances and current challenges.
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Affiliation(s)
- Elijah J Mun
- Division of Gastroenterology, University of Colorado School of Medicine, Aurora, CO 80045, United States
| | - Mihir S Wagh
- Interventional Endoscopy, Division of Gastroenterology, University of Colorado School of Medicine, Aurora, CO 80045, United States
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11
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Tada N, Kobara H, Nishiyama N, Fujihara S, Masaki T, Uedo N. Current Status of Endoscopic Full-Thickness Resection for Gastric Subepithelial Tumors: A Literature Review Over Two Decades. Digestion 2023; 104:415-429. [PMID: 37423206 DOI: 10.1159/000530679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/03/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND With the development of endoscopic technology and devices, endoscopic full-thickness resection (EFTR) has been challengingly introduced for gastric subepithelial tumors (SETs). The resection and closure strategies are under investigation. This systematic review was performed to assess the current status and limitations of EFTR for gastric SETs. SUMMARY MEDLINE was searched using the keywords "endoscopic full-thickness resection" or "gastric endoscopic full-thickness closure" AND "gastric" or "stomach" from January 2001 to July 2022. The outcome variables were the complete resection rate, major adverse event (AE) rate including delayed bleeding and delayed perforation, and closure-associated outcomes. Among 288 studies, 27 eligible studies involving 1,234 patients were included in this review. The complete resection rate was 99.7% (1,231/1,234). The major AE rate was 1.13% (14/1,234), with delayed bleeding in two (0.16%) patients, delayed perforation in one (0.08%), panperitonitis or abdominal abscess in three (0.24%), and other AEs in eight (0.64%). Surgical interventions were required intraoperatively or postoperatively in 7 patients (0.56%). Three patients underwent intraoperative conversion to surgery, due to intraoperative massive bleeding, technical difficulty of closure, and retrieval of falling tumor in the peritoneal cavity. Postoperative surgical rescues for AEs were required in four (0.32%). Subgroup analysis of AE outcomes showed no significant differences among closure techniques consisting of endoclips, purse-string suturing, and over-the-scope clips. KEY MESSAGES This systematic review demonstrated acceptable outcomes of EFTR and closure for gastric SETs, indicating that EFTR is a promising forthcoming procedure.
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Affiliation(s)
- Naoya Tada
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Noriko Nishiyama
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Shintaro Fujihara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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12
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Crafa F, Vanella S, Morante A, Catalano OA, Pomykala KL, Baiamonte M, Godas M, Antunes A, Costa Pereira J, Giaccaglia V. Non-exposed endoscopic wall-inversion surgery with one-step nucleic acid amplification for early gastrointestinal tumors: Personal experience and literature review. World J Gastroenterol 2023; 29:3883-3898. [PMID: 37426319 PMCID: PMC10324533 DOI: 10.3748/wjg.v29.i24.3883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/11/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Laparoscopic and endoscopic cooperative surgery is a safe, organ-sparing surgery that achieves full-thickness resection with adequate margins. Recent studies have demonstrated the safety and efficacy of these procedures. However, these techniques are limited by the exposure of the tumor and mucosa to the peritoneal cavity, which could lead to viable cancer cell seeding and the spillage of gastric juice or enteric liquids into the peritoneal cavity. Non-exposed endoscopic wall-inversion surgery (NEWS) is highly accurate in determining the resection margins to prevent intraperitoneal contamination because the tumor is inverted into the visceral lumen instead of the peritoneal cavity. Accurate intraoperative assessment of the nodal status could allow stratification of the extent of resection. One-step nucleic acid amplification (OSNA) can provide a rapid method of evaluating nodal tissue, whilst near-infrared laparoscopy together with indocyanine green can identify relevant nodal tissue intraoperatively.
AIM To determine the safety and feasibility of NEWS in early gastric and colon cancers and of adding rapid intraoperative lymph node (LN) assessment with OSNA.
METHODS The patient-based experiential portion of our investigations was conducted at the General and Oncological Surgery Unit of the St. Giuseppe Moscati Hospital (Avellino, Italy). Patients with early-stage gastric or colon cancer (diagnosed via endoscopy, endoscopic ultrasound, and computed tomography) were included. All lesions were treated by NEWS procedure with intraoperative OSNA assay between January 2022 and October 2022. LNs were examined intraoperatively with OSNA and postoperatively with conventional histology. We analyzed patient demographics, lesion features, histopathological diagnoses, R0 resection (negative margins) status, adverse events, and follow-up results. Data were collected prospectively and analyzed retrospectively.
RESULTS A total of 10 patients (5 males and 5 females) with an average age of 70.4 ± 4.5 years (range: 62-78 years) were enrolled in this study. Five patients were diagnosed with gastric cancer. The remaining 5 patients were diagnosed with early-stage colon cancer. The mean tumor diameter was 23.8 ± 11.6 mm (range: 15-36 mm). The NEWS procedure was successful in all cases. The mean procedure time was 111.5 ± 10.7 min (range: 80-145 min). The OSNA assay revealed no LN metastases in any patients. Histologically complete resection (R0) was achieved in 9 patients (90.0%). There was no recurrence during the follow-up period.
CONCLUSION NEWS combined with sentinel LN biopsy and OSNA assay is an effective and safe technique for the removal of selected early gastric and colon cancers in which it is not possible to adopt conventional endoscopic resection techniques. This procedure allows clinicians to acquire additional information on the LN status intraoperatively.
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Affiliation(s)
- Francesco Crafa
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Serafino Vanella
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Aristide Morante
- Division of Gastorenterology and Endoscopy, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Onofrio A Catalano
- Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Kelsey L Pomykala
- Department of Nuclear Medicine, Department of Radiological Sciences, University Hospital Essen, University of Duisburg-Essen, Essen 45141, Germany
| | - Mario Baiamonte
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Maria Godas
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Alexandra Antunes
- Department of General Surgery, Braga Hospital, Braga 4710-243, Portugal
| | | | - Valentina Giaccaglia
- Department of Surgery, Medclinic City Hospital, Dubai 505004, United Arab Emirates
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13
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Ye L, Zhong JH, Liu YP, Chen DD, Ni SY, Peng FQ, Zhang S. Extensively infarcted giant solitary hamartomatous polyp treated with endoscopic full-thickness resection: A case report. World J Clin Cases 2023; 11:1782-1787. [PMID: 36969998 PMCID: PMC10037273 DOI: 10.12998/wjcc.v11.i8.1782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/17/2023] [Accepted: 02/15/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Solitary hamartomatous polyps (SHPs) are rare lesions. Endoscopic full-thickness resection (EFTR) is a highly efficient and minimally invasive endoscopic procedure that benefits from complete lesion removal and high safety.
CASE SUMMARY A 47-year-old man was admitted to our hospital after experiencing hypogastric pain and constipation for over fifteen days. Computed tomography and endoscopy revealed a giant pedunculated polyp (approximately 18 cm long) in the descending and sigmoid colon. This is the largest SHP reported to date. Having considered the condition of the patient and mass growth, the polyp was removed using EFTR.
CONCLUSION On the basis of clinical and pathological evaluations, the mass was considered an SHP.
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Affiliation(s)
- Lu Ye
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Ji-Hong Zhong
- Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
| | - Yong-Pan Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
| | - Dan-Dan Chen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Si-Yi Ni
- Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
| | - Fa-Quan Peng
- Department of Pathology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
| | - Shuo Zhang
- Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
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14
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Liao F, Shao D, Yao S, Pan X, Long S, Zhou X, Li G, Zhu Y, Chen Y, Zhu Z, Shu X. Routine nasogastric tube placement after gastric endoscopic full-thickness resection of tumor size ≤ 2 cm may be unnecessary: a propensity score-matching analysis. Surg Endosc 2023; 37:932-940. [PMID: 36050609 DOI: 10.1007/s00464-022-09560-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Endoscopic full-thickness resection is a common endoscopic procedure for treating gastrointestinal submucosal tumors. Nasogastric tube placement is frequently performed after abdominal surgery, but the routine use of this approach remains controversial. The aim of this research was to explore whether nasogastric tube placement after gastric endoscopic full-thickness resection is necessary. METHODS A retrospective study enrolled patients who underwent gastric endoscopic full-thickness resection in our hospital between January 2014 and January 2019, and all the patients had a tumor size ≤ 2 cm. The patients were divided into two groups according to whether a nasogastric tube was placed. Postprocedural adverse events and hospital stay duration were compared between the two groups using 1:1 propensity score matching. RESULTS A total of 461 patients were enrolled in this study, including 385 patients in the nasogastric tube group (NGT group) and 76 patients in the non-nasogastric tube group (non-NGT group). After matching, the baseline characteristics of 73 patients in the NGT group and 73 patients in the non-NGT group were balanced (p > 0.05). The postprocedural fever rate in the NGT group was significantly higher than that in the non-NGT group (23.3% vs. 9.6%, p = 0.044). 6.9% (5/73) of patients experienced severe nasogastric tube-related throat discomfort. However, the duration of hospitalization stay was not different between the two groups. CONCLUSIONS For patients with tumor size ≤ 2 cm, routine nasogastric tube placement after gastric endoscopic full-thickness resection may be unnecessary.
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Affiliation(s)
- Foqiang Liao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng, Street, Nanchang, 330006, Jiangxi, China
| | - Danting Shao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng, Street, Nanchang, 330006, Jiangxi, China
| | - Shuman Yao
- Fuzhou Medical College of Nanchang University, Fuzhou, 344000, Jiangxi, China
| | - Xiaolin Pan
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng, Street, Nanchang, 330006, Jiangxi, China
| | - Shunhua Long
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng, Street, Nanchang, 330006, Jiangxi, China
| | - Xiaojiang Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng, Street, Nanchang, 330006, Jiangxi, China
| | - Guohua Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng, Street, Nanchang, 330006, Jiangxi, China
| | - Yin Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng, Street, Nanchang, 330006, Jiangxi, China
| | - Youxiang Chen
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng, Street, Nanchang, 330006, Jiangxi, China
| | - Zhenhua Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng, Street, Nanchang, 330006, Jiangxi, China.
| | - Xu Shu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng, Street, Nanchang, 330006, Jiangxi, China.
- Jiangxi Clinical Research Center for Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China.
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15
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Li MM, Zhang Y, Sun F, Huai MX, Zhang FY, Qu CY, Shen F, Li ZH, Xu LM. Feasibility and efficacy of endoscopic purse-string suture-assisted closure for mucosal defects induced by endoscopic manipulations. World J Gastroenterol 2023; 29:731-743. [PMID: 36742166 PMCID: PMC9896609 DOI: 10.3748/wjg.v29.i4.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/27/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close, although complete closure is recommended for better recovery. Endoscopic purse-string assisted suturing (EPSS) has been used in clinical practice and has proven to be an effective and safe technique for the closure of large mucosal defects. However, details regarding the efficacy of endoscopic pre-purse-string suture (P-EPSS) are unknown, especially that it offers several advantages over conventional EPSS (C-EPSS).
AIM To elucidate the outcomes of EPSS-assisted closure in different clinical situations, and evaluate the efficacy of P-EPSS.
METHODS This retrospective observational study included a total of 180 patients who underwent closure assisted by P-EPSS (n = 63) or C-EPSS (n = 117) between July 2014 and June 2020. The P-EPSS and C-EPSS groups were compared and the intergroup differences in aspects such as the lesion size, location, and mor-phology, incidence of complete closure, intraoperative perforation, and delayed adverse events were evaluated. Data on the features and clinical course of cases with adverse events were collected for further analysis.
RESULTS Patients with lesion size larger than 3 cm, lesions located at the fundus of stomach, or submucosal tumors originating from the deep mucosa were more likely to undergo P-EPSS-assisted closure. The P-EPSS group showed a sign-ificantly higher proportion of intraoperative perforation (56% vs 17%) and a much shorter procedure time (9.06 ± 6.14 min vs 14.84 ± 7.25 min). Among adverse events, the incidence of delayed perforation (5% vs 4%; P = 0.82) and delayed bleeding (3% vs 4%; P = 0.96) did not differ significantly between the groups. Multivariate analysis revealed that lesions with incomplete closure [odds ratio (OR) = 21.33; 95% confidence interval (CI): 5.45-83.45; P < 0.01] or size greater than 3 cm (OR = 3.14; 95%CI: 1.08-9.18; P = 0.039) showed a statistical tendency to result in an increase in delayed adverse events.
CONCLUSION The present study revealed that EPSS could achieve secure complete closure of mucosal defect. P-EPSS could shorten the procedure and yield complete closure of mucosal defects. Rather than closure-type selection, incomplete closure or lesion size larger than 3 cm were associated with worse outcomes.
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Affiliation(s)
- Ming-Ming Li
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Yi Zhang
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Fang Sun
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Man-Xiu Huai
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Fei-Yu Zhang
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Chun-Ying Qu
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Feng Shen
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Zheng-Hong Li
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Lei-Ming Xu
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
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16
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Matsui T, Kobara H, Nishiyama N, Nakatani K, Shi T, Tada N, Kozuka K, Kobayashi N, Chiyo T, Yachida T, Kondo A, Kishino T, Okano K, Fujihara S, Uchita K, Hirasawa K, Masaki T. Comparison of purse-string suture versus over-the-scope clip for gastric endoscopic full-thickness closure: traction and leak pressure testing in ex vivo porcine model. BMC Surg 2023; 23:20. [PMID: 36703127 DOI: 10.1186/s12893-023-01920-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 01/18/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The recently developed endoscopic full-thickness resection technique requires reliable closure. The main closure methods are the purse-string suture (PSS) technique and over-the-scope clip (OTSC) technique; however, basic data on the closure strength of each technique are lacking. This study was performed to compare the closure strengths of these two methods in an ex vivo porcine model. METHODS In the traction test, a virtual 5-cm full-thickness closure line was closed by the following six methods three times each: conventional hemoclips, mucosal PSS, seromuscular PSS, mucosal OTSC, seromuscular OTSC, and surgical suture. The primary endpoint was the tension at the starting point of dehiscence, measured in Newtons (N) by an automatic traction machine. In the leak test, a 15-mm gastric full-thickness defect was closed by PSS or OTSC six times each, and the closed stomach was then pressurized in a water container. The primary endpoint was the leak pressure when air bubbles appeared. The secondary endpoints were the procedure time and presence of complete inverted closure. RESULTS The mean tension was 2.16, 3.68, 5.15, 18.30, 19.30, and 62.40 N for conventional hemoclips, mucosal PSS, seromuscular PSS, mucosal OTSC, seromuscular OTSC, and surgical suture, respectively. Complete inverted closure was observed for seromuscular PSS, seromuscular OTSC, and surgical suture. The mean leak pressure was 13.7 and 24.8 mmHg in the PSS and OTSC group, respectively (P < 0.01). The mean procedure time was 541 and 169 s in the PSS and OTSC group, respectively (P < 0.01). Complete inverted closure was observed in OTSC alone. CONCLUSION The OTSC, which allows complete inverted closure, showed greater closure strength than PSS. Considering the size limitation suitable for single OTSC, a therapeutic strategy for closing the larger size is further warranted.
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17
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Gu L, Wu Y, Yi J, Ouyang M, Liu X. Comparison of endoscopic full-thickness resection and ligation-assisted endoscopic full-thickness resection for small (≤ 1.5 cm) gastric subepithelial tumors originating from muscularis propria. Surg Endosc 2023. [PMID: 36690893 DOI: 10.1007/s00464-023-09881-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/08/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND In the treatment of small gastric subepithelial tumors originating from muscularis propria (SET-MPs), endoscopic full-thickness resection (EFTR) has been an effective procedure and ligation-assisted EFTR (EFTR-L) seems a feasible and promising operation. We aimed to compare the therapeutic outcomes of EFTR-L and EFTR to evaluate effect and safety of either method in the treatment of small (≤ 1.5 cm) gastric SET-MPs. METHODS Between January 2018 to May 2022, we retrospectively enrolled a total of 119 patients with gastric SET-MPs treated by EFTR-L (79 patients) or EFTR (40 patients) at Xiangya Hospital Central South University. Clinical characteristics, operation efficacy, adverse events (AEs), and operation cost were compared between the 2 groups. Univariate and multiple logistic and linear regressions were applied to analyze the therapeutic outcomes of the procedure, and covariates were adjusted in the multiple analysis. RESULTS The operation time of EFTR-L group (16.34 ± 5.75 min) was significantly shorter than EFTR group (51.23 ± 21.21 min, P < 0.001), and the difference remained significant after adjusting the covariates (adjusted mean difference, 30.56; 95% confidence interval, 25.65-35.47; P < 0.001). The operation cost of EFTR-L group was lower than EFTR group (1268.52 ± 457.22 vs 1643.18 ± 295.08 $; P < 0.001). The complete resection rate of the EFTR-L group was 98.72% and of the EFTR group 100%. The incidence of abdominal pain in the EFTR-L group (5.06%) was lower than in the EFTR group (27.50%, P = 0.008). A patient in the EFTR group underwent severe pneumoperitoneum and received abdominocentesis during operation. One case of peritonitis occurred in the EFTR-L group but recovered from intensified antibiotic therapy. No delayed blood or perforation occurred. CONCLUSIONS Compared to EFTR, EFTR-L might be a feasible procedure for small (≤ 1.5 cm) gastric SET-MPs due to the acceptable efficacy, shorter operation time, and lower cost.
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18
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Kim GE, Kothari S, Siddiqui UD. Nontunneling Full Thickness Techniques for Neoplasia. Gastrointest Endosc Clin N Am 2023; 33:155-168. [PMID: 36375880 DOI: 10.1016/j.giec.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Colorectal cancer is the third most common cancer worldwide and the fourth leading cause of cancer-related deaths in the world, second in the United States. Although most lesions are managed surgically especially when they have already invaded into the submucosal layer, endoscopic full-thickness resection (EFTR) has become an emerging technique that can serve as a safe and effective alternative management for locally invasive gastrointestinal cancers. This article discusses the indications and various techniques and limitations of nontunneled EFTRs of gastrointestinal cancer and reviews the current literature on the outcomes of EFTR.
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Affiliation(s)
- Grace E Kim
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, 15841 South Maryland Avenue MC4076, Chicago, IL 60637, USA.
| | - Shivangi Kothari
- Division of Gastroenterology/Hepatology, University of Rochester Medical Center & Strong Memorial Hospital, 2601 Elmwood Avenue, Box 646, Rochester, NY 14642, USA
| | - Uzma D Siddiqui
- Section of Gastroenterology, Hepatology, and Nutrition, Center for Endoscopic Research and Therapeutics and Advanced Endoscopy Training, University of Chicago, 35700 South Maryland Avenue MC 8043, Chicago, IL 60637, USA
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19
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Zwager LW, Moons LMG, Farina Sarasqueta A, Laclé MM, Albers SC, Hompes R, Peeters KCMJ, Bekkering FC, Boonstra JJ, Ter Borg F, Bos PR, Bulte GJ, Gielisse EAR, Hazen WL, Ten Hove WR, Houben MHMG, Mundt MW, Nagengast WB, Perk LE, Quispel R, Rietdijk ST, Rando Munoz FJ, de Ridder RJJ, Schwartz MP, Schreuder RM, Seerden TCJ, van der Sluis H, van der Spek BW, Straathof JWA, Terhaar Sive Droste JS, Vlug MS, van de Vrie W, Weusten BLAM, de Wijkerslooth TD, Wolters HJ, Fockens P, Dekker E, Bastiaansen BAJ. Long-term oncological outcomes of endoscopic full-thickness resection after previous incomplete resection of low-risk T1 CRC (LOCAL-study): study protocol of a national prospective cohort study. BMC Gastroenterol 2022; 22:516. [PMID: 36513968 DOI: 10.1186/s12876-022-02591-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND T1 colorectal cancer (CRC) without histological high-risk factors for lymph node metastasis (LNM) can potentially be cured by endoscopic resection, which is associated with significantly lower morbidity, mortality and costs compared to radical surgery. An important prerequisite for endoscopic resection as definite treatment is the histological confirmation of tumour-free resection margins. Incomplete resection with involved (R1) or indeterminate (Rx) margins is considered a strong risk factor for residual disease and local recurrence. Therefore, international guidelines recommend additional surgery in case of R1/Rx resection, even in absence of high-risk factors for LNM. Endoscopic full-thickness resection (eFTR) is a relatively new technique that allows transmural resection of colorectal lesions. Local scar excision after prior R1/Rx resection of low-risk T1 CRC could offer an attractive minimal invasive strategy to achieve confirmation about radicality of the previous resection or a second attempt for radical resection of residual luminal cancer. However, oncologic safety has not been established and long-term data are lacking. Besides, surveillance varies widely and requires standardization. METHODS/DESIGN In this nationwide, multicenter, prospective cohort study we aim to assess feasibility and oncological safety of completion eFTR following incomplete resection of low-risk T1 CRC. The primary endpoint is to assess the 2 and 5 year luminal local tumor recurrence rate. Secondary study endpoints are to assess feasibility, percentage of curative eFTR-resections, presence of scar tissue and/or complete scar excision at histopathology, safety of eFTR compared to surgery, 2 and 5 year nodal and/or distant tumor recurrence rate and 5-year disease-specific and overall-survival rate. DISCUSSION Since the implementation of CRC screening programs, the diagnostic rate of T1 CRC is steadily increasing. A significant proportion is not recognized as cancer before endoscopic resection and is therefore resected through conventional techniques primarily reserved for benign polyps. As such, precise histological assessment is often hampered due to cauterization and fragmentation and frequently leads to treatment dilemmas. This first prospective trial will potentially demonstrate the effectiveness and oncological safety of completion eFTR for patients who have undergone a previous incomplete T1 CRC resection. Hereby, substantial surgical overtreatment may be avoided, leading to treatment optimization and organ preservation. Trial registration Nederlands Trial Register, NL 7879, 16 July 2019 ( https://trialregister.nl/trial/7879 ).
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Affiliation(s)
- L W Zwager
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - L M G Moons
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Farina Sarasqueta
- Department of Pathology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - M M Laclé
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S C Albers
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - R Hompes
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - K C M J Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - F C Bekkering
- Department of Gastroenterology and Hepatology, IJsselland Hospital, Capelle Aan Den Ijssel, The Netherlands
| | - J J Boonstra
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - F Ter Borg
- Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands
| | - P R Bos
- Department of Gastroenterology and Hepatology, Gelderse Vallei, Ede, The Netherlands
| | - G J Bulte
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E A R Gielisse
- Department of Gastroenterology and Hepatology, Rode Kruis Hospital, Beverwijk, The Netherlands
| | - W L Hazen
- Department of Gastroenterology and Hepatology, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - W R Ten Hove
- Department of Gastroenterology and Hepatology, Alrijne Medical Group, Leiden, The Netherlands
| | - M H M G Houben
- Department of Gastroenterology and Hepatology, Haga Teaching Hospital, the Hague, The Netherlands
| | - M W Mundt
- Department of Gastroenterology and Hepatology, Flevoziekenhuis, Almere, The Netherlands
| | - W B Nagengast
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | - L E Perk
- Department of Gastroenterology and Hepatology, Haaglanden Medical Center, The Hague, The Netherlands
| | - R Quispel
- Department of Gastroenterology and Hepatology, Reinier de Graaf, Delft, The Netherlands
| | - S T Rietdijk
- Department of Gastroenterology and Hepatology, OLVG, Amsterdam, The Netherlands
| | - F J Rando Munoz
- Department of Gastroenterology and Hepatology, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - R J J de Ridder
- Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M P Schwartz
- Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands
| | - R M Schreuder
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
| | - T C J Seerden
- Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands
| | - H van der Sluis
- Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands
| | - B W van der Spek
- Department of Gastroenterology and Hepatology, Noordwest Hospital Group, Alkmaar, The Netherlands
| | - J W A Straathof
- Department of Gastroenterology and Hepatology, Màxima Medical Center, Veldhoven, The Netherlands
| | - J S Terhaar Sive Droste
- Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, S' Hertogenbosch, The Netherlands
| | - M S Vlug
- Department of Gastroenterology and Hepatology, Dijklander Hospital, Hoorn, The Netherlands
| | - W van de Vrie
- Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - B L A M Weusten
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - T D de Wijkerslooth
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - H J Wolters
- Department of Gastroenterology and Hepatology, Martini Hospital, Groningen, The Netherlands
| | - P Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - E Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - B A J Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands. .,Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands. .,Cancer Center Amsterdam, Amsterdam, The Netherlands.
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20
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Høgh A, Deding U, Bjørsum-Meyer T, Buch N, Baatrup G. Endoscopic full-thickness resection (eFTR) in colon and rectum: indications and outcomes in the first 37 cases in a single center. Surg Endosc 2022; 36:8195-8201. [PMID: 35536486 DOI: 10.1007/s00464-022-09263-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/09/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Segmental resection of the colon or rectum for cancer is major surgery with substantial procedure-related morbidity and mortality. A steep increase in the frequency of early cancer and advanced adenoma detection has been evident these late years. Introducing more minimal invasive resection techniques may decrease procedure-related complications and mortality. We aimed to describe the results from introducing endoscopic full-thickness resection (eFTR) in a unit specialized in advanced endoscopic resection of colon neoplasias. Primary outcomes were R0 resection rate and complications. METHODS endoscopic full-thickness resection was introduced in our unit in 2017. Patients were referred for eFTR based on indications: (i) completion of resection after unexpected cancer, (ii) suspicion of or clinically confirmed early cancer (T1) without signs of dissemination, or (iii) adenomas not suitable for other endoscopic resection techniques due to difficult position or recurrence. Data on eFTR procedures and follow-up were retrieved from patient journals. RESULTS Thirty-seven eFTR procedures were commenced in the period of March 2017 until June 2020, and one of these was abandoned. The overall R0 resection rate was 83.3%. In subgroups of indications i-iii, it was 87.5, 80.0, and 80.0%, respectively. Three perforations and one case of late bleeding occurred. One patient died within 30 days due to late perforation. Six technical failures were evident including operator-induced failures. Five of the technical failures occurred in the first half of the procedures indicating the learning curve of the endoscopist. CONCLUSION Implementation of the eFTR procedure has been largely successful, especially in patients referred for completion of resection after unexpected cancer. Complication rates were acceptable, and the technique and quality increased significantly during the study. Careful selection of patients for eFTR is crucial for achieving successful resection. Size and position of lesion seem more important than indication. eFTR is not effective for lesions > 30 mm.
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Affiliation(s)
- Anders Høgh
- Department of Surgery, Odense University Hospital, Svendborg, Denmark.
| | - Ulrik Deding
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Thomas Bjørsum-Meyer
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Niels Buch
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
| | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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21
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Wang YP, Xu H, Shen JX, Liu WM, Chu Y, Duan BS, Lian JJ, Zhang HB, Zhang L, Xu MD, Cao J. Predictors of difficult endoscopic resection of submucosal tumors originating from the muscularis propria layer at the esophagogastric junction. World J Gastrointest Surg 2022; 14:918-929. [PMID: 36185554 PMCID: PMC9521476 DOI: 10.4240/wjgs.v14.i9.918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/05/2022] [Accepted: 08/18/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Endoscopic resection approaches, including endoscopic submucosal dissection (ESD), submucosal tunneling endoscopic resection (STER) and endoscopic full-thickness resection (EFTR), have been widely used for the treatment of submucosal tumors (SMTs) located in the upper gastrointestinal tract. However, compared to SMTs located in the esophagus or stomach, endoscopic resection of SMTs from the esophagogastric junction (EGJ) is much more difficult because of the sharp angle and narrow lumen of the EGJ. SMTs originating from the muscularis propria (MP) in the EGJ, especially those that grow extraluminally and adhere closely to the serosa, make endoscopic resection even more difficult.
AIM To investigate the predictors of difficult endoscopic resection for SMTs from the MP layer at the EGJ.
METHODS A total of 90 patients with SMTs from the MP layer at the EGJ were included in the present study. The difficulty of endoscopic resection was defined as a long procedure time, failure of en bloc resection and intraoperative bleeding. Clinicopathological, endoscopic and follow-up data were collected and analyzed. Statistical analysis of independent risks for piecemeal resection, long operative time, and intraoperative bleeding were assessed using univariate and multivariate analyses.
RESULTS According to the location and growth pattern of the tumor, 44 patients underwent STER, 14 patients underwent EFTR, and the remaining 32 patients received a standard ESD procedure. The tumor size was 20.0 mm (range 5.0–100.0 mm). Fourty-seven out of 90 lesions (52.2%) were regularly shaped. The overall en bloc resection rate was 84.4%. The operation time was 43 min (range 16–126 min). The intraoperative bleeding rate was 18.9%. There were no adverse events that required therapeutic intervention during or after the procedures. The surgical approach had no significant correlation with en bloc resection, long operative time or intraoperative bleeding. Large tumor size (≥ 30 mm) and irregular tumor shape were independent predictors for piecemeal resection (OR: 7.346, P = 0.032 and OR: 18.004, P = 0.029, respectively), long operative time (≥ 60 min) (OR: 47.330, P = 0.000 and OR: 6.863, P = 0.034, respectively) and intraoperative bleeding (OR: 20.631, P = 0.002 and OR: 19.020, P = 0.021, respectively).
CONCLUSION Endoscopic resection is an effective treatment for SMTs in the MP layer at the EGJ. Tumors with large size and irregular shape were independent predictors for difficult endoscopic resection.
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Affiliation(s)
- Yu-Ping Wang
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
- Endoscopy Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350004, Fujian Province, China
| | - Hong Xu
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
- Department of Gastroenterology and Hepatology, Hangzhou Red Cross Hospital, Hangzhou 310003, Zhejiang Province, China
| | - Jia-Xin Shen
- Endoscopy Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350004, Fujian Province, China
| | - Wen-Ming Liu
- Endoscopy Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350004, Fujian Province, China
| | - Yuan Chu
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Ben-Song Duan
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Jing-Jing Lian
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Hai-Bin Zhang
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Li Zhang
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Mei-Dong Xu
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Jia Cao
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
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22
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Fang H, Yao T, Chen Y, Lu Y, Xiong K, Su Y, Zhang Y, Wang Y, Zhang L. An innovative endoscopic management strategy for postoperative fistula after laparoscopic sleeve gastrectomy. Surg Endosc 2022; 36:6439-6445. [PMID: 35102432 DOI: 10.1007/s00464-021-08992-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Postoperative fistula is a life-threatening complication that lacks a standard treatment strategy after laparoscopic sleeve gastrectomy (LSG). This observational study is the first to report the efficacy and safety of endoscopic full-thickness resection (EFTR) combined with purse-string sutures in treating this complication. PATIENTS AND METHODS The old fistula was resected by EFTR, cut radially, and then sutured with a purse-string. The primary endpoint was complete fistula closure within two months. Endoscopic procedure-related complications were also recorded. RESULTS Eight of 788 LSG patients developed fistulas with an incidence of 1.01%, primarily under the gastroesophageal junction, and the average distance from the center of the fistula to the cardia was 30 ± 6.3 mm. Two patients were cured by conservative treatment, and six received endoscopic sutures. The time from LSG to fistula diagnosis was 12.3 ± 14.4 days. The time from fistula diagnosis to endoscopic repair was 43.8 ± 55.8 days and 21.4 ± 10.0 days after eliminating the data of first case. The average fistula size was 12 ± 10 mm, the average endoscopic procedure duration was 40 ± 16 min, and the average number of endoscopic procedures required was 1.6 ± 0.8. Five patients achieved the primary endpoint, and one patient refused a third endoscopic suture after two sutures. The endoscopy success rate was 83.3%. No endoscopic procedure-related complications occurred. CONCLUSIONS EFTR combined with purse-string sutures is an innovative, safe, and effective endoscopic strategy for postoperative fistula after LSG, avoiding reoperation and allowing early oral feeding.
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Affiliation(s)
- Haiming Fang
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Tingting Yao
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yating Chen
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yan Lu
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Kangwei Xiong
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yuan Su
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yujue Zhang
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yong Wang
- Department of General and Bariatric Surgery, the Second Hospital of Anhui Medical University, Hefei, Anhui, China.
| | - Lijiu Zhang
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China.
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China.
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23
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McKechnie T, Govind S, Lee J, Lee Y, Hong D, Eskicioglu C. Endoscopic Full-Thickness Resection for Colorectal Lesions: A Systematic Review and Meta-Analysis. J Surg Res 2022; 280:440-449. [PMID: 36054955 DOI: 10.1016/j.jss.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/07/2022] [Accepted: 07/28/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Endoscopic full-thickness resection (EFTR) with an over-the-scope full-thickness resection device is a relatively new technique for the resection of colorectal lesions. Multiple centers have published the results of case series and observational cohorts regarding the use of this technique for managing difficult polyps. This study aims to aggregate the results of these studies to determine the effectiveness and safety of this technique in the resection of these technically challenging colonic lesions. METHODS MEDLINE, EMBASE, and CENTRAL were searched. Articles were included if they reported technical success rate for EFTR of colonic lesions. The primary outcome was technical success rate and secondary outcomes included rate of R0 resection and overall 30-d morbidity. DerSimonian and Laird random-effects meta-analysis of proportions was used to generate effect sizes for pooled outcomes. RESULTS From 2211 citations, 21 studies with 1539 patients (mean age 67.2 y, 39.5% female) undergoing 1551 procedures were included. Difficult to resect benign lesions were the most commonly excised lesions (hyperplastic: 35.9%; adenomas: 30.2%), followed by T1 adenocarcinomas (25.6%) and neuroendocrine tumors (6.1%). Technical success rate was 89% (95% confidence interval [CI] 87-92), and R0 resection rate was 79% (95% CI 76-82). Mean procedure time was 53.5 min and mean specimen size was 17.5 mm. Overall 30-d morbidity was 11% (95% CI 7-13), and incidences of perforation and postpolypectomy bleeding were 2% (95% CI 1-2) and 5% (95% CI 3-7), respectively. Lesion recurrence at 3-mo follow-up was 8%. CONCLUSIONS EFTR requires further large sample size, comparative studies with reporting of long-term oncologic data. However, preliminary findings indicate that it is a safe and effective technique with high rates of technical success and acceptable rates of R0 resection when employed by experienced endoscopists for high-risk colonic lesions.
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Affiliation(s)
- Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Shaylan Govind
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jay Lee
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
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24
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Abstract
Endoscopic resection is first-line therapy in the management of superficial neoplasms throughout the gastrointestinal tract, as well as an increasingly viable therapeutic alternative in the resection of selected small deep lesions throughout the upper and lower gastrointestinal tract. The mainstay of therapy has traditionally been endoscopic snare polypectomy and endoscopic mucosal resection. However, recent innovative advancements in therapeutic endoscopy have provided for the ability to resect large superficial lesions and selected subepithelial lesions in en bloc and margin-negative fashion. In this review, we discuss the current state of the art in advanced endoscopic resection techniques including endoscopic submucosal dissection and endoscopic full-thickness resection.
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Affiliation(s)
- Phillip S Ge
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1466, Houston, TX, 77030-4009, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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25
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Hayat M, Azeem N, Bilal M. Colon Polypectomy with Endoscopic Submucosal Dissection and Endoscopic Full-Thickness Resection. Gastrointest Endosc Clin N Am 2022; 32:277-298. [PMID: 35361336 DOI: 10.1016/j.giec.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endoscopic resection has become the gold standard for the management of most of the large colorectal polyps. Various endoscopic resection techniques include endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and endoscopic full-thickness resection (EFTR). ESD is a minimally invasive method for the resection of advanced lesions in the gastrointestinal (GI) tract to achieve en-bloc resection. While, EFTR is more commonly used in lesions with suspected deeper submucosal invasion, lesions originating from muscularis propria, or those with advanced fibrosis. This article reviews the indications, technique, and adverse events for use of ESD and EFTR in the colon.
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Affiliation(s)
- Maham Hayat
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, 800 Stanton L Young Boulevard, Oklahoma City, OK 73104, USA
| | - Nabeel Azeem
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN 55455, USA
| | - Mohammad Bilal
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN 55455, USA; Advanced Endoscopy, Division of Gastroenterology & Hepatology, Minneapolis Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417, USA.
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26
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Li FY, Zhang XL, Zhang QD, Wang YH. Successful treatment of an enormous rectal mucosa-associated lymphoid tissue lymphoma by endoscopic full-thickness resection: A case report. World J Gastroenterol 2022; 28:1078-1084. [PMID: 35431493 PMCID: PMC8968516 DOI: 10.3748/wjg.v28.i10.1078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/15/2021] [Accepted: 12/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colorectal mucosa-associated lymphoid tissue lymphoma (MALToma), a rare kind of nongastric MALToma, lacks consensus on its endoscopic features and standard therapies. According to previous studies on the clinical characteristics and outcomes of colorectal MALToma, endoscopic resection remains a good therapeutic strategy.
CASE SUMMARY A 71-year-old woman suffered intermittent hematochezia for 1 mo, accompanied with abdominal pains but without weight loss, fever, chills or fatigue. Colonoscopy showed a massive hemispheric mass with rough and hyperemic mucosa in the lower rectum. Narrow-band imaging magnifying endoscopy detected some branching abnormal blood vessels and disappearance of glandular structure, which was similar with the tree-like appearance sign in gastric MALToma. Endoscopic ultrasonography revealed the lesion to be hypoechoic, boundary-defined, and echo uniform inside, originating from the muscularis propria. Abdominal enhanced computed tomography (CT) demonstrated a soft tissue mass with defined boundary. No enlarged superficial lymph nodes were detected by B-mode ultrasound. C13-urea breath test and serum Helicobacter pylori antibody were both negative. The patient underwent endoscopic full-thickness resection. Postoperative pathological analysis indicated colorectal MALToma. The patient remained asymptomatic after discharge, and follow-up positron emission tomography–CT and colonoscopy showed no residual lesion, remnants or lymph node metastasis.
CONCLUSION This case provides new information on the specific endoscopic features of colorectal MALToma and an alternative treatment for patients.
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Affiliation(s)
- Fang-Yuan Li
- Digestive Endoscopy Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of TCM, Nanjing 210046, Jiangsu Province, China
| | - Xiao-Long Zhang
- Digestive Endoscopy Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of TCM, Nanjing 210046, Jiangsu Province, China
| | - Qi-De Zhang
- Digestive Endoscopy Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of TCM, Nanjing 210046, Jiangsu Province, China
| | - Yao-Hui Wang
- Department of Pathology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of TCM, Nanjing 210046, Jiangsu Province, China
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27
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Granata A, Martino A, Zito FP, Ligresti D, Amata M, Lombardi G, Traina M. Exposed endoscopic full-thickness resection for duodenal submucosal tumors: Current status and future perspectives. World J Gastrointest Endosc 2022; 14:77-84. [PMID: 35316982 PMCID: PMC8908326 DOI: 10.4253/wjge.v14.i2.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/31/2021] [Accepted: 01/14/2022] [Indexed: 02/06/2023] Open
Abstract
Exposed endoscopic full-thickness resection (EFTR), with or without laparoscopic assistance, is an emergent natural orifice transluminal endoscopic surgery technique with promising safety and efficacy for the management of gastrointestinal submucosal tumors (SMTs) arising from the muscularis propria (MP), especially of the gastric wall. To date, evidence concerning duodenal exposed EFTR is lacking, mainly due to both the technical difficulty involved because of the special duodenal anatomy and concerns about safety and effectiveness of transmural wall defect closure. However, given the non-negligible morbidity and mortality associated with duodenal surgery, the recent availability of dedicated endoscopic tools for tissue-approximation capable to realize full-thickness defect closure could help in promoting the adoption of this endosurgical technique among referral centers. The aim of our study was to review the current evidence concerning exposed EFTR with or without laparoscopic assistance for the treatment of MP-arising duodenal SMTs.
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Affiliation(s)
- Antonino Granata
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo 90127, Italy
| | - Alberto Martino
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Francesco Paolo Zito
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Dario Ligresti
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo 90127, Italy
| | - Michele Amata
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo 90127, Italy
| | - Giovanni Lombardi
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Mario Traina
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo 90127, Italy
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28
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Li J, Wang QQ, Xue S, Zhang YY, Xu QY, Zhang XH, Feng L. Gastric submucosal lesion caused by an embedded fish bone: A case report. World J Clin Cases 2022; 10:1099-1105. [PMID: 35127925 PMCID: PMC8790457 DOI: 10.12998/wjcc.v10.i3.1099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/01/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Submucosal tumors (SMTs) refer to elevated lesions that originate from the layers below the mucosa of the digestive tract, including the muscularis, submucosa and muscularis propria. With the development and application of endoscopy and endoscopic ultrasonography (EUS), the detection rate of SMTs has increased significantly in recent years. Various diseases can lead to SMTs. However, a foreign body embedded in the gastric antrum showing clinical manifestations of a SMT is rare.
CASE SUMMARY We report the case of a 47-year-old woman, who presented with upper abdominal discomfort for one year, and was subsequently diagnosed with a gastric submucosal lesion caused by an embedded foreign body by EUS and computed tomography. Considering the size and potential complications of this lesion, endoscopic full-thickness resection was performed to achieve full resection in our endoscopy center. A fish bone was found in the lesion during the operation, and was successfully removed, and the defect was later closed with endoscopic purse-string sutures.
CONCLUSION This case report highlights the management strategies of SMTs, the importance of being familiar with diagnostic methods related to submucosal lesions, and being able to conduct effective treatment when this rare condition is highly suspected.
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Affiliation(s)
- Jian Li
- Endoscopy Center, Minhang Hospital, Fudan University, Shanghai 201100, China
| | - Qiu-Qiu Wang
- Endoscopy Center, Minhang Hospital, Fudan University, Shanghai 201100, China
| | - Shuai Xue
- Endoscopy Center, Minhang Hospital, Fudan University, Shanghai 201100, China
| | - Yan-Yan Zhang
- Endoscopy Center, Minhang Hospital, Fudan University, Shanghai 201100, China
| | - Qin-Yu Xu
- Endoscopy Center, Minhang Hospital, Fudan University, Shanghai 201100, China
| | - Xiao-Hong Zhang
- Endoscopy Center, Minhang Hospital, Fudan University, Shanghai 201100, China
| | - Li Feng
- Endoscopy Center, Minhang Hospital, Fudan University, Shanghai 201100, China
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Wang C, Wang BQ, Li TT, Wang JL, Sun GB. Clinical application of "suspension method" in endoscopic full-thickness resection for muscularis propria tumors of the gastric fundus. Shijie Huaren Xiaohua Zazhi 2022; 30:43-48. [DOI: 10.11569/wcjd.v30.i1.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND With the development of endoscopic technology, clinicians often use endoscopic full-thickness resection (EFTR) for the treatment of gastric muscularis propria tumors, but traditional methods have many disadvantages for gastric fundus submucosal tumors. Using suspension method to assist EFTR can solve the disadvantages of traditional methods, but there are few clinical studies on its efficacy and safety.
AIM To investigate the clinical value of "suspension method" in EFTR for muscularis propria tumors of the gastric fundus.
METHODS A retrospective analysis was performed on the clinical data of 22 patients with muscularis propria tumors in the gastric fundus who underwent EFTR at the Gastroenterology Department of Tianjin Fifth Central Hospital from August 2017 to June 2021. According to the surgical method used, the patients were divided into a traditional EFTR group and a modified "suspension method" + EFTR group. Operative time, intraoperative bleeding, wound suture time, and hospital stay were compared between the two groups.
RESULTS The operative time, intraoperative bleeding, and wound suture time in the modified "suspension method" + EFTR group were significantly lower than those in the traditional EFTR group (P < 0.05).
CONCLUSION "Suspension method" combined with EFTR can shorten the operation time and wound suture time, and decrease the intraoperative bleeding. It is a safe, feasible, and effective method for the treatment of muscularis propria tumors of the gastric fundus, and is suitable for clinical application.
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Affiliation(s)
- Chao Wang
- Department of Gastroenterology, The Fifth Central Hospital of Tianjin, Tianjin 300450, China
| | - Bai-Qing Wang
- Department of Gastroenterology, The Fifth Central Hospital of Tianjin, Tianjin 300450, China
| | - Tian-Tian Li
- Department of Gastroenterology, The Fifth Central Hospital of Tianjin, Tianjin 300450, China
| | - Jue-Lei Wang
- Department of Gastroenterology, The Fifth Central Hospital of Tianjin, Tianjin 300450, China
| | - Guang-Bin Sun
- Department of Gastroenterology, The Fifth Central Hospital of Tianjin, Tianjin 300450, China
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Goto O, Kaise M, Iwakiri K. What's New with Endoscopic Treatments for Early Gastric Cancer in the "Post-ESD Era"? Digestion 2022; 103:92-98. [PMID: 34518449 DOI: 10.1159/000518892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/05/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopic treatments for gastric cancers have still been progressing even after the great success of endoscopic submucosal dissection (ESD). SUMMARY In further advancements of ESD, safe and less-invasive procedures are challenged by managing postoperative bleeding, one of the major adverse events in ESD. Covering the mucosal defect after removal of lesions appears reasonable and effective for preventing delayed bleeding from the post-ESD ulcers. Shielding with biodegradable sheets is attempted on clinical trials, which show equivocal results. Although suturing of the mucosal rims is technically challenging, pilot studies demonstrate favorable outcomes for avoiding post-ESD bleeding even in cases at high risk. In cases after noncurative resection of ESD, the selection of patients who truly require additional gastrectomy with lymph node dissection is important to provide necessary surgery. Risk stratification of lymph node metastases and surgery has been developed, which offers tailor-made management to each patient considering the risks and benefits. In surgery, function-preserving gastrectomy to minimize the resection area in both lymphadenectomy and the primary site is clinically introduced. The sentinel node navigation surgery is promising to realize the minimally invasive gastrectomy, and it should strongly fit ESD as well as laparoscopic endoscopic cooperative surgery or endoscopic full-thickness resection, although nonexposure approaches are desirable. Key Message: Development for less-invasive managements on gastric cancer will be continued in step with the advancement of endoscopic treatments.
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Affiliation(s)
- Osamu Goto
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Mitsuru Kaise
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Katsuhiko Iwakiri
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
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Gu L, Wu Y, Yi J, Liu XW. [Current status and research advances on the use of assisted traction technique in endoscopic full-thickness resection]. Zhonghua Wei Chang Wai Ke Za Zhi 2021; 24:1122-1128. [PMID: 34923801 DOI: 10.3760/cma.j.cn441530-20210412-00160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Endoscopic full-thickness resection (EFTR) allows completely resecting deep submucosal tumors (SMTs) in the gastrointestinal wall, which has a broad application prospect in clinic. However, its application and promotion are limited by complex surgical procedures and high surgical risk. Various auxiliary traction techniques are expected to reduce the operation difficulty and risk of EFTR and improve its operative success rate. To provide a reference for clinicians, we summarize various auxiliary traction techniques in EFTR in this article. The clip-with-line method is simple to operate and widely used, whereas its traction is limited and there is a risk of clip falling off. The snare traction method and the clip-snare traction method has advantage of large traction force, but its thrust is affected by the hardness of snare. The traction point of the grasping forceps traction method is flexible and easy to adjust. Nevertheless, it requires the use of a dual-channel upper endoscope, which is difficult to operate. The transparent cap traction method and the full-thickness resection device traction method takes a short time and is easy to promote, whereas the resectable lesion is limited, and the size of the lesion may affect the success rate. In contrast, the suture loop needle-T-tag tissue anchors assisted method has a large resection range, but the operation is complicated and the feasibility has not been verified. The robot-assisted method has flexible operation and excellent visualization, whereas it is expensive and difficult to operate. There is no report of the application of magnetic anchor technology in EFTR, but it may have good application prospects in the auxiliary traction of EFTR.
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Affiliation(s)
- L Gu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease, Changsha 410008, China
| | - Y Wu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease, Changsha 410008, China
| | - J Yi
- Department of Gastroenterology, Xiangya Hospital, Central South University, Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease, Changsha 410008, China
| | - X W Liu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease, Changsha 410008, China
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Wei Y, Zhou Q, Ji M, Zhang S, Li P. Over-the-scope clip-assisted endoscopic full-thickness resection has potential to treat complex nonampullary duodenal lesions: a single-center case series. BMC Gastroenterol 2021; 21:476. [PMID: 34911448 PMCID: PMC8675504 DOI: 10.1186/s12876-021-02068-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/13/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND AIMS The duodenum is considered a challenging area for the endoscopic resection of lesions. This study aimed to evaluate the efficacy and safety of over-the-scope clip (OTSC)-assisted endoscopic full-thickness resection (EFTR) for complex nonampullary duodenal lesions unsuitable for conventional resection techniques. METHODS AND PATIENTS We conducted a retrospective case review of 13 consecutive patients with complex nonampullary duodenal tumors that were unsuitable for conventional resection techniques; these patients underwent EFTR assisted with OTSC at Beijing Friendship Hospital, Capital Medical University from September 2015 to September 2020. The OTSC device was placed, and tumors were resected after the lesions were identified. Data were abstracted for demographics, lesion features, histopathologic diagnoses, technical success rates, complete resection (R0 resection) rates, and complications. RESULTS Thirteen patients with duodenal lesions (6 adenomas and 7 submucosal tumors with nonlifting signs, incomplete lifting signs, difficult locations, failed ESD/EMR attempts or suspected origin in the muscularis propria) subjected to EFTR were included. The sizes of all the lesions evaluated by endoscopy were smaller than 20 mm, and most of them (84.6%, 11/13) were smaller than 12 mm. All 13 applications of the clips, endoscopic resection and full-thickness resection were successful (13/13, 100%). Complete resection was achieved in 12 patients (12/13, 92.3%). There were no immediate or delayed complications, including bleeding, infection and perforation. CONCLUSIONS OTSC -assisted EFTR appears to be effective and safe for complex nonampullary duodenal lesions smaller than 20 mm (particularly those ≤ 10-12 mm) that are unsuitable for conventional resection techniques.
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Affiliation(s)
- Yongqiu Wei
- Department of Gastroenterology, Beijing Friendship Hospital, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing, 10050, China
| | - Qiaozhi Zhou
- Department of Gastroenterology, Beijing Friendship Hospital, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing, 10050, China
| | - Ming Ji
- Department of Gastroenterology, Beijing Friendship Hospital, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing, 10050, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing, 10050, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing, 10050, China.
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Granata A, Martino A, Ligresti D, Zito FP, Amata M, Lombardi G, Traina M. Closure techniques in exposed endoscopic full-thickness resection: Overview and future perspectives in the endoscopic suturing era. World J Gastrointest Surg 2021; 13:645-654. [PMID: 34354798 PMCID: PMC8316845 DOI: 10.4240/wjgs.v13.i7.645] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/29/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023] Open
Abstract
Exposed endoscopic full-thickness resection (EFTR) without laparoscopic assistance is a minimally invasive natural orifice transluminal endoscopic surgery technique that is emerging as a promising effective and safe alternative to surgery for the treatment of muscularis propria-originating gastric submucosal tumors. To date, various techniques have been used for the closure of the transmural post-EFTR defect, mainly consisting in clip- and endoloop-assisted closure methods. However, the recent advent of dedicated tools capable of providing full-thickness defect suture could further improve the efficacy and safety of the exposed EFTR procedure. The aim of our review was to evaluate the efficacy and safety of the different closure methods adopted in gastric-exposed EFTR without laparoscopic assistance, also considering the recent advent of flexible endoscopic suturing.
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Affiliation(s)
- Antonino Granata
- Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo 90127, Italy
| | - Alberto Martino
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Dario Ligresti
- Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo 90127, Italy
| | - Francesco Paolo Zito
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Michele Amata
- Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo 90127, Italy
| | - Giovanni Lombardi
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Mario Traina
- Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo 90127, Italy
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Lu ZY, Zhao DY. Gastric schwannoma treated by endoscopic full-thickness resection and endoscopic purse-string suture: A case report. World J Gastroenterol 2021; 27:3940-3947. [PMID: 34321856 PMCID: PMC8291012 DOI: 10.3748/wjg.v27.i25.3940] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/02/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Schwannomas, also known as neurinomas, are tumors that derive from Schwann cells. Gastrointestinal schwannomas are extremely rare, but the stomach is the most common site. Gastric schwannomas are usually asymptomatic. Endoscopy and imaging modalities might offer useful preliminary diagnostic information. However, to diagnose schwannoma, the immunohistochemical positivity for S-100 protein is essential, whereas CD117, CD34, SMA, desmin, and DOG-1 are negative.
CASE SUMMARY A 45-year-old female was found to have a gastric mass during a medical examination, which was diagnosed as a gastric schwannoma. We performed endoscopic full-thickness resection and endoscopic purse-string suture. Pathology and immunohistochemical staining confirmed the diagnosis of gastric schwannoma through the positivity of S-100 protein. Furthermore, to exclude the misdiagnosis of gastrointestinal stromal tumor, we performed a mutational detection of the c-Kit and PDGFRA genes. Postoperative follow-up revealed that the patient recovered well.
CONCLUSION Immunohistochemical staining is essential for the diagnosis of schwannoma. Endoscopic full-thickness resection is an effective treatment method for gastric schwannoma.
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Affiliation(s)
- Zhi-Yu Lu
- Departments of Gastroenterology, Institute of Digestive, Southwest Hospital, Army Military Medical University, Chongqing 400038, China
| | - Dun-Yong Zhao
- Departments of Gastroenterology, Institute of Digestive, Southwest Hospital, Army Military Medical University, Chongqing 400038, China
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Falt P, Zapletalová J, Urban O. Endoscopic full-thickness resection versus endoscopic submucosal dissection in the treatment of colonic neoplastic lesions ≤ 30 mm-a single-center experience. Surg Endosc 2021; 36:2062-2069. [PMID: 33860350 PMCID: PMC8847190 DOI: 10.1007/s00464-021-08492-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/28/2021] [Indexed: 02/07/2023]
Abstract
Endoscopic full-thickness resection (FTR) is a novel technique of endoscopic treatment of colorectal neoplastic lesions not suitable for endoscopic polypectomy or mucosal resection. FTR appears to be a reasonable alternative to technically demanding endoscopic submucosal dissection (ESD) for lesions ≤ 30 mm. However, comparison between FTR and ESD has not been published yet and their mutual positioning in the treatment algorithm is still unclear. The purpose of the analysis was to evaluate efficacy and safety of FTR in the treatment of colorectal lesions ≤ 30 mm by comparing prospectively followed FTR cohort to retrospective ESD cohort in the setting of single tertiary endoscopy center. Primary outcomes were technical success rate, R0 resection and curative resection rate, and complication rate. A total of 52 patients in FTR and 50 patients in ESD group were treated between 2015 and 2018. Technical success rate was significantly higher in FTR group (92 vs. 74%, P = 0.01) as well as R0 resection rate (85 vs. 62%, P = 0.01) and curative resection rate (75 vs. 56%, P = 0.01). Complications occurred more frequently in ESD group (40 vs. 13%, P = 0.002), mainly due to high incidence of electrocoagulation syndrome (24 vs. 0%). Total procedure time was substantially shorter in FTR group (26.4 ± 11.0 min vs. estimated 90-240 min). Local residual neoplastic lesions were detected numerically more often in FTR group (12 vs. 5%, P = 0.12). No patient died during follow-up. Compared to ESD, FTR proved significantly higher technical success rate, higher R0 and curative resection rate, and shorter procedure time. In the FTR group, there were significantly less complications but higher incidence of local residual neoplasia. Further research including randomized trials is needed to compare both resection techniques.
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Affiliation(s)
- Přemysl Falt
- University Hospital and Faculty of Medicine, 2nd Department of Internal Medicine, Gastroenterology and Geriatrics, Palacký University, Olomouc, Czech Republic
| | - Jana Zapletalová
- Department of Medical Biophysics, Faculty of Medicine, Palacký University, Olomouc, Czech Republic
| | - Ondřej Urban
- University Hospital and Faculty of Medicine, 2nd Department of Internal Medicine, Gastroenterology and Geriatrics, Palacký University, Olomouc, Czech Republic.
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Guo JT, Zhang JJ, Wu YF, Liao Y, Wang YD, Zhang BZ, Wang S, Sun SY. Endoscopic full-thickness resection using an over-the-scope device: A prospective study. World J Gastroenterol 2021; 27:725-736. [PMID: 33716450 PMCID: PMC7934006 DOI: 10.3748/wjg.v27.i8.725] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/13/2020] [Accepted: 01/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic submucosal dissection to treat mucosal and submucosal lesions sometimes results in low rates of microscopically margin-negative (R0) resection. Endoscopic full-thickness resection (EFTR) has a high R0 resection rate and allows for the definitive diagnosis and treatment of selected mucosal and submucosal lesions that are not suitable for conventional resection techniques.
AIM To evaluate the efficacy and safety of EFTR using an over-the-scope clip (OTSC).
METHODS This prospective, single-center, non-randomized clinical trial was conducted at the endoscopy center of Shengjing Hospital of China Medical University. The study included patients aged 18-70 years who had gastric or colorectal submucosal tumors (SMTs) (≤ 20 mm in diameter) originating from the muscularis propria based on endoscopic ultrasound (EUS) and patients who had early-stage gastric or colorectal cancer (≤ 20 mm in diameter) based on EUS and computed tomography. All lesions were treated by EFTR combined with an OTSC for wound closure between November 2014 and October 2016. We analyzed patient demographics, lesion features, histopathological diagnoses, R0 resection (negative margins) status, adverse events, and follow-up results.
RESULTS A total of 68 patients (17 men and 51 women) with an average age of 52.0 ± 10.5 years (32-71 years) were enrolled in this study, which included 66 gastric or colorectal SMTs and 2 early-stage colorectal cancers. The mean tumor diameter was 12.6 ± 4.3 mm. The EFTR procedure was successful in all cases. The mean EFTR procedure time was 39.6 ± 38.0 min. The mean OTSC defect closure time was 5.0 ± 3.8 min, and the success rate of closure for defects was 100%. Histologically complete resection (R0) was achieved in 67 (98.5%) patients. Procedure-related adverse events were observed in 11 (16.2%) patients. The average post-procedure length of follow-up was 48.2 ± 15.7 mo. There was no recurrence during follow-up.
CONCLUSION EFTR combined with an OTSC is an effective and safe technique for the removal of select subepithelial and epithelial lesions that are not amenable to conventional endoscopic resection techniques.
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Affiliation(s)
- Jin-Tao Guo
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Jing-Jing Zhang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yu-Fan Wu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Ye Liao
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yi-Dan Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Bao-Zhen Zhang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Sheng Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Si-Yu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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Zhao Y, Pang T, Zhang B, Wang L, Lv Y, Ling T, Zhang X, Huang Q, Xu G, Zou X. Retrospective Comparison of Endoscopic Full-Thickness Versus Laparoscopic or Surgical Resection of Small (≤ 5 cm) Gastric Gastrointestinal Stromal Tumors. J Gastrointest Surg 2020; 24:2714-21. [PMID: 31823317 DOI: 10.1007/s11605-019-04493-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/24/2019] [Indexed: 02/07/2023]
Abstract
AIM AND BACKGROUND The aim of this study was to compare the efficacy and safety between endoscopic full-thickness resection (EFR) and laparoscopic or surgical resection methods for gastric gastrointestinal stromal tumor (GIST) in size of 5.0 cm or less. Gastric GISTs are common, and resection is the most effective treatment. METHOD We retrospectively reviewed 216 resections of gastric GISTs in size of up to 5.0 cm at our center from 2009 to 2017.Eligible resection cases were divided into EFR (n = 85), laparoscopic(n = 64), and surgical (n = 67) groups. The clinical records, patient demographic, symptoms, perioperative data, pathological findings, and long-term follow-up outcomes were collected and compared statistically. RESULTS No tumor rupture or recurrence occurred in the three groups. The prevalence of complications was significantly lower in EFR (5.9%) than both laparoscopic (7.8%) and surgical group (16.4%) (P < 0.01). In EFR group, the R0 resection rate (95.3%) was significantly lower than in the laparoscopic group and surgical group (100%) (P < 0.001). The hospital cost (OR = 62.79, CI: 12.954-304.363, P < 0.0001) were significantly lower in the EFR than in the laparoscopic group. The hospital cost (OR = 39.032, CI: 8.045-189.371, P < 0.0001) and post-operative diet time (OR = 2.779, CI: 1.225-6.304, P < 0.05) were also significantly lower in the EFR than in the surgical group. CONCLUSION EFR was a feasible treatment for gastric GISTs of size of ≤ 5.0 cm with an acceptable complete resection rate. In addition, EFR had significantly fewer postoperative complications, shorter length of hospital stay, and lower cost.
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Abstract
Background Ectopic spleen is extremely rare. Most cases are congenital, acquired ectopic spleen may be a consequence of surgery or trauma to the spleen. The ectopic spleen in the gastric wall we reported is even rarer.
Case presentation We report a 41-year-old female patient, with a past history of splenectomy, who presented with heartburn. Gastroscopy revealed a swelling in the fundus in the stomach. Ultrasonography and computed tomographic examination suggested the possibility of gastrointestinal stromal tumor. We performed endoscopic resection of the mass. Pathological examination of the resected mass showed ectopic spleen. Conclusion When a patient with a history of splenectomy presents with a gastric submucosal tumor, ectopic spleen should also be considered in the differential diagnoses. And minimally invasive endoscopic treatment can achieve the purpose of diagnosis and treatment for unobvious submucosal tumors.
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Affiliation(s)
- Linfu Zheng
- Department of Gastroenterology, 900th Hospital of PLA, Oriental Hospital Affiliated to Xiamen University, Fujian Medical University, Fuzhou, 350025, China
| | - Dazhou Li
- Department of Gastroenterology, 900th Hospital of PLA, Oriental Hospital Affiliated to Xiamen University, Fujian Medical University, Fuzhou, 350025, China
| | - Wen Wang
- Department of Gastroenterology, 900th Hospital of PLA, Oriental Hospital Affiliated to Xiamen University, Fujian Medical University, Fuzhou, 350025, China.
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Zhang Y, Peng JB, Mao XL, Zheng HH, Zhou SK, Zhu LH, Ye LP. Endoscopic resection of large (≥ 4 cm) upper gastrointestinal subepithelial tumors originating from the muscularis propria layer: a single-center study of 101 cases (with video). Surg Endosc 2020; 35:1442-1452. [PMID: 32989549 DOI: 10.1007/s00464-020-08033-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Although endoscopic resection (ER) is already established as a minimally invasive technique for small (< 4.0 cm) upper gastrointestinal subepithelial tumors originating from the muscularis propria layer (MP-SETs), published data of ER for large (≥ 4.0 cm) upper gastrointestinal MP-SETs are extremely rare and limited to case reports. This retrospective study aimed to evaluate the feasibility and safety of ER for large (≥ 4.0 cm) upper gastrointestinal MP-SETs in a large case series. METHODS Between June 2012 and December 2018, 101 patients with large (≥ 4 cm) upper gastrointestinal MP-SETs were enrolled in this study. The main outcome measures included complete resection, total complications, and local residual or recurrent tumor. RESULTS The rate of complete resection was 86.1%. Thirteen patients (12.9%) experienced complications including gas-related complications (6/101, 5.9%), localized peritonitis (4/101, 4.0%), esophageal/cardiac mucosal laceration (2/101, 2.0%), and delayed bleeding (1/101, 1.0%). These 13 patients recovered after endoscopic and conservative treatment. The independent risk factor for incomplete resection was tumor size (P = 0.005), and the independent risk factors for total complications were tumor size (P = 0.011) and tumor extraluminal growth (P = 0.037). During the median follow-up of 36 months, local residual tumor was detected in 1 patient. No local recurrence occurred in any patient. CONCLUSIONS Despite being associated with a relatively low complete resection rate, ER is an alternative therapeutic method for large (≥ 4.0 cm) upper gastrointestinal MP-SETs when performed by an experienced endoscopist. This method is especially valuable for patients who are unwilling to undergo surgery.
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Affiliation(s)
- Yu Zhang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang, China
| | - Jin-Bang Peng
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang, China
| | - Xin-Li Mao
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang, China
| | - Hai-Hong Zheng
- Department of Pathology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, Zhejiang, China
| | - Shen-Kang Zhou
- Department of Gastrointestinal Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, Zhejiang, China
| | - Lin-Hong Zhu
- Department of Medical Administration, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - Li-Ping Ye
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang, China.
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Jung AL, Park SW, Hong GY, Moon HC, Eun SJ. Endoscopic Full-Thickness Resection for Gastric Subepithelial Lesions Arising from the Muscularis Propria. Clin Endosc 2020; 54:131-135. [PMID: 32819051 PMCID: PMC7939773 DOI: 10.5946/ce.2020.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/21/2020] [Indexed: 12/17/2022] Open
Abstract
Most cases of gastric subepithelial lesions follow a good clinical course; however, some lesions progress to malignant tumors, and treatment of tumors with a high risk of malignancy is essential. Surgical excision has been the primary treatment for tumors originating from the propria muscle layer, but it has the disadvantages of being invasive and causing postoperative functional abnormalities. With the development of endoscopic techniques and instruments, the role of endoscopic resection, which is a less invasive method for the removal of gastric subepithelial lesions, has been attracting attention. We performed an endoscopic full-thickness resection for 8 patients with gastric subepithelial lesions originating from the muscularis propria. No fatal complications occurred. Our findings suggest the need to develop various devices for resection and closure and to accumulate further experience through additional studies to prevent complications and specimen loss.
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Affiliation(s)
- Ah Lon Jung
- Division of Gastroenterology, Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Sang Wook Park
- Division of Gastroenterology, Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Gun Young Hong
- Division of Gastroenterology, Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Hyeong Chul Moon
- Division of Gastroenterology, Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Seo Joon Eun
- Division of Gastroenterology, Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
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Yu S, Wang XM, Chen X, Xu HY, Wang GJ, Ni N, Sun YX. Endoscopic full-thickness resection to treat active Dieulafoy's disease: A case report. World J Gastroenterol 2020; 26:4557-4563. [PMID: 32874064 PMCID: PMC7438190 DOI: 10.3748/wjg.v26.i30.4557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/06/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND At present, minimally invasive endoscopic treatment is mostly used for patients with actively bleeding Dieulafoy’s lesions, , as it has the advantages of minimal trauma, short operation time and good hemostatic effect, although bleeding can easily recur postoperatively. Recently, extensive gastric cuneiform resection has been advocated for use in these patients because the constant-diameter artery follows a long path to the gastric mucosa.
CASE SUMMARY A 47-year-old man was admitted to the hospital for repeated hematemesis and black stool, and he was diagnosed with Dieulafoy’s disease. We chose a method that not only simulates surgical gastric cuneiform resection but also reduces trauma. We performed enlarged local endoscopic full-thickness resection of the gastric wall and abdominal constant-diameter artery and sutured the gastric wall. Postoperative follow-up showed that the constant-diameter artery had been resected from the gastric wall, which was confirmed to have no blood flow signals by endoscopic ultrasonography.
CONCLUSION Endoscopic full-thickness resection of the gastric wall and abdominal constant-diameter artery with suturing of the gastric wall has demonstrated potential as a new treatment for Dieulafoy's disease.
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Affiliation(s)
- Shan Yu
- Department of Gastroenterology, Panzhihua Central Hospital, Panzhihua 617067, Sichuan Province, China
| | - Xiao-Ming Wang
- Department of Gastroenterology, Panzhihua Central Hospital, Panzhihua 617067, Sichuan Province, China
| | - Xin Chen
- Department of Gastroenterology, Panzhihua Central Hospital, Panzhihua 617067, Sichuan Province, China
| | - Hong-Yan Xu
- Department of Gastroenterology, Panzhihua Central Hospital, Panzhihua 617067, Sichuan Province, China
| | - Guang-Jie Wang
- Department of Gastroenterology, Panzhihua Central Hospital, Panzhihua 617067, Sichuan Province, China
| | - Na Ni
- Department of Gastroenterology, Panzhihua Central Hospital, Panzhihua 617067, Sichuan Province, China
| | - Yu-Xin Sun
- Department of Gastroenterology, Panzhihua Central Hospital, Panzhihua 617067, Sichuan Province, China
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Hollenbach M, Feisthammel J, Hoffmeister A. [Interventional endoscopy in the gastrointestinal tract : Indications and limitations]. Internist (Berl) 2020; 61:1017-1030. [PMID: 32748102 DOI: 10.1007/s00108-020-00845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The spectrum of endoscopic techniques has been greatly enlarged in recent years. Lesions and also (iatrogenic) complications that required surgical procedures in the past can now often be treated endoscopically. Advances in endoscopic mucosal resection and submucosal dissection also enable the resection of large or laterally spreading polyps in the gastrointestinal tract. Full-thickness resection is also possible by means of specially designed clips. By the creation of a submucosal tunnel submucosal lesions can be completely excised and the muscle fibers of the lower esophageal sphincter can be endoscopically severed in achalasia patients. Endosonography-guided interventions have developed into the standard procedure for complicated pancreatitis and the use of cholangioscopy offers new therapeutic procedures for the bile and pancreatic ducts. In this continuing medical education article interventional endoscopic techniques are presented and critically evaluated.
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Affiliation(s)
- M Hollenbach
- Bereich Gastroenterologie, Klinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - J Feisthammel
- Bereich Gastroenterologie, Klinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - A Hoffmeister
- Bereich Gastroenterologie, Klinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
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Gericke M, Mende M, Schlichting U, Niedobitek G, Faiss S. Repeat full-thickness resection device use for recurrent duodenal adenoma: A case report. World J Gastrointest Endosc 2020; 12:193-197. [PMID: 32843929 PMCID: PMC7415228 DOI: 10.4253/wjge.v12.i6.193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/25/2020] [Accepted: 05/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic full-thickness resection of adenomas or subepithelial tumors is a novel and promising endoscopic technique. There have been several recent studies of full-thickness resection device (FTRD) use in the colon, but data regarding its use and efficacy in the duodenum are still limited.
CASE SUMMARY A 64-year-old female underwent resection of a recurrent adenoma of 7 mm in size in the duodenum after FTRD use for an adenoma eight months prior. The biopsies revealed a low-grade adenoma. The adenoma was removed using the gastroduodenal FTRD, and the pathology results revealed clear margins. Except for minor bleeding that was treated by argon plasma coagulation, no further complications occurred.
CONCLUSION Repeat use of the FTRD appears to be a safe and efficacious approach for the treatment of recurrent duodenal lesions. Further prospective studies are needed to investigate the long-term safety and utility of repeat FTRD use after Endoscopic full-thickness resection.
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Affiliation(s)
- Maximilian Gericke
- Department of Gastroenterology, Sana Klinikum Lichtenberg, Berlin 13065, Germany
| | - Matthias Mende
- Department of Gastroenterology, Sana Klinikum Lichtenberg, Berlin 13065, Germany
| | - Uwe Schlichting
- Department of Pathology, Sana Klinikum Lichtenberg, Berlin 13065, Germany
| | - Gerald Niedobitek
- Department of Pathology, Sana Klinikum Lichtenberg, Berlin 13065, Germany
| | - Siegbert Faiss
- Department of Gastroenterology, Sana Klinikum Lichtenberg, Berlin 13065, Germany
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Marcella C, Sarwar S, Ye H, Shi RH. Efficacy and Safety of Endoscopic Treatment for Gastrointestinal Stromal Tumors in the Upper Gastrointestinal Tract. Clin Endosc 2020; 53:458-465. [PMID: 32178486 PMCID: PMC7403013 DOI: 10.5946/ce.2019.121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 12/23/2019] [Indexed: 12/11/2022] Open
Abstract
Background/Aims: Endoscopic treatment (ET) has been applied for decades to treat subepithelial tumors, including gastrointestinal stromal tumors (GISTs). However, the efficacy of ET remains debatable. In this study, we evaluated the efficacy and safety of ET for GISTs in the upper gastrointestinal tract.
Methods: This retrospective single-center study included 97 patients who underwent ET. All patients were enrolled from July 2014 to July 2018. Parameters such as demographics, size, resection margin, complications, pathological features, procedure time, total cost, and follow-up were investigated and analyzed.
Results: Our study achieved 100% en bloc resection and 77.4% (72/93) R0 resection. The most common location was the fundus with a mean tumor size of 2.1±1.4 cm. The mean age, procedure time, hospital stay, and cost were 59.7±11.3 years, 64.7±35.2 minutes, 6.8 days, and 5,337 dollars, respectively. According to National Institutes of Health classification, 63 (64.9%), 26 (26.8%), 5 (5.2%), and 3 (3.1%) patients belonged to the very low, low, intermediate, and high risk classification, respectively. Immunohistochemistry results showed a 100% positive rate of CD34, DOG-1, CD117, and Ki67. A mean follow-up of 21.3±13.0 months showed no recurrence or metastasis.
Conclusions: ET is effective and safe for curative removal of GISTs in the upper gastrointestinal tract, and it can be a treatment of choice for patients with no metastasis.
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Affiliation(s)
- Cicilia Marcella
- Department of Gastroenterology, Southeast University Affiliated Zhongda Hospital, Nanjing, China
| | - Shakeel Sarwar
- Department of Orthopedics, Southeast University Affiliated Zhongda Hospital, Nanjing, China
| | - Hui Ye
- Department of Gastroenterology, Southeast University Affiliated Zhongda Hospital, Nanjing, China
| | - Rui Hua Shi
- Department of Gastroenterology, Southeast University Affiliated Zhongda Hospital, Nanjing, China
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He J, Chen BS, Zhou PH, Zhong YS, Chen WF, Zhang YQ, Li QL, Hu JW. [A novel and simplified closure method for defect closure after endoscopic full-thickness resection of gastric submucosal tumors: short-term outcomes of "Shao-Mai" closure method]. Zhonghua Wei Chang Wai Ke Za Zhi 2020; 23:183-187. [PMID: 32074800 DOI: 10.3760/cma.j.issn.1671-0274.2020.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the feasibility and short-term efficacy of a novel and simplified closure method developed by our team for the defect closure after endoscopic full-thickness resection (EFTR) for gastric submucosal tumors (SMT) in the gastric wall. Methods: A prospective single-arm clinical study was used. Inclusion criteria: (1) the lesion was located in the fundus or the greater curvature of the stomach, and was confirmed to originate from the muscularis propria layer; (2) the diameter of the tumor was ≤3.5 cm, and the tumor had no extensive adhesion to the peritoneal tissues and organs in extraperitoneal cavity; (3) the tumor had no malignant features under ultrasound endoscopy; (4) the patient agreed to participate in the study; (5) patients with severe complications were excluded. Based on the above criteria, 20 patients with gastric SMT at the Endoscopy Center of Zhongshan Hospital of Fudan University from January 2015 to March 2018 were enrolled in this study, including 5 males and 15 females with mean age of 61.1 (38 to 70) years. Grasping forceps-assisted endo-loop snare ligation device which is called "Shao-Mai" method was used to close the defect site. All the patients underwent EFTR and "Shao-Mai" method to perform defect closure. After successful tumor resection by EFTR, an endo-loop was anchored onto the edge of the gastric defect with grasping forceps assistance and closed tightly. The observation indicators included tumor size, en bloc resection, operation time, postoperative complications and hospital stay. The follow-up indicators included tumor residual, local recurrence, and metachronous lesions. Results: All the 20 lesions were located in the muscularis propria with a size of 0.5-3.5 (mean 1.4) cm. Three of them were located in the greater curvature of the mid-upper gastric body, 17 were located in the fundus. The endoscopic "Shao-Mai" closure was successfully performed after EFTR in all the 20 cases. Endoscope was used uniquely through the entire process, without laparoscopic assistance. The operative time was 20-100 (mean 43.8) minutes, while the "Shao-Mai" closure procedure took a range of 3-30 (mean 10.1) minutes. The en bloc resection rate was 100%. The pathological diagnosis included 17 gastrointestinal stromal tumors and 3 leiomyomas. No major complications occurred during or after surgery. All the patients were discharged 1-11 (mean 3.1) days after operation. The wounds of all the cases were healed completely six months after operation and only scar was observed without ulcer. No residual lesion, tumor recurrence or metastasis, leakage or fistula of digestive tract were found during the follow-up period of 15-54 (median 41) months. Conclusion: The endoscopic "Shao-Mai" closure method is a simplified novel way, which is feasible, effective, and safe for closing the gastric defect after EFTR.
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Affiliation(s)
- J He
- Endoscopy Center of Xiamen Hospital of Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - B S Chen
- Endoscopy Center of Xiamen Hospital of Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - P H Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai Engineering and Research Center of Diagnostic and Therapeutic Endoscopy, Shanghai 200032, China
| | - Y S Zhong
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai Engineering and Research Center of Diagnostic and Therapeutic Endoscopy, Shanghai 200032, China
| | - W F Chen
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai Engineering and Research Center of Diagnostic and Therapeutic Endoscopy, Shanghai 200032, China
| | - Y Q Zhang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai Engineering and Research Center of Diagnostic and Therapeutic Endoscopy, Shanghai 200032, China
| | - Q L Li
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai Engineering and Research Center of Diagnostic and Therapeutic Endoscopy, Shanghai 200032, China
| | - J W Hu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai Engineering and Research Center of Diagnostic and Therapeutic Endoscopy, Shanghai 200032, China
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Li P, Ma B, Gong S, Zhang X, Li W. Efficacy and safety of endoscopic full-thickness resection in the colon and rectum using an over-the-scope device: a meta-analysis. Surg Endosc. 2021;35:249-259. [PMID: 31953724 DOI: 10.1007/s00464-020-07387-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 01/10/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Relevant publications were identified by searching PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science before December 1, 2019. Studies in which ≥ 10 cases of colorectal lesions were resected with endoscopic full-thickness resection (EFTR) were included. Rates of efficacy (technical success (en bloc), full-thickness resection and R0 resection), rates of safety (bleeding, perforation and postpolypectomy syndrome) and rates of follow-up (residual/recurrent adenoma, fate of over-the-scope clip and surgery for any reason) were pooled and analyzed. Forest plots were graphed based on random effects models. Subgroup analyses and sensitivity analyses were also performed if significant heterogeneity existed. RESULTS A total of 469 patients across 9 studies were eligible for analysis. The pooled rates of technical success, full-thickness resection and R0 resection were 94.0% (95% CI 89.8-97.3%), 89.5% (83.9-94.2%) and 84.9% (75.1-92.8%), respectively. The pooled estimates of bleeding, perforation and postpolypectomy syndrome were 2.2% (95% CI 0.4-4.9%), 0.19% (95% CI 0.00-1.25%) and 2.3% (95% CI 0.1-6.3%), respectively. Finally, the pooled rates of residual/recurrent adenoma, fate of OTSC and surgery for any reason were 8.5% (95% CI 4.1-14.0%), 80.3% (95% CI 67.5-90.8%) and 6.3% (2.4-11.7%), respectively. CONCLUSIONS EFTR for nonlifting, invasive lesions in the colon and rectum appears to be effective and safe. However, future studies are necessary to explore the role of EFTR in large colorectal lesions and specify its indications.
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Zhai YQ, Chai NL, Li HK, Lu ZS, Feng XX, Zhang WG, Liu SZ, Linghu EQ. Endoscopic submucosal excavation and endoscopic full-thickness resection for gastric schwannoma: five-year experience from a large tertiary center in China. Surg Endosc. 2020;34:4943-4949. [PMID: 31811454 DOI: 10.1007/s00464-019-07285-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/28/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Endoscopic resection (ER) is an effective and safe method for gastric submucosal tumors, mostly composed of gastrointestinal stromal tumors and leiomyomas. The role of ER in gastric schwannoma (GS) has rarely been described. Our aim was to evaluate the efficacy and safety of ER for GS. METHODS This is a retrospective study in consecutive patients who underwent ER for GS from March 2013 to October 2018 at our center. Clinicopathological, endoscopic, and follow-up data were collected and analyzed. RESULTS A total of 16 consecutive patients (9 females, 56.3%) were included, with a mean age of 50.4 years (range 25-75 years). The mean tumor size was 22.9 ± 15.1 mm (range 10-55 mm). Thirteen tumors (81.3%) were located in the middle third of the stomach and 12 tumors (75%) grew with intraluminal pattern. Endoscopic submucosal excavation (ESE) was performed in 7 patients while endoscopic full-thickness resection (EFTR) was done in 9 patients. R0 resection was achieved in 14 patients (87.5%). The mean operative time was 91.6 ± 52.8 min (range 36-203 min) and the mean postoperative length of hospital stays was 8.3 ± 2.7 days (range 6-13 days). No adverse events were encountered except for fevers in 2 patients. No patients required surgical resection or intervention. During long-term follow-up of mean 21.8 months (range 6-62 months), no residue, recurrence, or metastasis was observed. CONCLUSIONS ER is effective and safe for patients with GS with favorable long-term outcomes.
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Ge N, Hu JL, Yang F, Yang F, Sun SY. Endoscopic full-thickness resection for treating small tumors originating from the muscularis propria in the gastric fundus: An improvement in technique over 15 years. World J Gastrointest Oncol 2019; 11:1054-1064. [PMID: 31798785 PMCID: PMC6883187 DOI: 10.4251/wjgo.v11.i11.1054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/31/2019] [Accepted: 09/12/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The fundus of the stomach is regarded as a difficult area for endoscopic resection of small tumors originating from the muscularis propria (MP tumors). Three endoscopic resection techniques have been developed to treat these tumors, including ligation-assisted endoscopic full-thickness resection (L-EFTR), snare-assisted EFTR (S-EFTR), and endoscopic submucosal dissection-assisted EFTR (E-EFTR). To date, no studies have compared these techniques.
AIM We aimed to evaluate and compare S-EFTR with L-EFTR and E-EFTR for treating small MP tumors in the gastric fundus.
METHODS We retrospectively reviewed patients with primary small MP tumors in the gastric fundus and treated by these three techniques between January 2016 and December 2018 at Shengjing Hospital, China. Standard demographic and clinicopathologic data, including sex, age, tumor size, surgeon details, and pathological results, were collected. Data regarding operation duration, cost, en-bloc resection, and severe complications were also extracted and compared.
RESULTS A total of 36 patients (27 women) with a mean age of 55.8 ± 10.20 years were included in this study. The mean tumor size was 9.0 ± 3.98 mm. All the methods showed a 100% en-bloc resection rate and 0% severe complication rate. There was no statistically significant difference among the three groups in the operation duration (P = 0.148). The cost comparison for the whole procedure was as follows: E-EFTR > L-EFTR > S-EFTR (5837.5 ± 7212.96 CNY, 5970.7 ± 3465.27 CNY, 5852.0 ± 6438.25 CNY, respectively, P < 0.001).
CONCLUSION S-EFTR, L-EFT, and E-EFTR are all effective for resection of small MP tumors in the gastric fundus. S-EFTR is superior in terms of cost-effectiveness.
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Affiliation(s)
- Nan Ge
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Jin-Long Hu
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Fei Yang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Fan Yang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Si-Yu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Li B, Shi Q, Qi ZP, Yao LQ, Xu MD, Lv ZT, Yalikong A, Cai SL, Sun D, Zhou PH, Zhong YS. The efficacy of dental floss and a hemoclip as a traction method for the endoscopic full-thickness resection of submucosal tumors in the gastric fundus. Surg Endosc 2019; 33:3864-73. [PMID: 31376013 DOI: 10.1007/s00464-019-06920-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/12/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic full-thickness resection (EFTR) provides a significant advancement to the treatment of gastrointestinal submucosal tumors (SMTs). However, technological challenges, particularly in the gastric fundus, hinder its wider application. Here, we investigated the efficacy of a simple traction method that used dental floss and a hemoclip (DFC) to facilitate EFTR. METHODS Between July 2014 and December 2016, we retrospectively reviewed data from all patients with SMTs in the gastric fundus originating from the muscularis propria layer that were treated by EFTR at Zhongshan Hospital of Fudan University. Baseline characteristics and clinical outcomes, including procedure time and complications rate, were compared between groups of patients receiving DFC-EFTR and conventional EFTR. RESULTS A total of 192 patients were included in our analysis (64 in the DFC-EFTR group and 128 in the conventional EFTR group). Baseline characteristics for the two groups were similar. The mean time for DFC-EFTR and conventional EFTR was 44.2 ± 24.4 and 54.2 ± 33.2 min, respectively (P = 0.034). Although no serious adverse events presented in any of our cases, post-EFTR electrocoagulation syndrome (PEECS), as a minor complication, was less frequent in the DFC-EFTR group (3.1% vs. 12.5%, P = 0.036). Univariate and multivariate analysis identified that DFC, when used in EFTR, played a significant role in reducing procedure time and the rate of PEECS. The mean procedure time was significantly shorter in the DFC-EFTR group for lesions over 1.0 cm (P = 0.005), when the lesions were located in the greater curvature of the gastric fundus (P = 0.025) or when the lesions presented with intraluminal growth (P = 0.032). Moreover, when EFTR was carried out by experts, the mean procedure time was 20.4% shorter in the DFC-EFTR group (P = 0.038). CONCLUSIONS This study indicated that DFC-EFTR for SMTs in the gastric fundus resulted in a shorter procedure time and reduced the risk of PEECS, a minor complication.
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Ribeiro Gomes AC, Pinho R. Now, More than Ever Before, Colonoscopy Is a Therapeutic Procedure. GE Port J Gastroenterol 2019; 26:229-231. [PMID: 31328135 PMCID: PMC6624739 DOI: 10.1159/000494845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 10/25/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Ana Catarina Ribeiro Gomes
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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