Attempted Endoscopic En Bloc Resection of Mucosal and Submucosal Tumors Using Insulated-Tip Knives: A Pilot Series

Rösch, Thomas; Sarbia, Mario; Schumacher, Brigitte; Deinert, Katja; Frimberger, E; Toermer, T.; Stolte, Manfred; Neuhaus, Horst

doi:10.1055/s-2004-825838

Cited by 238 publications

(162 citation statements)

References 17 publications

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“…FNA in our series was able to confirm GIST only in 2 of 8 cases without the evaluation of the mitotic index. The high success rate (90 % in our series) achieved with ESD and the absence of relevant complications suggest this procedure as a diagnostic and in some case therapeutic option in the resection of SMTs [15][16][17][18][19]. The main limitation of this study was that patients were assigned to ESD based solely on the patient's attitude.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study

et al. 2012

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Background A submucosal tumor (SMT) of the stomach, which is an occasional finding during routine upper gastrointestinal endoscopy, may pose diagnostic and therapeutic challenges. Methods To assess whether endoscopic submucosal dissection (ESD) is a feasible approach to definitively cure SMTs, the authors performed a retrospective cohort study with two endoscopic italian centers.Results The study consisted of 20 patients with SMTs who underwent ESD. The patients underwent ESD and were followed up by endoscopy. We analyzed complete resection rate, frequency of complications, and survival. The overall rate of R0 resection was 90 % (18/20), with two endoscopic failures, one for a submucosal tumor and one for a neoplasm deeply infiltrating the proper muscle layer. The median procedure time was 119.1 min (range 40-240 min). The median size of the resected specimens was 29 mm (range 15-60 mm). Perforation occurred in 3 patients; all were treated conservatively. There were no cases of severe bleeding. Based on histopathological findings, 6 cases of ectopic pancreas, 1 of ectopic spleen, 3 of leiomyoma, and 10 of gastrointestinal stromal tumor (GIST) were diagnosed. Complete resection was obtained in all GIST cases. Among the 10 GIST cases treated by ESD, no death occurred: the 5-year disease-specific survival rate was 100 %. Conclusions The high success rate of 90 % and the low incidence of complications should indicate ESD is the correct diagnostic and definitive treatment in selected patients.

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Section: Discussionmentioning

confidence: 99%

Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study

et al. 2012

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“…ESD has the advantage of a high probability of en bloc and histologically complete resection even in huge lesions because the technique involves dissection of the submucosal tissue beneath the lesion [14][15][16] . To date, the fact that ESD can facilitate a histologically complete resection of NETs has been verified for the use of ESD for treatment of rectal carcinoid tumors (now referred to as NETs) [17][18][19] .…”

Section: Introductionmentioning

confidence: 99%

Endoscopic submucosal dissection for foregut neuroendocrine tumors: An initial study

Zhang²,

Chen³

et al. 2012

WJG

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AIM:To evaluate the feasibility and efficacy of endoscopic submucosal dissection (ESD) for foregut neuroendocrine tumors (NETs). METHODS:From April 2008 to December 2010, patients with confirmed histological diagnosis of foregut NETs were included. None had regional lymph node enlargement or distant metastases to the liver or lung on preoperative computerized tomography scanning or endoscopic ultrasonography (EUS). ESD was attempted under general anesthesia. After making several marking dots around the lesion, a mixture solution was injected into the submucosa. The mucosa was incised outside the marking dots. Dissection of the submucosal layer beneath the tumor was performed under direct vision to achieve complete en bloc resection of the specimen. Tumor features, clinicopathological characteristics, complete resection rate, and complications were evaluated. Foregut NETs were graded as G1, G2, or G3 on the basis of proliferative activity by mitotic count or Ki-67 index. All patients underwent regular follow-up to evaluate for any local recurrence or distant metastasis. RESULTS:Those treated by ESD included 24 patients with 29 foregut NETs. The locations of the 29 lesions are as follows: esophagus (n = 1), cardia (n = 1), stomach (n = 23), and duodenal bulb (n = 4). All lesions were found incidentally during routine upper gastrointestinal endoscopy for other indications, and none had symptoms of carcinoid syndrome. Preoperative EUS showed that all tumors were confined to the submucosa. Among the 24 gastric lesions, 16 lesions in 11 patients were type I gastric NETs arising in chronic atrophic gastritis with hypergastrinemia, while the other 8 solitary lesions were type Ⅲ because of absence of atrophic gastritis in these cases. All of the tumors were removed in an en bloc fashion. The average maximum diameter of the lesions was 9.4 mm (range: 2-30 mm), and the procedure time was 20.3 min (range: 10-45 min). According to the World Health Organization 2010 classification, histological evaluation determined that 26 lesions were NET-G1, 2 gastric lesions were NET-G2, and 1 esophageal lesion was neuroendocrine carcinoma (NEC). Complete resection was achieved in 28 lesions (28/29, 96.6%), and all of them were confined to the submucosa in histopathologic assessment with no lymphovascular invasion. The remaining patient with NEC underwent additional surgery because the resected specimens revealed angiolymphatic and muscularis invasion, as well as incomplete Li QL et al . ESD for foregut NETs 5800October 28, 2012|Volume 18|Issue 40| WJG|www.wjgnet.com resection. Delayed bleeding occurred in 1 case 3 d after ESD, which was managed by endoscopic treatment. There were no procedure-related perforations. During a mean follow-up period of 24.4 mo (range: 12-48 mo), local recurrence occurred in only 1 patient 7 mo after initial ESD. This patient successfully underwent repeat ESD. Metastasis to lymph nodes or distal organs was not observed in any patient. No patients died during the study period.CONCLUSION: ESD appears to...

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“…Tumor tissue was removed completely in these patients but a small perforation occurred in one patient, in whom the tumor involved the muscularis propria and had grown outward to the serosa. Roesch et al [8] have treated 14 patients with submucosal tumors of the esophagus and the stomach by endoscopic surgery. In their series, there were five patients with GIST of the stomach.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic enucleation of gastrointestinal stromal tumors of the stomach: Report of five cases

Katoh¹,

Itoh²,

Mohri³

et al. 2008

WJG

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Attempted Endoscopic En Bloc Resection of Mucosal and Submucosal Tumors Using Insulated-Tip Knives: A Pilot Series

Cited by 238 publications

References 17 publications

Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study

Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study

Endoscopic submucosal dissection for foregut neuroendocrine tumors: An initial study

Endoscopic enucleation of gastrointestinal stromal tumors of the stomach: Report of five cases

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