Bloc biopsy by using submucosal endoscopy with a mucosal flap method for gastric subepithelial tumor tissue sampling (with video)

Kobara, Hideki; Mori, Hideki; Fujihara, Shintaro; Nishiyama, Noriko; Kobayashi, Mitsuyoshi; Kamata, Hideki; Masaki, Tsutomu

doi:10.1016/j.gie.2012.08.008

Cited by 40 publications

(52 citation statements)

References 24 publications

(30 reference statements)

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“…Patients were administered intravenous midazolam (0.05 mg/kg) and pethidine (50 mg) prior to TBB, which consisted of five major procedures (16). Briefly, in the first step, after placing several dots around the tumor at a margin of ~5 mm, with one dot at the top of the tumor, a small incision was made to create a 10-mm opening flap, followed by submucosal injection of 0.4% hyaluronate sodium solution (mucoup; johnson & johnson K.K., Tokyo, japan) with a needle knife (KD-441q; olympus).…”

Section: Methodsmentioning

confidence: 99%

“…In particular, the immunohistological (IH) analysis needed for a definitive final diagnosis has revealed the low diagnostic rate of EuS-FNA (34-61.6%) (13,14). we previously developed a bloc biopsy method involving submucosal endoscopy with a mucosal flap (SEmF) (15), called tunneling bloc biopsy (TBB), to obtain core biopsy specimens under direct vision from growing endoluminal SETs (16). To date, no studies have investigated whether the amount of tissue sample can affect the accuracy of histological diagnostic methods, including IH analysis, mitotic count and histological Ki-67 staining.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of the amount of tissue sample necessary for mitotic count and Ki-67 index in gastrointestinal stromal tumor sampling

et al. 2014

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Abstract. There are no established opinions concerning whether the amount of tissue affects the accuracy of histological analyses in gastrointestinal stromal tumors (GISTs). The aim of the present study was to investigate the appropriate amount of tissue sample needed for mitotic count based on the risk classification of GISTs and the Ki-67 index using the following three methods: endoscopic ultrasound-guided fine-needle aspiration (FNA), a novel sampling method called tunneling bloc biopsy (TBB), and biopsy forceps followed by TBB (Bf). Forty-three samples (12 FNA, 17 TBB and 14 Bf) diagnosed as GISTs by immunohistological analysis were utilized. The major and minor axes and overlay area of one piece of specimen (OPS) from the three sampling methods were measured using digital imaging software and were analyzed comparatively regarding the acquisition of histological data. The mean major and minor axes (mm) and overlay areas (mm 2 ) were in the order of TBB > Bf > FNA. The evaluable rates by mitotic count and Ki-67 were, respectively, 75% (9/12) and 83.3% (10/12) for FNA samples, 100% (17/17) and 100% (17/17) for TBB samples, and 100% (14/14) and 100% (14/14) for Bf samples (P>0.05). Three FNA samples were judged unevaluable due to too small specimens in overall diagnosis including mitotic count and Ki-67, calculating the cut-off value for the overlay area of OPS as 0.17 mm 2 . Comparing the concordance rates between the pre-and post-operative samples, TBB samples was significantly better than FNA (P<0.05). Conclusively, while the amounts of tissues obtained by TBB and Bf are unnecessary for the histological assessment of mitotic count and Ki-67 index, developments of the FNA method are needed to minimize sample error. Considering the technical aspects, as well as the size of the specimens, could help to guide therapeutic planning and improve diagnostic yield for GI subepithelial tumors.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Analysis of the amount of tissue sample necessary for mitotic count and Ki-67 index in gastrointestinal stromal tumor sampling

et al. 2014

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“…However, some tumors, particularly gastrointestinal s t rom a l tu m ors ( G I STs ) , exhibit potential malignancy [1,2]. Submucosal tunneling bl o c bi op s y ( ST B ) u s i ng the endoscopic submucosal dissection (ESD) technique has been demonstrated as technically feasible and safe [3,4].…”

Section: Introductionmentioning

confidence: 99%

Open Biopsy guided by Endoscopic Ultrasonography from a Gastric Submucosal Tumor growing Outside the Stomach

Mori

Kobara

Nishiyama

et al. 2015

JGLD

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Submucosal tunneling bloc biopsy for submucosal tumors growing inside the gastric wall is a safe and reliable method. However, it is difficult for an endoscopist to perform submucosal tunneling bloc biopsy and detect the demarcation line between the proper muscular layer and the capsule layer of submucosal tumors growing outside the gastric wall.A submucosal tumor in the lesser curvature of the stomach was identified in a 74-year-old man by esophagogastroduodenoscopy. Computed tomography revealed hetero-density with partial calcification of the tumor growing outside the gastric wall, that connected to approximately 10 mm of the muscular layer. Almost all of the tumor body was located outside the stomach. After the small connecting area was detected by endoscopic ultrasonography, two markings were placed at the opposite ends of the tumor. The tumor was removed via snare resection between the markings located immediately above the top of the tumor. After the biopsy site was reconfirmed using endoscopic ultrasonography, a large bloc biopsy was conducted. This new "open biopsy under endoscopic ultrasonography" is a simple, safe, and reliable method to obtain samples from any type of submucosal tumor growing inside or outside the stomach.

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“…Currently, minimally invasive local resection techniques, such as hybrid natural orifice transluminal endoscopic surgery (NOTES), which consists of endoscopic full-thickness resection (EFTR), have been developed for the treatment of endoluminal GISTs (2,3). Furthermore, endoscopic diagnostic methods for SETs have been proposed (4,5), including our safe and reliable method of bloc biopsy performed under a direct endoscopic view by using submucosal endoscopy with a mucosal flap method (SEMF) (4). Although considered by some as a novel optimal endoscopic mini-invasive technique for the management of SETs, there are currently no established guidelines for endoscopic submucosal dissection (ESD).…”

Section: Introductionmentioning

confidence: 99%

Indications of endoscopic submucosal dissection for symptomatic benign gastrointestinal subepithelial or carcinoid tumors originating in the submucosa

Kobara

Mori

Rafiq

et al. 2013

Molecular and Clinical Oncology

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Abstract. Endoscopic submucosal dissection (ESD) for upper gastrointestinal (GI) subepithelial tumors (SETs) originating in the muscularis propria (MP) layer is associated with numerous issues regarding secure closure and measures against accidental perforation. However, symptomatic benign GI SETs or carcinoid tumors originating in the submucosa (SM) may be safely resected en-bloc using ESD. In this study, the feasibility and safety of ESD as a novel method for endoscopic resection for such GI SETs revealed on endoscopic ultrasonography (EUS) was investigated. A total of 12 consecutive cases of patients with symptomatic benign SETs (n=3; 1 esophageal hemangioma and 2 gastric lipomas) or small carcinoid tumors (n=9; <10 mm, with an extremely low risk of metastasis) originating in the SM as determined on EUS, between March, 2009 and April, 2013, were retrospectively reviewed. The lesions were resected by ESD after confirming that the tumors originated from the SM. The complication rate following en-bloc resection was also determined. En-bloc resection was achieved in all 12 cases, the mean procedure time was 45 min (range, 20-120 min) and no complications occurred intra-or postoperatively. There was no tumor recurrence or disease-related mortality reported during the follow-up period (median follow-up time, 13.4 months). Histopathological curative resection was achieved with ESD without complications in all 9 cases with carcinoid tumors. Therefore, if EUS reveals a SET originating in the SM without infiltration of the MP and resection is indicated due to the presence of abdominal symptoms, ESD may be a feasible option for diagnostic treatment with minimal invasiveness. However, larger-scale prospective studies are required to establish the feasibility and safety of this procedure.

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Bloc biopsy by using submucosal endoscopy with a mucosal flap method for gastric subepithelial tumor tissue sampling (with video)

Cited by 40 publications

References 24 publications

Analysis of the amount of tissue sample necessary for mitotic count and Ki-67 index in gastrointestinal stromal tumor sampling

Analysis of the amount of tissue sample necessary for mitotic count and Ki-67 index in gastrointestinal stromal tumor sampling

Open Biopsy guided by Endoscopic Ultrasonography from a Gastric Submucosal Tumor growing Outside the Stomach

Indications of endoscopic submucosal dissection for symptomatic benign gastrointestinal subepithelial or carcinoid tumors originating in the submucosa

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