Efficacy and safety of endoscopic resection for small submucosal tumors originating from the muscularis propria layer in the gastric fundus

Li, Bing; Chen, Tao; Qi, Zhipeng; Yao, Ling; Xu, Mei‐Dong; Shi, Qiang; Cai, Shi‐Lun; Sun, Da; Zhou, Ping‐Hong; Zhong, Yunshi

doi:10.1007/s00464-018-6549-6

Cited by 33 publications

(33 citation statements)

References 32 publications

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Section: Discussionmentioning

confidence: 99%

“…Li et al. 26 found that tumor size was a significant contributor to a longer procedure time. Additionally, our previous study on EFTR revealed that a tumor size of ≥30 mm and a tumor located in the gastric corpus are risk factors for technical difficulties.…”

Section: Discussionmentioning

confidence: 99%

“…25 Although the complete resection and complications rates are comparable between EFTR and ESE, ESE had a shorter fasting time, shorter hospital stay, and lower cost. 26,27 Although STER reduced the potential rate of air leakage and perforation, ESE was associated with a shorter surgical time, and it is preferable for SMTs that are !40 mm or those that are located at sites for which it is difficult to create a submucosal tunnel. 18,28 Although ESE is a feasible technique for gastric SMTs, it is a relatively complicated procedure, and technical difficulties sometimes occur even for experienced surgeons, which ultimately prolongs the procedure time or leads to procedure-related complications.…”

Section: Discussionmentioning

confidence: 99%

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Factors predicting technical difficulties during endoscopic submucosal excavation for gastric submucosal tumor

et al. 2021

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Objective Endoscopic submucosal excavation (ESE) has been established as an effective method for removal of gastric submucosal tumors (SMTs). The aim of the present study was to explore risk factors for technical difficulties in ESE. Methods In this retrospective study, we collected clinical data from patients who underwent ESE for gastric SMTs. Difficult ESE was defined as a procedure time ≥90 minutes, piecemeal resection, and/or occurrence of major adverse events. Univariate and multivariate analyses were performed to explore the risk factors for a difficult ESE. Results ESE was successfully performed in 96.5% (195/202) of patients from April 2011 to December 2019. The average tumor size was 17.41 mm, and en bloc resection was achieved in 97.4% of patients (190/195). Five patients (2.56%, 5/195) had complications, including two with delayed bleeding, two with fever, and one with chest pain accompanying ST-T changes in an electrocardiogram. Twenty-four patients (11.88%, 24/202) had a difficult ESE. Logistic analysis showed that outgrowth behavior and an inexperienced surgeon were risk factors for a difficult ESE. Conclusion ESE may be safe and effective to treat patients with gastric SMTs. Outgrowth behavior and an inexperienced surgeon were risk factors for a difficult ESE.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Factors predicting technical difficulties during endoscopic submucosal excavation for gastric submucosal tumor

et al. 2021

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“…Chiu et al[19] also confirmed that gastric subepithelial lesions located at the cardia, lesser curvature, and antrum could be treated by creating a submucosal tunnel. The fundus of the stomach is regarded as a difficult area for endoscopic resection[20,21].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic full-thickness resection for treating small tumors originating from the muscularis propria in the gastric fundus: An improvement in technique over 15 years

Guo¹,

Hu²,

Yang³

et al. 2019

WJGO

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BACKGROUNDThe 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.AIMWe aimed to evaluate and compare S-EFTR with L-EFTR and E-EFTR for treating small MP tumors in the gastric fundus.METHODSWe 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.RESULTSA 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).CONCLUSIONS-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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“…There have been many reports describing endoscopic resection of small GISTs and SMTs using ESD techniques, endoscopic full-thickness resection (EFTR), or others [70][71][72][73]. Endoscopic resection of small GISTs has been shown to be safe and feasible, and it has shown good prognostic outcomes.…”

Section: Surgical Therapy Of Small Gistsmentioning

confidence: 99%

Recent Progress and Challenges in the Diagnosis and Treatment of Gastrointestinal Stromal Tumors

Nishida

Yoshinaga²,

Takahashi

et al. 2021

Cancers

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Gastrointestinal stromal tumors (GISTs) are the most frequent malignant mesenchymal tumors in the gastrointestinal tract. The clinical incidence of GISTs is estimated 10/million/year; however, the true incidence is complicated by frequent findings of tiny GISTs, of which the natural history is unknown. The initial work-up with endoscopy and endoscopic ultrasonography plays important roles in the differential diagnosis of GISTs. Surgery is the only modality for the permanent cure of localized GISTs. In terms of safety and prognostic outcomes, laparoscopy is similar to laparotomy for GIST treatment, including tumors larger than 5 cm. GIST progression is driven by mutations in KIT or PDGFRA or by other rare gene alterations, all of which are mutually exclusive. Tyrosine kinase inhibitors (TKIs) are the standard therapy for metastatic/recurrent GISTs. Molecular alterations are the most reliable biomarkers for TKIs and for other drugs, such as NTRK inhibitors. The pathological and genetic diagnosis prior to treatment has been challenging; however, a newly developed endoscopic device may be useful for diagnosis. In the era of precision medicine, cancer genome profiling by targeted gene panel analysis may enable potential targeted therapy even for GISTs without KIT or PDGFRA mutations.

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Efficacy and safety of endoscopic resection for small submucosal tumors originating from the muscularis propria layer in the gastric fundus

Cited by 33 publications

References 32 publications

Factors predicting technical difficulties during endoscopic submucosal excavation for gastric submucosal tumor

Factors predicting technical difficulties during endoscopic submucosal excavation for gastric submucosal tumor

Endoscopic full-thickness resection for treating small tumors originating from the muscularis propria in the gastric fundus: An improvement in technique over 15 years

Recent Progress and Challenges in the Diagnosis and Treatment of Gastrointestinal Stromal Tumors

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