Endoscopic full thickness resection for gastric tumors originating from muscularis propria

Jain, Deepanshu; Mahmood, Ejaz; Desai, Aakash; Singhal, Shashideep

doi:10.4253/wjge.v8.i14.489

Cited by 29 publications

(18 citation statements)

References 29 publications

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“…In a systematic review concerning the role of EFTR in gastric SMT (211 patients) of the MP layer, mean success rate for EFTR of gastric tumors originating from MP was 96.8%. No mortality was reported; gastric wall defect closure either by metallic clips or by OTSC had similar outcomes, although experience with OTSC was limited to smaller lesions …”

Section: Discussionmentioning

confidence: 99%

“…No mortality was reported; gastric wall defect closure either by metallic clips or by OTSC had similar outcomes, although experience with OTSC was limited to smaller lesions. 58 Recently, Yu et al, published the first paper concerning long-term outcomes of endoscopic resection of gastric GIST. In a retrospective single-center study of 60 patients with gastric GIST retrieved by ESD/EFTR with a follow-up period of 36.15 AE 12.92 months, they concluded that endoscopic resection is a safe and effective approach for gastric stromal tumor (<5 cm) removal.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic full‐thickness resection for gastrointestinal submucosal tumors

Cai

Carreras-Presas

Zhou

2018

Digestive Endoscopy

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Endoscopic full-thickness resection (EFTR) is a "changing-concept" endoscopic resection technique, which safely allows resecting deep submucosal tumors (SMTs) in the gastrointestinal (GI) wall. It's a highly promising endoscopic procedure that allows full-thickness excision of a small piece of the complete GI wall by using only a flexible endoscope. EFTR is a meeting point between surgery and endoscopy and probably the onset of many prospective combined minimally invasive therapeutic techniques that science will explore. In this review, use of the EFTR technique for gastrointestinal SMTs is highlighted, focusing on some technical aspects, indications, contraindications and outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endoscopic full‐thickness resection for gastrointestinal submucosal tumors

Cai

Carreras-Presas

Zhou

2018

Digestive Endoscopy

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“…Given the limited intramural extension of GISTs, laparoscopic segmental or wedge resection is currently regarded as the gold standard for their treatment 1 . However, in recent years, a novel minimally invasive technique called exposed endoscopic full-thickness resection (Eo-EFTR) without laparoscopic assistance has emerged as a promising approach with good efficacy and safety in the resection of gastric submucosal tumors (G-SMTs) originating from the muscularis propria (MP) through natural orifice transluminal endoscopic surgery (NOTES) 2 3 4 5 6 .…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of gastric exposed endoscopic full-thickness resection without laparoscopic assistance: a systematic review

et al. 2020

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Background and study aims Exposed endoscopic full-thickness resection (Eo-EFTR) without laparoscopic assistance is a minimally invasive natural orifice transluminal endoscopic surgery (NOTES) technique that has shown promising efficacy and safety in resection of gastric submucosal tumors (G-SMTs) arising from muscularis propria (MP). However, data on the efficacy and safety of gastric Eo-EFTR mostly come from relatively small retrospective studies and concern regarding its use still exists. The aim of our systematic review was to assess the efficacy and safety of gastric Eo-EFTR without laparoscopic assistance. Methods A detailed MEDLINE and EMBASE search was performed for papers published from January 1998 to November 2019 and reporting on gastric Eo-EFTR without laparoscopic assistance. The search strategy used the terms “endoscopic full thickness resection” and “gastric” or “stomach”. The primary outcomes were complete resection and surgical conversion rates. The secondary outcomes were overall major adverse events, delayed bleeding, delayed perforation, peritonitis, abdominal abscess and/or abdominal infection and successful Eo-EFTR. Results Fifteen Asian studies were included in our final review, providing data on 750 Eo-EFTR-treated G-SMTs. The per-lesion rate of complete resection and surgical conversion were 98.8 %\0.8 %, respectively. The per-lesion rate of major adverse events, delayed bleeding, delayed perforation and peritonitis, abdominal abscess and/or abdominal infection was 1.6 %\0.5 %\0.1 %\0.9 %, respectively. The per-lesion rate of successful Eo-EFTR (i. e. complete tumor resection and effective endoscopic defect closure) was 98.3 %. Conclusions Eo-EFTR without laparoscopic assistance appears to be highly effective and safe NOTES for removing deep G-SMTs, particularly those arising from MP layer.

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“…Our study revealed the high success rate the EPSS method obtained for post-EFTR gastric wall defect (with the maximal diameter of 70 mm) closure. The over-the-scope-clips (OTSCs), previously reported to be safe and technically reasonable for lesions ≤ 20 mm, were also used in one case with gastric wall defect approaching 40 mm in our study [ 37 – 39 ]. However, the OTSC-assisted EFTR has not been widely covered by Chinese health insurance, which limits its standardization and implementation.…”

Section: Discussionmentioning

confidence: 99%

Resection of the gastric submucosal tumor (G-SMT) originating from the muscularis propria layer: comparison of efficacy, patients’ tolerability, and clinical outcomes between endoscopic full-thickness resection and surgical resection

et al. 2020

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Background and aims Endoscopic full-thickness resection (EFTR) has been increasingly applied in the treatment of gastric submucosal tumors (G-SMTs) with explorative intention. This study aimed to compare the efficacy, tolerability, and clinical outcomes of EFTR and surgical intervention for the management of muscularis propria (MP)-derived G-SMTs. Methods Between September 2011 and May 2019, the clinical records of patients with MP-derived G-SMTs undergoing EFTR at our endoscopic unit were collected. A cohort of people with primary MP-derived G-SMTs treated by surgery was matched in a 1:1 ratio to EFTR group with regard to patients' baseline characteristics, clinicopathologic features of the tumor and the procedure date. The perioperative outcomes and follow-up data were analyzed. Results In total, 62 and 62 patients were enrolled into the surgery and EFTR group, respectively, with median follow-up of 786 days. The size of G-SMTs (with ulceration) ranged from 10 to 90 mm. For patients with tumor smaller than 30 mm, surgery and EFTR group presented comparable procedural success rate (both were 100%), en bloc resection rate (100% vs. 94.7%), tumor capsule rupture rate (0% vs. 5.3%), and pathological R0 resection rate (both were 100%). EFTR had a statistically significant advantage over surgery for estimated blood loss (3.12 ± 5.20 vs. 46.97 ± 60.73 ml, p ≤ 0.001), discrepancy between the pre-and postprocedural hemoglobin level (5.18 ± 5.43 vs. 9.84 ± 8.25 g/L, p = 0.005), bowel function restoration [1 (0-5) vs. 3 (1-5) days, p ≤ 0.001], and hospital cost (28,617.09 ± 6720.78 vs. 33,963.10 ± 13,454.52 Yuan, p = 0.033). The patients with tumor larger than 30 mm showed roughly the same outcomes after comparison analysis of the two groups. However, the clinical data revealed lower en bloc resection rate (75.0% vs. 100%, p = 0.022) and higher tumor capsule rupture rate (25.0% vs. 0%, p = 0.022) for EFTR when compared to surgery. The procedure time, duration of postprocedural fasting and antibiotics usage, and hospital stay of the two groups were equivalent. The occurrence rate of adverse events within postoperative day 7 were 74.2% and 72.6% after EFTR and surgery, respectively (p = 1.000). No complications occurred during the follow-up. Conclusion For treatment of MP-derived G-SMTs (with or without ulceration), our study showed the feasibility and safety of EFTR, which also provided better results in terms of procedural blood loss, the postoperative bowel function restoration and cost-effectiveness when compared to surgery, whereas the surgery was superior in en bloc resection rate for G-SMTs larger than 30 mm. The postprocedural clinical outcomes seemed to be equivalent in these two resection methods.

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Endoscopic full thickness resection for gastric tumors originating from muscularis propria

Cited by 29 publications

References 29 publications

Endoscopic full‐thickness resection for gastrointestinal submucosal tumors

Endoscopic full‐thickness resection for gastrointestinal submucosal tumors

Efficacy and safety of gastric exposed endoscopic full-thickness resection without laparoscopic assistance: a systematic review

Resection of the gastric submucosal tumor (G-SMT) originating from the muscularis propria layer: comparison of efficacy, patients’ tolerability, and clinical outcomes between endoscopic full-thickness resection and surgical resection

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