Endoscopic full-thickness resection of gastric subepithelial tumors: a single-center series

Schmidt, Arthur; Bauder, Markus; Riecken, Bettina; Renteln, Daniel von; Muehleisen, H.; Caca, Karel

doi:10.1055/s-0034-1390786

Cited by 60 publications

(40 citation statements)

References 15 publications

(15 reference statements)

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“…Since GISTs arise from the muscularis propria layer, established endoscopic resection techniques in the upper gastrointestinal tract (endoscopic mucosal resection, endoscopic submucosal dissection) can be expected to be associated with an increased risk of incomplete resection. Endoscopic full-thickness resection of the gastric wall has also been demonstrated to be feasible in single-center series [54,55], but as long as methods for postinterventional gastric wall closure are not standardized, these techniques must be considered as experimental. In contrast to gastric GISTs, transanal excision via transanal endoscopic microsurgery may be a safe alternative to transabdominal resection in small rectal GISTs [56,57,58].…”

Section: Management Of Localized Gistsmentioning

confidence: 99%

State of the Art in the Treatment of Gastrointestinal Stromal Tumors

Garlipp

Bruns

2014

Gastrointest Tumors

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Background: Gastrointestinal stromal tumors (GISTs) are the most frequently diagnosed mesenchymal neoplasms of the gastrointestinal tract. Despite their biological and clinical heterogeneity, the majority of these tumors are positive for the receptor tyrosine kinase KIT and are driven by KIT- or platelet-derived growth factor receptor alpha (PDGFRA)-activating mutations. There are still uncertainties regarding their clinical and molecular characterization and the optimal treatment regimens, making it difficult to establish a universal treatment algorithm for these tumors. Summary: From a clinical perspective, the main difference between GISTs and other gastrointestinal neoplasms is that the benign or malignant behavior of GISTs cannot be predicted from histopathology, but instead relies on empirically established scoring systems. Clinical data suggest that malignant potential may be an inherent quality of some GISTs rather than a feature acquired by the tumor during disease progression. Thus, some patients may require prolonged anti-tumor treatment even after complete surgical removal of the tumor. Key Message: Although GISTs are the most frequently occurring mesenchymal neoplasms in the gastrointestinal tract, no universal treatment algorithms exist. This paper reviews the current evidence that guides the management of GISTs. Practical Implications: The management of localized GISTs involves the use of surgical resection, with the inclusion of preoperative tyrosine kinase inhibitor treatment for locally advanced, primarily unresectable tumors and for resectable cases requiring extensive surgery. Imatinib is also indicated as adjuvant therapy after complete surgical removal of GISTs with a high estimated risk of recurrence unless specific mutations conferring imatinib resistance are present. The optimal duration of adjuvant treatment is still controversial. For patients with metastatic imatinib-sensitive GISTs, imatinib constitutes the first-line standard treatment. Molecular characterization of the tumor (with respect to the PDGFRA and KIT genes) is mandatory prior to imatinib therapy. Sunitinib and regorafenib are established as alternative treatments for patients demonstrating generalized disease progression on imatinib. New tyrosine kinase inhibitors such as ponatinib and crenolanib as well as drugs targeting alternative pathways are currently under investigation. Surgery and locally ablative treatments may be indicated in some metastatic patients.

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Section: Management Of Localized Gistsmentioning

confidence: 99%

State of the Art in the Treatment of Gastrointestinal Stromal Tumors

Garlipp

Bruns

2014

Gastrointest Tumors

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“…EFTR without laparoscopic assistance was performed as previously described [4,7]. The post-resection large defect was closed immediately by means of LeClamp TM endoloops and metallic clips and using a single-channel endoscope.…”

Section: Methodsmentioning

confidence: 99%

“…The latest National Comprehensive Cancer Network (NCCN) task force report has suggested that all GISTs 2 cm or larger should be resected [3]. With the progressive increase in experience in endoscopic submucosal dissection (ESD), endoscopic full-thickness resection (EFTR) without laparoscopic assistance has been applied to remove GISTs with extra-luminal growth and/or close proximity to the serosa [4][5][6][7][8][9]. The key step of the EFTR procedure is the complete closure of wall defects left by full-thickness resection and thereby avoiding surgical intervention.…”

mentioning

confidence: 99%

Application of novel endoloops to close the defects resulted from endoscopic full-thickness resection with single-channel gastroscope: a multicenter study

Shi

Chen

et al. 2016

Surg Endosc

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“…GERDX TM (G‐Surg, Seeon, Germany) is also a similar suturing device. Schmidt et al . demonstrated the feasibility of EFTR of gastric subepithelial tumors using NDO Plicator and GERDX.…”

Section: Endoscopic Full‐thickness Closurementioning

confidence: 99%

Endoscopic closure after intraluminal surgery

Akimoto

Goto

Nishizawa

et al. 2017

Digestive Endoscopy

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Endoscopic submucosal dissection is established as a curative endoscopic method for gastrointestinal epithelial neoplasms with a high possibility of complete en bloc resection; however, postoperative adverse events of bleeding and delayed perforation remain. To prevent or minimize them, several techniques for endoscopic mucosal closure have been introduced, such as using endoscopic clips, combined use of hemoclips and supplement devices, and specially designed endoscopic suturing devices. Furthermore, endoscopic full-thickness suturing technique for gastrointestinal wall defect has been developed based on the concept in natural orifice transluminal endoscopic surgery and endoscopic full-thickness resection. Several closure techniques, including over-the-scope clip, threaded bars inserted in a hollow needle, stitches or staplers, and a curved needle and thread are reported. Secure closure of the iatrogenic defect may further expand the range of therapeutic endoscopy. Accumulation of evidence for the efficacy of endoscopic closure and establishment of these techniques are desired.

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Endoscopic full-thickness resection of gastric subepithelial tumors: a single-center series

Cited by 60 publications

References 15 publications

State of the Art in the Treatment of Gastrointestinal Stromal Tumors

State of the Art in the Treatment of Gastrointestinal Stromal Tumors

Application of novel endoloops to close the defects resulted from endoscopic full-thickness resection with single-channel gastroscope: a multicenter study

Endoscopic closure after intraluminal surgery

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