Endoscopic full-thickness resection of gastric gastrointestinal stromal tumor: a Japanese case series

Shichijo, Satoki; Uedo, Noriya; Yanagimoto, Yoshitomo; Yamamoto, Keiji; Kono, Mitsuhiro; Fukuda, Hiromu; Shimamoto, Yusaku; Nakagawa, Kentaro; Ohmori, Masayasu; Arao, Masamichi; Iwatsubo, Taro; Iwagami, Hiroyoshi; Inoue, Shuntaro; Matsuno, Kenshi; Matsuura, Noriko; Nakahira, Hiroko; Maekawa, Akira; Kanesaka, Takashi; Takeuchi, Yoji; Higashino, Koji; Ohmori, Takeshi; Ishihara, Ryu

doi:10.20524/aog.2019.0413

Cited by 24 publications

(27 citation statements)

References 33 publications

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“…GISTs do not have a well-defined capsule; therefore, in cases of R1 resection, it is necessary to perform scar tissue removal, for example, by using (EFTR) with a dedicated Ovesco ® set (Tübingen, Germany). By comparison, Shichijo et al [ 15 ] presented the results of an alternative hybrid variant of the EFTR technique using elements of ESD, clipping, and ligating with endoloop. In 62% of the tumours, the resection margins were indeterminate, even in cases of deep resections followed by perforation.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the long-term efficacy of GIST removal by ESD is controversial, especially in cases of gastric wall defects and tumour ruptures [ 19 ]. The most common complications include perforations, which occur in 1.2–9.7% of cases, and bleeding (up to 15% cases) [ 12 , 14 , 15 , 17 , 18 , 20 , 21 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Deep resection during ESD, which is necessary to provide adequate excision, is associated with a perforation rate of up to 12% [ 11 , 12 , 13 , 14 ]. Thus, tumours infiltrating the deeper layers of the stomach wall may limit the clinical usefulness of some techniques [ 15 ]. In this study, we retrospectively compared ESD to the endoscopic hybrid resection technique in terms of safety, efficacy, and disease recurrence for selected types of GISTs.…”

Section: Introductionmentioning

confidence: 99%

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On the Track of New Endoscopic Alternatives for the Treatment of Selected Gastric GISTs—A Pilot Study

Raiter¹,

Pawlak

Kozłowska-Petriczko

et al. 2021

Medicina

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Background and Objectives: GISTs (Gastrointestinal stromal tumors) are the most common mesenchymal gastrointestinal tract tumours and are mainly located in the stomach. Their malignant potential depends on size, location, and type. Endoscopic techniques are a less invasive modality for patients not eligible for surgery. ESD (endoscopic submucosal dissection) is mainly used for the removal of smaller GISTs, with intraluminal growth and a more superficial location. Thus, R0 resection capability in some cases may be not sufficient, limited by tumour size, location in the gastric wall, and its connection level with the muscularis propria. In such cases, an endoscopic full-thickness resection can become a new alternative. In this retrospective pilot study, we evaluated ESD and hybrid resection techniques in terms of safety, efficacy, and disease recurrence for selected types of gastric GISTs. Materials and Methods: A retrospective comparison was conducted in a group of patients who underwent ESD or a hybrid technique combining endoscopic resection with endoscopic suturing using the OverStitch system (HT) for type II or III gastric GISTs. A total of 21 patients aged 70 ± 8 years underwent endoscopic resection. Seventeen lesions were treated with ESD and four with the HT. Results: R0 resection was achieved in all patients treated using HT (type III lesions) and in 53% of those treated with ESD (p = 0.08). None of the type III lesions treated with ESD were excised with R0. Lesions treated with R0 ESD resections were significantly smaller (1.76 ± 0.35 cm) than those with R1 ESD resections (2.39 ± 0.40 cm) (p < 0.01). The mean lesion size treated with the HT was 2.88 ± 0.85 cm. Conclusions: HT may be a new resection modality for large gastric GISTs with high muscularis propria connection grades. Further studies are required to evaluate its safety and efficacy and to form precise inclusion criteria for endoscopic resection techniques.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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On the Track of New Endoscopic Alternatives for the Treatment of Selected Gastric GISTs—A Pilot Study

Raiter¹,

Pawlak

Kozłowska-Petriczko

et al. 2021

Medicina

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“…We identified 11 retrospective cohort studies reporting short and mid-term outcomes of exposed EFTR of gastric SMTs, as summarized in Table 3. [47][48][49][50][51][52][53][54][55][56][57] Majority of the resected SMTs were confirmed to be GIST histologically. While the sample size of each series is still small, the published data demonstrated high complete resection rate (90.3%-100%).…”

Section: Endoscopic Full-thickness Resectionmentioning

confidence: 97%

Third space endoscopy: Current evidence and future development

Liu

Chiu

2020

Int J Gastrointest Interv

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Therapeutic endoscopy has evolved tremendously over the past decades and the development of submucosal endoscopy opens the third space for treatment of gastrointestinal diseases. This review focused on the recent development in third space endoscopy, with introduction of its development from peroral endoscopic myotomy (POEM) to beyond. Two recent randomized trials comparing POEM against pneumatic dilation and laparoscopic Heller myotomy (LHM) demonstrated significantly better relief of dysphagia for POEM compared to pneumatic dilation, while POEM achieved similar outcomes compared to LHM. Apart from achalasia, third space endoscopy is now developed to manage spastic esophageal motility disorders, esophageal diverticular diseases, gastroparesis, and Hirschsprung's disease. Subepithelial tumors can also be resected through tunneling and endoscopic fullthickness resection. In future, third space endoscopy will be one of the major areas in development of diagnostic and therapeutic endoscopy using novel imaging technologies and therapeutic devices.

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“…Despite the rapid development of endoscopic treatment in Japan, few authors have reported on the use of endoscopic treatments for gastrointestinal mesenchymal tumors (GIMTs) originating from the muscularis propria (MP) 1–4 . Six patients underwent endoscopic muscularis dissection (EMD) for GIMTs originating from the MP in our institute between September 2017 and August 2019.…”

Section: Brief Explanationmentioning

confidence: 99%