Endoscopic full-thickness resection with defect closure using an over-the-scope clip for gastric subepithelial tumors originating from the muscularis propria

Abstract

BackgroundEndoscopic full-thickness resection (EFTR) is a mini-invasive technique for gastric subepithelial tumors originating from the muscularis propria, which enables a full-thickness resection of tumors and can provide a complete basis for pathological diagnosis. Gastric fistula closure after EFTR is a challenge for endoscopists. In this study, we introduced EFTR with fistula closure using the over-the-scope clip (OTSC) system for gastric subepithelial tumors originating from the muscularis propria.ObjectivesTo evaluate the feasibility and safety of fistula closure with OTSC by a retrospective analysis on the cases of EFTR with defect closure using OTSC for gastric subepithelial tumors originating from the muscularis propria in our hospital.MethodsThe patients were selected who underwent EFTR for gastric subepithelial tumors originating from the muscularis propria (tumor diameter ≤2 cm) in our hospital from October 2013 to March 2014. After a full-thickness resection of tumors, the bilateral gastric mucous membranes of defect were clamped using twin graspers and then drawn into the transparent cap of OTSC, and the OTSC was released to close the defect after full suctioning. The success rate of defect closure with OTSC was observed, and the endoscopic follow-up was performed at 1 week, 1 and 6 months after operation to check OTSC closure.ResultsTotally 23 patients were included into the study. The full-thickness resection rate of gastric tumors in the muscularis propria was 100 % (23/23), the success rate of defect closure was 100 %, and the average time of defect closure was 4.9 min (range 2–12 min). All patients experienced no postoperative complications such as bleeding and perforation. The postoperative follow-up time was 1–6 months (mean 3 months), and no OTSC detachment was found.ConclusionsOTSC can be used to perform EFTR with defect closure for gastric tumors in the muscularis propria (tumor diameter ≤2 cm). It is simple, convenient, safe and effective.Electronic supplementary materialThe online version of this article (doi:10.1007/s00464-015-4076-2) contains supplementary material, which is available to authorized users.

A comparison of submucosal tunneling endoscopic resection and endoscopic full-thickness resection for gastric fundus submucosal tumors

“…Several endoscopic techniques have been reported for closure of the defect such as clips, endoloop and clips, over-the-scopeclips and endoscopic suturing devices. While most of these techniques require specialized equipment and demand a skillful handling, closure with clips is still widely accepted (6)(7)(8)(9)16,22,23). In the present study, the defects of the 28 EFTR cases were all successfully closed with clips.…”

“…Ikeda et al (20) (6)(7)(8)(9)(10)21). In the present study, 28 gastric fundus SMTs were removed by EFTR with an en bloc resection rate of 96.4%.…”

Current Status of Exposed Endoscopic Full-Thickness Resection and Further Development of Non-Exposed Endoscopic Full-Thickness Resection

“…Cai et al [6] previously reported that the resection opening of EFTR could be closed with a hemoclip; however, some factors should be taken under considerations, for example, the issue of training and the need for the development of suturing instruments and devices [12,13]. …”

“…Guo et al [13] reported 23 cases of exposed EFTR with a defective closure identified using an OTSC system (Ovesco Endoscopy GmbH, Tuebingen, Germany) retrospectively. EFTRs were successfully performed (100%) and no complication was observed such as perforation even 3 months after EFTRs.…”

Endoscopic closure of iatrogenic perforation

“…60 When focusing on the closure of iatrogenic gastric perforation, the overall success rate was 93%. 53,[60][61][62][63][64][65][66][67][68][69] EBL has been reported as an effective closure for gastric perforation with the size of 10, 15, and 20 mm in porcine model. Numbers of band used for closure were 2, 3, and 6 bands depending on the size of defect.…”