Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria

Zhou, Ping‐Hong; Yao, Ling; Qin, Xinyu; Cai, Ming‐Yan; Xu, Mei‐Dong; Zhong, Yun‐Shi; Chen, Weifeng; Zhang, Yiqun; Qin, Wen‐Zheng; Hu, Jianwei; Liu, Jing-Zheng

doi:10.1007/s00464-011-1644-y

Cited by 279 publications

(244 citation statements)

References 18 publications

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“…Endoscopic resection is a first-line treatment for SMTs ≤50 mm in diameter (1,2). Alternative methods include endoscopic submucosal dissection (ESD), endoscopic submucosal excavation (ESE) and endoscopic full-thickness resection, but these may be associated with unsatisfactory outcomes due to incomplete resection and/or the risk of perforation during the procedure (3)(4)(5). Submucosal tunneling endoscopic resection (STER) has emerged as a novel technique for treating upper gastrointestinal SMTs and has yielded promising results (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Current status of submucosal tunneling endoscopic resection for gastrointestinal submucosal tumors originating from the muscularis propria layer (Review)

2017

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Abstract.Gastrointestinal submucosal tumors (SMTs) have been increasingly identified via the use of endoscopic ultrasonography, and removal is often recommended for SMTs that are >2 cm in diameter or symptomatic. Submucosal tunneling endoscopic resection (STER), also known as submucosal endoscopic tumor resection, endoscopic submucosal tunnel dissection or tunneling endoscopic muscularis dissection, is a novel endoscopic technique for treating gastrointestinal SMTs originating from the muscularis propria layer, and has been demonstrated to be effective in the removal of SMTs with a decreased rate of recurrence by clinical studies. STER may be performed for patients with esophageal or cardia SMTs, and its application has expanded beyond these types of SMTs due to modifications to the technique. The present study reviewed the applications, procedure, efficacy and complications associated with STER. IntroductionFollowing the identification of a gastrointestinal submucosal tumor (SMT), periodic surveillance using endoscopy and endoscopic ultrasonography (EUS) remains a major strategy, but the use of this strategy is associated with multiple concerns, including patient compliance and stress, cost-effectiveness, and the risks associated with repeated endoscopic procedures and delayed diagnosis of malignancy (1,2). Furthermore, certain tumors exhibit malignant potential, particularly those that originate from the muscularis propria (MP) layer or are large in diameter (1). Therefore, removing these SMTs is crucial. Current methods to remove SMTs include surgery and endoscopic resection, compared with the latter, surgical approaches are more invasive and associated with increased costs and a longer hospital stay. Endoscopic resection is a first-line treatment for SMTs ≤50 mm in diameter (1,2). Alternative methods include endoscopic submucosal dissection (ESD), endoscopic submucosal excavation (ESE) and endoscopic full-thickness resection, but these may be associated with unsatisfactory outcomes due to incomplete resection and/or the risk of perforation during the procedure (3-5). Submucosal tunneling endoscopic resection (STER) has emerged as a novel technique for treating upper gastrointestinal SMTs and has yielded promising results (6-17). STER possesses multiple advantages over other endoscopic methods, including the maintenance of mucosal integrity, the facilitation of an increased rate of healing and a decreased risk of pleural/abdominal infection. In addition, the submucosal tunnel helps to maintain a clear visual field, which facilitates an improved response to intraoperative bleeding. The present study summarized the current status of STER, including its applications, procedure, efficacy and complications. Preoperative assessmentPrior to performing STER, the presence, originating layer, size, and the presence or absence of malignancy-associated

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Section: Introductionmentioning

confidence: 99%

Current status of submucosal tunneling endoscopic resection for gastrointestinal submucosal tumors originating from the muscularis propria layer (Review)

2017

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“…Endoscopic full-thickness resection (EFTR) with or without laparoscopic cooperation has been successfully introduced as a promising technique for resection of gastric submucosal tumor in a clinical setting [1][2][3][4][5]. Furthermore, novel methods by which iatrogenic tumor dissemination can be prevented have been invented for gastric epithelial neoplasia.…”

Section: Introductionmentioning

confidence: 99%

Estimation of subepithelial lateral extent in submucosal early gastric cancer: retrospective histological analysis

et al. 2014

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Background Endoscopic full-thickness resection (EFTR) is expected to make possible minimally invasive local resection of early gastric cancer (EGC). However, no consensus exists regarding how far an optimal safety margin should be set in determining the resection area by endoscopy. We aimed to investigate the optimal lateral margin of EGC which could be a candidate for EFTR by measuring the subepithelial extent (SE) of tumors. Methods In 60 surgically resected submucosal EGCs 4 cm or smaller, 595 prepared slides which showed lateral tumor borders both on the epithelial surface and on the subepithelial layer were assessed. The distance between the epithelial and the subepithelial tumor edge was measured under microscopic observation, followed by analyses of the relationship between the measured SE and the histological characteristics. Results The average and the median SE were 1.1 mm (standard deviation 1.8 mm) and 0.3 mm (range 0-12.3 mm), respectively. The 99th percentile was 8.8 mm. With regard to the histological type, the median SE was significantly greater in diffuse-type tumor than in intestinal-type tumor (0.9 mm vs 0 mm, p \ 0.0001). With regard to the location of the subepithelilal tumor edge, the median SE was significantly greater in the submucosal layer than in the mucosal layer (2.6 mm vs 0.3 mm, p \ 0.0001). Conclusions In most lesions, the SE was less than 1 cm. A safety margin may be set at 1 cm in EFTR of submucosal EGC.

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“…With the enrichment of experience in ESD, endoscopic submucosal excavation and EFR were developed from ESD in order to remove submucosal gastrointestinal lesions, such as those that reach the muscularis propria layer and/or have close proximity to the serosa. EFR has produced good therapeutic effects and reduced the normal tissue resection (6). All four CFTs in this study originated from the muscularis propria, and 3 of 4 cases were extraluminal-growing.…”

Section: Shi Et Al Endoscopic Diagnosis and Treatment Of Cftmentioning

confidence: 69%

Endoscopic diagnosis and treatment of calcifying fibrous tumors

Shi¹,

Xu²,

Chen³

et al. 2015

Turk J Gastroenterol

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Background/Aims: The calcifying fibrous tumor (CFT) is classified as a benign fibrous lesion, and it is a rare pathologic entity. We evaluated the feasibility, efficacy and safety of endoscopy treatment for CFT. Materials and Methods: We retrospectively analyzed a total of 4 gastric CFTs that were treated with ESD or EFR at the endoscopic center of Zhongshan Hospital, Fudan University, in Shanghai, between Jan 2007 and Sept 2011. We used endoscopic ultrasound (EUS) to assess whether endoscopy treatment was suitable. Tumor characteristics, complications, the en bloc resection rate, and the local recurrence rate were evaluated. Results: Of the 4 patients, the median age was 55.5 years old. The mean maximum size of the lesions was 1.95±0.67 (range: 1.0-2.5). The EUS features of the lesions included a mass in the muscularis propria of the gastric wall and a heterogeneous hypoechoic (1/4) or homogeneous (3/4) hypoechoic pattern. All of the endoscopic treatments were completed successfully. The en bloc resection rate was 100%. Confirmed diagnoses were made by pathologic results. No local recurrence or complications were observed during the follow-up period (ranging from 15 to 28 months). Conclusion: Endoscopic treatment, especially ESD/EFR, appears to be a feasible and safe procedure for CFT with relatively few complications and low mortality.

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Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria

Abstract: EFR seems to be an efficacious, safe, and minimally invasive treatment for patients with gastric SMT, which makes it possible to resect deep gastric lesion and provide precise pathological diagnosis of it. With the development of EFR, the indication of endoscopic resection may be expanded.

Cited by 279 publications

References 18 publications

Current status of submucosal tunneling endoscopic resection for gastrointestinal submucosal tumors originating from the muscularis propria layer (Review)

Current status of submucosal tunneling endoscopic resection for gastrointestinal submucosal tumors originating from the muscularis propria layer (Review)

Estimation of subepithelial lateral extent in submucosal early gastric cancer: retrospective histological analysis

Endoscopic diagnosis and treatment of calcifying fibrous tumors

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