Endoscopy dissection of small stromal tumors emerged from the muscularis propria in the upper gastrointestinal tract: Preliminary study

Huang, Zhigang

doi:10.4253/wjge.v4.i12.565

Cited by 28 publications

(18 citation statements)

References 23 publications

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“…The enucleation method for GIST has higher risk of perforation than those methods used in early gastric cancer because GIST originates from a proper muscle layer and deeper dissection is necessary for the complete dissection 110,111. Additionally, a risk of incomplete resection coexists because GISTs are frequently fragile and do not form a true capsule.…”

Section: Endoscopic Enucleationmentioning

confidence: 99%

Surgical Treatment of Gastric Gastrointestinal Stromal Tumor

Suh

Yang

2013

J Gastric Cancer

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Gastrointestinal stromal tumor is the most common mesenchymal tumor in the gastrointestinal tract and is most frequently developed in the stomach in the form of submucosal tumor. The incidence of gastric gastrointestinal stromal tumor is estimated to be as high as 25% of the population when all small and asymptomatic tumors are included. Because gastric gastrointestinal stromal tumor is not completely distinguished from other submucosal tumors, a surgical excisional biopsy is recommended for tumors >2 cm. The surgical principles of gastrointestinal stromal tumor are composed of an R0 resection with a normal mucosa margin, no systemic lymph node dissection, and avoidance of perforation, which results in peritoneal seeding even in cases with otherwise low risk profiles. Laparoscopic surgery has been indicated for gastrointestinal stromal tumors <5 cm, and the indication for laparoscopic surgery is expanded to larger tumors if the above mentioned surgical principles can be maintained. A simple exogastric resection and various transgastric resection techniques are used for gastrointestinal stromal tumors in favorable locations (the fundus, body, greater curvature side). For a lesion at the gastroesophageal junction in the posterior wall of the stomach, enucleation techniques have been tried preserve the organ's function. Those methods have a theoretical risk of seeding a ruptured tumor, but this risk has not been evaluated by well-designed clinical trials. While some clinical trials are still on-going, neoadjuvant imatinib is suggested when marginally unresectable or multiorgan resection is anticipated to reduce the extent of surgery and the chance of incomplete resection, rupture or bleeding.

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Section: Endoscopic Enucleationmentioning

confidence: 99%

Surgical Treatment of Gastric Gastrointestinal Stromal Tumor

Suh

Yang

2013

J Gastric Cancer

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“…CO2 insufflation was used in all procedures. ESE and STER procedures have been reported in various literatures [3][4][5][6][7][8][9][10][11][12]; here, we briefly described the key steps illustrated by endoscopic images.…”

Section: Procedures Of Ese and Stermentioning

confidence: 98%

“…Endoscopic submucosal excavation (ESE) and submucosal tunneling endoscopic resection (STER) provide definitive histological diagnosis as well as therapeutic approaches for GI submucosal tumors (SMTs) arising from muscularis propria (MP), which used to be a diagnostic dilemma [2]. While ESE is basically a technical extension of ESD-just excavating deeper into MP [3][4][5][6][7]; STER uses a submucosal tunnel as an operating space to resect targeted tumor. This recently rising tunneling technique possesses an obvious advantage of preserving the integrity of covering mucosa as a barrier against air/ liquid leakage.…”

mentioning

confidence: 99%

Endoscopic resection of submucosal tumors in muscularis propria: the choice between direct excavation and tunneling resection

et al. 2014

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“…After descriptions of dissection of tumors off the muscular layer without full-thickness resection using techniques similar to endoscopic submucosal dissection (variously called enucleation, endoscopic muscular dissection, or endoscopic submucosal excavation) [54][55][56], including TTS clip closure of transmural perforations during the resection attempt [57,58], investigators started to pursue EFTR. Zhou et al [59] published a series of 26 patients with successful "cut-first" EFTR of gastric SETs (primarily gastrointestinal stromal tumor [GIST] and leiomyoma) with successful TTS clip or omental patch clip closure of all cases and without complications.…”

Section: Gastric Subepithelial Tumorsmentioning

confidence: 99%