Abstract:Objective Endoscopic submucosal excavation (ESE) has been established as an effective method for removal of gastric submucosal tumors (SMTs). The aim of the present study was to explore risk factors for technical difficulties in ESE. Methods In this retrospective study, we collected clinical data from patients who underwent ESE for gastric SMTs. Difficult ESE was defined as a procedure time ≥90 minutes, piecemeal resection, and/or occurrence of major adverse events. Univariate and multivariate analyses were pe… Show more
“…The ESE procedure ( Figure 2 ) and EFTR procedure ( Figure 3 ) were performed as previously reported. 20–22 Figure 2 ESE treatment of solitary gastric neurofibroma. ( A ) Submucosal bulge of posterior gastric fundus; ( B ) EUS showed that the solitary GN was hypoechoic; ( C ) incision and stripping of tumor mucosa; ( D ) exposing and excavating lesions; ( E ) ESE wound after tumor excavation; ( F ) metal clip to close the wound; ( G ) excavated tumor specimen.…”
Section: Methodsmentioning
confidence: 99%
“…The postoperative management was performed as previously reported. 20–22 Patients were fasted for 3–5 days and gradually transitioned to a normal diet in two weeks, all of whom intravenous proton-pump inhibitor (PPI) and antibiotics were used for 3 days. Patients need to review gastroscopy at the 3th, 6th, 12th months after the ESE/EFTR for the first year, and then once a year.…”
Purpose
The studies on solitary gastric neurofibroma (GN) consist of only individual case reports, with little data and relevant information. We aimed to summarize the clinical features, endoscopic features, imaging findings, and pathological features and study the safety and efficacy of endoscopic treatment of solitary GN.
Patients and Methods
We retrospectively collected and analyzed clinical data of patients who underwent endoscopic treatment in Department of Gastroenterology of a well-known tertiary hospital from August 2007 to September 2019 and were accurately diagnosed as having solitary GN.
Results
A total of 788 patients with gastric submucosal tumors underwent endoscopic treatment, among whom 11 patients were found to have solitary GNs. The incidence of solitary GNs was 1.4%. All 11 patients were treated with endoscopy. Five patients underwent endoscopic full-thickness resection (EFTR) and six patients underwent endoscopic submucosal excavation (ESE). The en bloc resection rate of the 11 lesions was 100.0%. The median endoscopic operation time was 80 minutes. Average length of hospital stay was 6.4 ± 1.6 days. The median follow-up time was 29 months. No recurrence, distant metastasis, or disease-related death occurred during the follow-up.
Conclusion
EFTR and ESE can serve as feasible, safe, and effective treatments for solitary GN.
“…The ESE procedure ( Figure 2 ) and EFTR procedure ( Figure 3 ) were performed as previously reported. 20–22 Figure 2 ESE treatment of solitary gastric neurofibroma. ( A ) Submucosal bulge of posterior gastric fundus; ( B ) EUS showed that the solitary GN was hypoechoic; ( C ) incision and stripping of tumor mucosa; ( D ) exposing and excavating lesions; ( E ) ESE wound after tumor excavation; ( F ) metal clip to close the wound; ( G ) excavated tumor specimen.…”
Section: Methodsmentioning
confidence: 99%
“…The postoperative management was performed as previously reported. 20–22 Patients were fasted for 3–5 days and gradually transitioned to a normal diet in two weeks, all of whom intravenous proton-pump inhibitor (PPI) and antibiotics were used for 3 days. Patients need to review gastroscopy at the 3th, 6th, 12th months after the ESE/EFTR for the first year, and then once a year.…”
Purpose
The studies on solitary gastric neurofibroma (GN) consist of only individual case reports, with little data and relevant information. We aimed to summarize the clinical features, endoscopic features, imaging findings, and pathological features and study the safety and efficacy of endoscopic treatment of solitary GN.
Patients and Methods
We retrospectively collected and analyzed clinical data of patients who underwent endoscopic treatment in Department of Gastroenterology of a well-known tertiary hospital from August 2007 to September 2019 and were accurately diagnosed as having solitary GN.
Results
A total of 788 patients with gastric submucosal tumors underwent endoscopic treatment, among whom 11 patients were found to have solitary GNs. The incidence of solitary GNs was 1.4%. All 11 patients were treated with endoscopy. Five patients underwent endoscopic full-thickness resection (EFTR) and six patients underwent endoscopic submucosal excavation (ESE). The en bloc resection rate of the 11 lesions was 100.0%. The median endoscopic operation time was 80 minutes. Average length of hospital stay was 6.4 ± 1.6 days. The median follow-up time was 29 months. No recurrence, distant metastasis, or disease-related death occurred during the follow-up.
Conclusion
EFTR and ESE can serve as feasible, safe, and effective treatments for solitary GN.
“…A limitation with ESD is risk of perforation for submucosal mass lesions arising from the muscularis propria layer due to the depth of the involvement. Both STER and ESE are minimally invasive techniques with high reported complete resection rates [5 ▪▪ ,30 ▪ ]. The STER technique involves creation of a submucosal tunnel via a longitudinal incision typically performed 5 cm proximal to the lesion followed by resection and retrieval of the lesion and then closure of the tunnel via endoscopic clips or suture.…”
Purpose of reviewGastric submucosal mass lesions are a collection of tumours that arise in the stomach and are deep to the mucosal layer. Distinct from gastric epithelial carcinomas, these tumours are generally more indolent. They are often found incidentally on upper endoscopy. Most often they present as smooth protuberant masses covered by normal intact gastric mucosa. The majority are asymptomatic. Endoscopic ultrasound (EUS) is frequently employed to further characterize the lesions. EUS can be diagnostic of some lesions, such as lipomas, and can be used to guide fine needle aspiration to diagnose others. Adding to the traditional management approaches of observation and surgical resection, numerous new and emerging endoscopic therapies are now being used to resect these gastric tumours.Recent findingsThis review focuses on evolving strategies in the diagnosis and management of submucosal mass lesions. Although surgical intervention was once the lone option for intervention, there are an increasing number of endoscopic therapies. There have also been advancements in neoadjuvant therapies and in distinguishing the malignant potential of submucosal mass lesions.SummaryGastric submucosal lesions are common. EUS is frequently indicated in the evaluation and diagnosis. For tumours for which observation is not recommended, novel endoscopic therapies may offer less invasive management options.
“…Procedural difficulty in EFTR may be variable depending on endoscopist experience, 39 lesion size, 40 and tumor location. Submucosal tumors in the fundus have been associated with greater technical difficulty during endoscopic resection 41,42 .…”
Section: Endoscopic Resection Of Gastric Gistmentioning
confidence: 99%
“…19 Tunneled EFTR may result in lower peritoneal seeding for higher risk SETs but the presence of tumor ulceration often presents difficulty during submucosal dissection and may result in a separate mucosal defect away from the entrance of the tunnel. Procedural difficulty in EFTR may be variable depending on endoscopist experience, 39 lesion size, 40 and tumor location. Submucosal tumors in the fundus have been associated with greater technical difficulty during endoscopic resection.…”
Section: Development and Progress Of Lecs And Related Proceduresmentioning
Management of upper gastrointestinal (UGI) tract gastrointestinal stromal tumor (GIST) has evolved significantly over the past two decades. For GIST size smaller than 5 cm, laparoscopic resection has become the current standard. To avoid postoperative gastric deformity and preserve gastric function, laparoscopic endoscopic cooperative surgery (LECS) was developed and various modifications have been reported and utilized successfully. Pure endoscopic resection techniques have also been reported at a similar period of time, which further push the boundary of incisionless surgery in managing these lesions. Both tunneling and nontunneling exposed type endoscopic full thickness resection are well described procedures for resection of small UGI GIST. In this review, a summary of these procedures is provided, and the pros and cons of each technique from the perspective of a surgical endoscopist are discussed in detail. LECS and endoscopic resection are complementary to each other. The choice of technique should be tailored to the location, morphology, and size of the target lesions, taking into account the experience of the laparoscopic surgeons and endoscopists.
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