Feasibility of endoscopic resection without laparoscopic assistance for giant gastric subepithelial tumors originating from the muscularis propria layer (with video)

Yu, Zhang; Meng, Qian; Zhou, Xian-Bin; Chen, Guang; Zhu, Lin-Hong; Mao, Xin-Li; Ye, Li-Ping

doi:10.1007/s00464-022-09019-x

Cited by 4 publications

(6 citation statements)

References 21 publications

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“…Moreover, tumors with extraluminal growth are at risk of falling into the peritoneal cavity during resection. As for defect closure, the circular perforation and edema of incisal edges increase the difficulty in defect closure with clips 6 . Long‐term intraperitoneal exposure to gastric contents and air also increases the risk of localized peritonitis and aeroperitoneum.…”

Section: Discussionmentioning

confidence: 99%

“…As for defect closure, the circular perforation and edema of incisal edges increase the difficulty in defect closure with clips. 6 Long-term intraperitoneal exposure to gastric contents and air also increases the risk of localized peritonitis and aeroperitoneum. With advances in endoscopic techniques, several devices are used to close defects.…”

Section: Discussionmentioning

confidence: 99%

“…With advances in endoscopic techniques, exposed endoscopic full-thickness resection (Eo-EFTR), which creates an intentional perforation and resects the tumor with the full thickness of the stomach wall, has proven to be an effective and minimally invasive treatment for gastric SMTs originating from the deep muscularis propria layer or with extraluminal growth. [6][7][8][9] The resection procedure is challenging, with a need to create adequate exposure of the operative field of vision, a risk of tumor falling into the peritoneal cavity, and in particular, subsequent defect closure to avoid peritonitis, pneumoperitoneum, and late perforation. 10 In recent years, some suture devices and modalities have been developed to simplify the closure, such as endoloop and clips that are used for purse-string suture, 11,12 the OverStitch system, 13 and the over-the-scope clip (OTSC).…”

Section: Introductionmentioning

confidence: 99%

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A modified exposed endoscopic full‐thickness resection: Traction‐assisted resection while defect closing

Nan

et al. 2023

J of Digest Diseases

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Objectives: Exposed endoscopic full-thickness resection (Eo-EFTR) has proven effective and economical for patients with gastric submucosal tumors (SMTs), showing great prospects. However, the poor operative field of view, the risk of tumors falling into the peritoneal cavity, especially the difficulties in defect closure, have limited its widespread application. Herein, we described a modified traction-assisted Eo-EFTR technique aimed at simplifying both the dissection and defect closure procedures.Methods: Nineteen patients who underwent the modified Eo-EFTR for gastric SMTs in the Chinese People's Liberation Army General Hospital were enrolled in the study. Following a 2/3 circumferential full-thickness incision, a clip with dental floss was anchored to the resected part of the tumor surface. With the dental floss traction, the gastric defect was reshaped into a V shape, which facilitated the deployment of clips to close the defect. The defect closure and tumor dissection procedures were then performed alternately. Patients' demographics, tumor characteristics, and therapeutic outcomes were evaluated retrospectively. Results: All tumors had an R0 resection. The median procedure time was 43 min (range 28-89 min). No severe perioperative adverse events occurred. Two patients experienced transient fever, and three patients complained of mild abdominal pain on the first day after the operation. All patients recovered on the next day with conservative management. No residual lesion or recurrence was reported during the follow-up period of 30.1 months. Conclusion:The safety and practicability of the modified technique might allow for wide clinical applications of Eo-EFTR in gastric SMTs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A modified exposed endoscopic full‐thickness resection: Traction‐assisted resection while defect closing

Nan

et al. 2023

J of Digest Diseases

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“…Recently, the European Society of Gastrointestinal Endoscopy (ESGE) guidelines have suggested that ER for gastric GISTs of size < 3.5 cm with intraluminal growth is an alternative to laparoscopic surgery[ 6 ]. With advances in endoscopic techniques for the closure of large gastric wall defects, a Chinese study found that it is feasible to treat giant gastric SETs of size ≥ 6 cm by ER with favorable long-term outcomes, although the minimum diameter of the tumor was associated with en bloc resection[ 26 ]. In our early period of ER, there were two cases of tumors > 5 cm in size, and we found it difficult to perform endoscopic retrieval of the entire tumor.…”

Section: Discussionmentioning

confidence: 99%

Goldilocks principle of minimally invasive surgery for gastric subepithelial tumors

Chang,

Tsao,

Yen

et al. 2023

World J Gastrointest Surg

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Tumour rupture of gastrointestinal stromal tumours (GISTs) has been considered to be a remarkable risk factor because of its unfavourable impact on the oncological outcome. Although tumour rupture has not yet been included in the current tumor-node-metastasis classification of GISTs as a prognostic factor, it may change the natural history of a low-risk GIST to a high-risk GIST. Originally, tumour rupture was defined as the spillage or fracture of a tumour into a body cavity, but recently, new definitions have been proposed. These definitions distinguished from the prognostic point of view between the major defects of tumour integrity, which are considered tumour rupture, and the minor defects of tumour integrity, which are not considered tumour rupture. Moreover, it has been demonstrated that the risk of disease recurrence in R1 patients is largely modulated by the presence of tumour rupture. Therefore, after excluding tumour rupture, R1 may not be an unfavourable prognostic factor for GISTs. Additionally, after the standard adjuvant treatment of imatinib for GIST with rupture, a high recurrence rate persists. This review highlights the prognostic value of tumour rupture in GISTs and emphasizes the need to carefully take into account and minimize the risk of tumour rupture when choosing surgical strategies for GISTs.

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“…Perioperative bleeding is another major complication of endoscopic resection of upper gastrointestinal tumors. The incidence of perioperative bleeding reported by recent studies ranges from 0 to 38.7%, which shows a high degree of variability (30,31).…”

Section: Other Endoscopic Approachestechniques Safety and Associated ...mentioning

confidence: 99%

Advances in endoscopic resection techniques of small gastric tumors originating from the muscularis propria

et al. 2022

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Gastrointestinal stromal tumors are common gastrointestinal tumors typically originating from the muscularis propria layer of the stomach. Small gastric stromal tumors are usually detected incidentally during routine endoscopic examination. Although they may have malignant potentially, controversies remain regarding the need for endoscopic resection of small gastric stromal tumors originating from the muscularis propria. According to the guidelines of the European Society of Medical Oncology, all gastrointestinal stromal tumors >2 cm in size should be resected with endoscopic surveillance recommended for tumors <2 cm. Endoscopic resection including endoscopic mucosal dissection (EMD), endoscopic submucosal dissection (ESD), submucosal tunneling endoscopic resection and snare assisted endoscopic resection. However, EMD and ESD procedures may be accompanied with serious complications including perforation, bleeding, and abdominal infection. Snare-assisted endoscopic resection is an alternative approach and has the advantages of a shorter procedure time and a low rate of perforation or bleeding. This study summarizes the safety and feasibility of a novel snare-assisted endoscopic resection technique and highlights the pros and cons of the different endoscopic approaches currently used for subepithelia small gastric tumors.

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Feasibility of endoscopic resection without laparoscopic assistance for giant gastric subepithelial tumors originating from the muscularis propria layer (with video)

Cited by 4 publications

References 21 publications

A modified exposed endoscopic full‐thickness resection: Traction‐assisted resection while defect closing

A modified exposed endoscopic full‐thickness resection: Traction‐assisted resection while defect closing

Goldilocks principle of minimally invasive surgery for gastric subepithelial tumors

Advances in endoscopic resection techniques of small gastric tumors originating from the muscularis propria

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