The efficacy of dental floss and a hemoclip as a traction method for the endoscopic full-thickness resection of submucosal tumors in the gastric fundus

Li, Bing; Shi, Qiang; Zhang, Qi; Yao, Ling; Xu, Mei‐Dong; Lv, Zhen-Tao; Yalikong, Ayimukedisi; Cai, Shi‐Lun; Sun, Da; Zhou, Ping‐Hong; Zhong, Yun‐Shi

doi:10.1007/s00464-019-06920-w

Cited by 26 publications

(32 citation statements)

References 29 publications

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“…Of these potential papers, 35 were excluded (▶ Table 1). Finally, 15 original articles were included in final analysis [10][11][12][22][23][24][25][26][27][28][29][30][31][32][33]. A flow diagram summarizing the procedure of study selection is presented in ▶ Fig.…”

Section: Study Selectionmentioning

confidence: 99%

Efficacy and safety of gastric exposed endoscopic full-thickness resection without laparoscopic assistance: a systematic review

et al. 2020

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Background and study aims Exposed endoscopic full-thickness resection (Eo-EFTR) without laparoscopic assistance is a minimally invasive natural orifice transluminal endoscopic surgery (NOTES) technique that has shown promising efficacy and safety in resection of gastric submucosal tumors (G-SMTs) arising from muscularis propria (MP). However, data on the efficacy and safety of gastric Eo-EFTR mostly come from relatively small retrospective studies and concern regarding its use still exists. The aim of our systematic review was to assess the efficacy and safety of gastric Eo-EFTR without laparoscopic assistance. Methods A detailed MEDLINE and EMBASE search was performed for papers published from January 1998 to November 2019 and reporting on gastric Eo-EFTR without laparoscopic assistance. The search strategy used the terms “endoscopic full thickness resection” and “gastric” or “stomach”. The primary outcomes were complete resection and surgical conversion rates. The secondary outcomes were overall major adverse events, delayed bleeding, delayed perforation, peritonitis, abdominal abscess and/or abdominal infection and successful Eo-EFTR. Results Fifteen Asian studies were included in our final review, providing data on 750 Eo-EFTR-treated G-SMTs. The per-lesion rate of complete resection and surgical conversion were 98.8 %\0.8 %, respectively. The per-lesion rate of major adverse events, delayed bleeding, delayed perforation and peritonitis, abdominal abscess and/or abdominal infection was 1.6 %\0.5 %\0.1 %\0.9 %, respectively. The per-lesion rate of successful Eo-EFTR (i. e. complete tumor resection and effective endoscopic defect closure) was 98.3 %. Conclusions Eo-EFTR without laparoscopic assistance appears to be highly effective and safe NOTES for removing deep G-SMTs, particularly those arising from MP layer.

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Section: Study Selectionmentioning

confidence: 99%

Efficacy and safety of gastric exposed endoscopic full-thickness resection without laparoscopic assistance: a systematic review

et al. 2020

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“…However, the procedure time may have been influenced by the severity of adhesion between the omentum and serosa because dissection of the severely adhered lesser omentum took the longest time in the posterior wall. A large-scale study showed the superiority of traction-assisted EFTR (n = 64) over non-assisted EFTR (n = 128) in terms of the total procedure time (44.2 vs. 54.2 min) and complication rate (3.1 % vs. 12.5 %) [12]. However, the description of the circumferential resection order was unclear.…”

Section: Discussionmentioning

confidence: 99%

Traction-assisted endoscopic full-thickness resection followed by O-ring and over-the-scope clip closure in the stomach: an animal experimental study

et al. 2021

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Background and study aims Exposed endoscopic full-thickness resection (EFTR) enables the operator to obtain a sufficient surgical margin. However, insufflation leakage and secure endoscopic full-thickness closure (EFTC) remain problematic. This study aimed to evaluate the safety and feasibility of a new exposed EFTR. Patients and methods Exposed EFTR was performed for 2-cm virtual lesions in different locations of the upper stomach in four dogs. EFTR mainly involved half-circumferential EFTR of the endpoint and clip-line traction. Pulley traction was applied with the forward approach for the greater curvature. EFTC involved endoscopic ligation with O-ring closure to diminish insufflation leakage, followed by over-the-scope clip closure. Results Complete resection and technical success were achieved in all four cases. One case of intraoperative bleeding was endoscopically managed. No postoperative complications occurred in any cases. The median maximum resected size was 27.5 mm. The median procedure time of the total operation, EFTR, and EFTC was 76, 37, and 35.5 minutes, respectively. The 1-month survival rate was 100 %. Conclusions This therapeutic strategy may lead to the establishment of exposed EFTR.

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“…In a previous study, we also investigated the efficacy of a simple traction method that used dental floss and a hemoclip to facilitate endoscopic full-thickness resection for submucosal tumors in the gastric fundus. 7 This traction method contributed to a shorter procedure time and lower adverse event rate. For colorectal lesions, we usually obtain traction by changing the patient's position to take advantage of the gravitational effect of the lesion itself.…”

Section: Responsementioning

confidence: 95%

“…In our recent series of 600 colonic cases performed by use of the DCT strategy, the cecal and nongranular laterally spreading tumors were predictive of success. 7 Li et al 1 report that such lesions were predictive of difficulty!A scoring system that predicts the difficulty and outcomes of colorectal ESD remains desirable, but it is important to choose the most clinically relevant endpoint when defining difficulty.…”

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procedure and also the factors that render the procedure challenging. In our recent series of 600 colonic cases performed by use of the DCT strategy, the cecal and nongranular laterally spreading tumors were predictive of success. 7 Li et al 1 report that such lesions were predictive of difficulty!A scoring system that predicts the difficulty and outcomes of colorectal ESD remains desirable, but it is important to choose the most clinically relevant endpoint when defining difficulty.

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The efficacy of dental floss and a hemoclip as a traction method for the endoscopic full-thickness resection of submucosal tumors in the gastric fundus

Cited by 26 publications

References 29 publications

Efficacy and safety of gastric exposed endoscopic full-thickness resection without laparoscopic assistance: a systematic review

Efficacy and safety of gastric exposed endoscopic full-thickness resection without laparoscopic assistance: a systematic review

Traction-assisted endoscopic full-thickness resection followed by O-ring and over-the-scope clip closure in the stomach: an animal experimental study

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