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

Kobara, Hideki; Nishiyama, Noriko; Fujihara, Shintaro; Tada, Naoya; Kozuka, Kazuhiro; Matsui, Takanori; Takata, Tadayuki; Chiyo, Taiga; Kobayashi, Nobuya; Fujita, Koji; Yachida, Tatsuo; Okano, Keiichi; Suzuki, Yasuyuki; Nishiyama, Akira; Mori, Hideki; Masaki, Tsutomu

doi:10.1055/a-1287-7482

Cited by 13 publications

(19 citation statements)

References 16 publications

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“…Similarly, this case series demonstrated that gastric full-thickness defects were successfully closed with OTSCs in all 14 cases. As shown in our video, the OTSC closure system enables us to achieve inverted seromuscular apposition [12,13]. A previous study indicated that inverted serosal apposition provides a more durable and reliable repair than everted mucosal apposition [14].…”

Section: Discussionmentioning

confidence: 66%

Endoscopic resection with one port placement: a newly developed technique for the safe management of advanced endoscopic resection for gastric gastrointestinal stromal tumors

Sawada

Hirasawa

Sato

et al. 2022

Preprint

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Backgrounds : Endoscopic full-thickness resection (EFTR) without laparoscopic assistance—pure EFTR—is an emerging, less invasive treatment for gastrointestinal stromal tumors (GISTs). However, the technique has seldom been applied outside of China due to concerns about pneumoperitoneum, maintenance of endoscopic view, and endoscopic suturing regarding its procedure. This study aimed to evaluate the efficacy and safety of endoscopic resection with one port placement (EROPP) for gastric GISTs. Methods This retrospective study included 14 patients with gastric GISTs originating from the muscularis propria who underwent EROPP between 2019 and 2021. One camera port was inserted in the umbilicus before starting the endoscopic procedure to maintain intra-abdominal pressure, which was monitored and adjusted via this port. While allowing for conversion to laparoscopic surgery if needed, EFTR was performed as follows: (1) circumferential incision of the mucosal and submucosal layer around the lesion by typical endoscopic submucosal dissection; (2) an intentional perforation and subsequent seromuscular resection using dental floss and an endo-clip for traction; and (3) closure of the gastric full-thickness defect with an over-the-scope-clip (OTSC) after peroral retrieval of the specimen. We retrospectively assessed the short-term outcomes and safety. Results All procedures were completed successfully without conversion to laparoscopic surgery. The median size of resected tumors was 23 mm (range, 10–35 mm) and the median procedure time was 37 min (range, 22–95 min). The rates of en bloc and curative resection were 100% and 86%, respectively. In two cases, another port was added to aspirate leaking fluid or to check the condition of the endoscopic closure. All gastric defects were endoscopically closed, mainly using OTSCs. The recovery course for all patients was uneventful and no adverse events were reported Conclusions EROPP is a safe and minimally invasive treatment for gastric GISTs and seems to be suitable as a pure EFTR procedure.

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Section: Discussionmentioning

confidence: 66%

Endoscopic resection with one port placement: a newly developed technique for the safe management of advanced endoscopic resection for gastric gastrointestinal stromal tumors

Sawada

Hirasawa

Sato

et al. 2022

Preprint

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“…In comparison with previously reported methods, modified LACC was easily available without special devices, because hand suturing and purse-string require a two-channel endoscope, and expensive devices are required for OTSC and OverStitch. However, median closure time for modified LACC (43.5 minutes) was not shorter than that of other reported methods for similar defect size in porcine or human studies: hand suturing, median 25 to 49.5 minutes 9 10 ; O-ring and OTSC, median 35.5 minutes 12 ; and pure-string suture, mean 14.6 minutes 8 . Further developments are needed to reduce procedure time.…”

Section: Discussionmentioning

confidence: 66%

“…a Multiple small incisions (basically eight incisions) just outside the defect were made circumferentially. minutes) was not shorter than that of other reported methods for similar defect size in porcine or human studies: hand suturing, median 25 to 49.5 minutes [9,10]; O-ring and OTSC, median 35.5 minutes [12]; and pure-string suture, mean 14.6 minutes [8]. Further developments are needed to reduce procedure time.…”

Section: Discussionmentioning

confidence: 75%

“…Several endoscopic closure devices and techniques have been developed, such as over-the-scope clip (OTSC) [2,5,6], purse-string suturing using endoloop and clips [1,7,8], hand suturing [9][10][11], O-ring and OTSC [12], and OverStitch [13], but these are complicated and require use of specific devices. For widespread use of EFTR, application of easily available and daily-use devices for closure is ideal.…”

Section: Introductionmentioning

confidence: 99%

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Modified line-assisted complete closure of the defect after gastric endoscopic full-thickness resection: a pilot study in porcine models

et al. 2022

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Background and study aims Closure after endoscopic full-thickness resection (EFTR) is challenging. We previously developed a simple endoscopic closure method: line-assisted complete closure (LACC). We performed a pilot study using porcine models to evaluate the feasibility of modified LACC after gastric EFTR. Patients and methods Six live pigs were included. EFTR (greater curvature of the gastric antrum [n = 3] and anterior wall of the gastric body [n = 3]) was performed under general anesthesia and the defect after EFTR was closed by modified LACC. The pigs were observed until postoperative day 4 (Day 4). The closure site was endoscopically evaluated and the presence or absence of peritonitis and fluid leakage was evaluated. The outcomes were the success rate of modified LACC on the day of the procedure, maintenance of defect closure, presence of peritonitis or leakage, and clinical course. Results Once complete closure was successfully achieved in all cases, maintenance of closure on Day 4 was not achieved. However, there was neither peritonitis nor fluid leakage. The defect was completely covered by surrounding tissues on Day 4 and the clinical course was good in all cases. Conclusions The feasibility of modified LACC after gastric EFTR was demonstrated in porcine models. Further improvement is needed to maintain defect closure.

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Section: Current Status Of Eftr: Various Applications With Outcomesunclassified

Endoscopic Full Thickness Resection: A Systematic Review

Pal

Ramchandani

Inavolu

et al. 2022

Journal of Digestive Endoscopy

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Background Endoscopic full thickness resection (EFTR) is an emerging therapeutic option for resecting subepithelial lesions (SELs) and epithelial neoplasms. We aimed to systematically review the techniques, applications, outcomes, and complications of EFTR. Methods A systematic literature search was performed using PubMed. All relevant original research articles involving EFTR were included for the review along with case report/series describing novel/rare techniques from 2001 to February 2022. Results After screening 7,739 citations, finally 141 references were included. Non-exposed EFTR has lower probability of peritoneal contamination or tumor seeding compared with exposed EFTR. Among exposed EFTR, tunneled variety is associated with lower risk of peritoneal seeding or contamination compared with non-tunneled approach. Closure techniques involve though the scope (TTS) clips, loop and clips, over the scope clips (OTSC), full thickness resection device (FTRD), and endoscopic suturing/plicating/stapling devices. The indications of EFTR range from esophagus to rectum and include SELs arising from muscularis propria (MP), non-lifting adenoma, recurrent adenoma, and even early gastric cancer (EGC) or superficial colorectal carcinoma. Other indications include difficult locations (involving appendicular orifice or diverticulum) and full thickness biopsy for motility disorders. The main limitation of FTRD is feasibility in smaller lesions (<20–25 mm), which can be circumvented by hybrid EFTR techniques. Oncologic resection with lymphadencetomy for superficial GI malignancy can be accomplished by hybrid natural orifice transluminal endoscopic surgery (NOTES) combining EFTR and NOTES. Bleeding, perforation, appendicitis, enterocolonic fistula, FTRD malfunction, peritoneal tumor seeding, and contamination are among various adverse events. Post OTSC artifacts need to be differentiated from recurrent/residual lesions to avoid re-FTRD/surgery. Conclusion EFTR is safe and effective therapeutic option for SELs, recurrent and non-lifting adenomas, tumors in difficult locations and selected cases of superficial GI carcinoma.

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

Cited by 13 publications

References 16 publications

Endoscopic resection with one port placement: a newly developed technique for the safe management of advanced endoscopic resection for gastric gastrointestinal stromal tumors

Endoscopic resection with one port placement: a newly developed technique for the safe management of advanced endoscopic resection for gastric gastrointestinal stromal tumors

Modified line-assisted complete closure of the defect after gastric endoscopic full-thickness resection: a pilot study in porcine models

Endoscopic Full Thickness Resection: A Systematic Review

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