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Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria

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Abstract

Background

This study was designed to evaluate the clinical efficacy, safety, and feasibility of endoscopic full-thickness resection (EFR) for gastric submucosal tumors (SMTs) originated from the muscularis propria.

Methods

Twenty-six patients with gastric SMTs originated from the muscularis propria were treated by EFR between July 2007 and January 2009. EFR technique consists of five major procedures: (1) injecting normal saline into the submucosa and precutting the mucosal and submucosal layer around the lesion; (2) a circumferential incision as deep as muscularis propria around the lesion by the endoscopic submucosal dissection (ESD) technique; (3) incision into serosal layer around the lesion with Hook knife; (4) completion of full-thickness incision to the tumor including the serosal layer with Hook, IT, or snare by gastroscopy without laparoscopic assistance; (5) closure of the gastric-wall defect with metallic clips.

Results

EFR was successfully performed in all 26 patients without laparoscopic assistance. The complete resection rate was 100%, and the mean operation time was 105 (range, 60–145) min. The mean resected lesion size was 2.8 (range, 1.2–4.5) cm. Pathological diagnosis of these lesions included gastrointestinal stromal tumors (GISTs) (16/26), leiomyomas (6/26), glomus tumors (3/26), and Schwannoma (1/26). No gastric bleeding, peritonitis sign, or abdominal abscess occurred after EFR. No lesion residual or recurrence was found during the follow-up period (mean, 8 months; range, 6–24 months).

Conclusions

EFR seems to be an efficacious, safe, and minimally invasive treatment for patients with gastric SMT, which makes it possible to resect deep gastric lesion and provide precise pathological diagnosis of it. With the development of EFR, the indication of endoscopic resection may be expanded.

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References

  1. Oyama T, Kikuchi Y (2002) Aggressive endoscopic mucosal resection in the upper GI tract—Hook knife EMR method. Min Invas Ther Allied Technol 11:291–295

    Google Scholar 

  2. Gotoda T, Kondo H, Ono H, Saito Y, Yamaguchi H, Saito D, Yokota T (1999) A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases. Gastrointest Endosc 50:560–563

    Article  PubMed  CAS  Google Scholar 

  3. Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229

    Article  PubMed  CAS  Google Scholar 

  4. Rosch T, Sarbia M, Schumacher B, Deinert K, Frimberger E, Toermer T, Stolte M, Neuhaus H (2004) Attempted endoscopic en bloc resection of mucosal and submucosal tumors using insulated-tip knives: a pilot series. Endoscopy 36:788–801

    Article  PubMed  CAS  Google Scholar 

  5. Minami S, Gotoda T, Ono H, Oda I, Hamanaka H (2006) Complete endoscopic closure of gastric perforation induced by endoscopic resection of early gastric cancer using endoclips can prevent surgery (with video). Gastrointest Endosc 63:596–601

    Article  PubMed  Google Scholar 

  6. DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF (2000) Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 231:51–58

    Article  PubMed  CAS  Google Scholar 

  7. Joensuu H, Fletcher C, Dimitrijevic S, Silberman S, Roberts P, Demetri G (2002) Management of malignant gastrointestinal stromal tumours. Lancet Oncol 3:655–664

    Article  PubMed  CAS  Google Scholar 

  8. Fritscher-Ravens A, Cuming T, Jacobsen B, Seehusen F, Ghanbari A, Kahle E, von Herbay A, Koehler P, Milla P (2009) Feasibility and safety of endoscopic full-thickness esophageal wall resection and defect closure: a prospective long-term survival animal study. Gastrointest Endosc 69:1314–1320

    Article  PubMed  Google Scholar 

  9. von Renteln D, Riecken B, Walz B, Muehleisen H, Caca K (2008) Endoscopic GIST resection using FlushKnife ESD and subsequent perforation closure by means of endoscopic full-thickness suturing. Endoscopy 40(Suppl 2):E224–E225

    Article  Google Scholar 

  10. Dray X, Giday SA, Buscaglia JM, Gabrielson KL, Kantsevoy SV, Magno P, Assumpcao L, Shin EJ, Reddings SK, Woods KE, Marohn MR, Kalloo AN (2009) Omentoplasty for gastrotomy closure after natural orifice transluminal endoscopic surgery procedures (with video). Gastrointest Endosc 70:131–140

    Article  PubMed  Google Scholar 

  11. von Renteln D, Schmidt A, Riecken B, Caca K (2008) Gastric full-thickness suturing during EMR and for treatment of gastric-wall defects (with video). Gastrointest Endosc 67:738–744

    Article  Google Scholar 

  12. Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S, Kobayashi K, Hashimoto T, Yamamichi N, Tateishi A (2006) Successful nonsurgical management of perforation complicating endoscopic submucosal dissection of gastrointestinal epithelial neoplasms. Endoscopy 38:1001–1006

    Article  PubMed  CAS  Google Scholar 

  13. Zhou P, Yao L, Qin X, Xu M, Zhong Y, Chen W (2009) Endoscopic submucosal dissection for locally recurrent colorectal lesions after previous endoscopic mucosal resection. Dis Colon Rectum 52:305–310

    Article  PubMed  Google Scholar 

  14. Zhou PH, Yao LQ, Qin XY (2009) Endoscopic submucosal dissection for colorectal epithelial neoplasm. Surg Endosc 23:1546–1551

    Article  PubMed  Google Scholar 

  15. Kantsevoy SV (2006) Endoscopic full-thickness resection: new minimally invasive therapeutic alternative for GI-tract lesions. Gastrointest Endosc 64:90–91

    Article  PubMed  Google Scholar 

  16. Abe N, Mori T, Takeuchi H, Ueki H, Yanagida O, Masaki T, Sugiyama M, Atomi Y (2008) Successful treatment of early stage gastric cancer by laparoscopy-assisted endoscopic full-thickness resection with lymphadenectomy. Gastrointest Endosc 68:1220–1224

    Article  PubMed  Google Scholar 

  17. Abe N, Takeuchi H, Yanagida O, Masaki T, Mori T, Sugiyama M, Atomi Y (2009) Endoscopic full-thickness resection with laparoscopic assistance as hybrid NOTES for gastric submucosal tumor. Surg Endosc 23:1908–1913

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported by the Medical Leading Project of Shanghai Municipal Science and Technology Committee (10411969600), Major Project of Shanghai Municipal Science and Technology Committee (09DZ1950102), Key Project of Shanghai Municipal Science and Technology Committee (09JC1403300), Special Project of Public Welfare Fund of Ministry of Health (200902002-3).

Disclosures

Drs. Ping-Hong Zhou, Li-Qing Yao, Xin-Yu Qin, Ming-Yan Cai, Mei-Dong Xu, Yun-Shi Zhong, Wei-Feng Chen, Yi-Qun Zhang, Wen-Zhen Qin, Jian-Wei Hu, and Jing-Zheng Liu have no conflicts of interest or financial ties to disclose.

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Correspondence to Li-Qing Yao.

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Zhou, PH., Yao, LQ., Qin, XY. et al. Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria. Surg Endosc 25, 2926–2931 (2011). https://doi.org/10.1007/s00464-011-1644-y

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  • DOI: https://doi.org/10.1007/s00464-011-1644-y

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