Skip to main content
Springer Nature Link
Log in

Gastric defect closure after endoscopic full-thickness resection: the closing while dissecting technique

  • Original Article
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Complete closure of gastric wall defects is critical following endoscopic full-thickness resection (EFTR). The aim of this study was to evaluate the efficacy, safety, and clinical outcome of a new endoscopic method: closing while dissecting.

Methods

Twenty-seven patients who underwent EFTR were retrospectively analyzed between January 2020 and March 2021. Gastric defects resulting from EFTR were closed using the “interrupted-close during dissection” technique with endoclips. Tumor characteristics, en bloc resection rates, and postoperative adverse events were evaluated.

Results

All submucosal tumors were successfully resected and complete resection was histologically confirmed. The mean maximal tumor diameter was 1.3 cm (ranging from 0.8 to 3.0 cm). The majority of these tumors were gastrointestinal stromal tumors (n = 20), Leiomyoma (n = 3), schwannomas (n = 2), others included fibroma (n = 1) and neurogenic tumor (n = 1). There were no cases of hemorrhage, peritonitis, or delayed perforation. Four patients complained of slight abdominal pain, but no hyperpyrexia or serious elevated white blood cell count was detected in the first 24 h after treatment. All wounds were healed on follow-up endoscopy 3 months after the procedure. The mean follow-up duration was 8.5 months (ranging from 3 to 17) and no tumor recurrences were observed.

Conclusions

The feasibility and safety of this interrupted-close during dissection approach allows for clinical applications in EFTR of gastric submucosal tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Nishida T, Yoshinaga S, Takahashi T, Naito Y (2021) Recent progress and challenges in the diagnosis and treatment of gastrointestinal stromal tumors. Cancers (Basel) 13(13):3158

    Article  CAS  Google Scholar 

  2. Nishida T, Kawai N, Yamaguchi S, Nishida Y (2013) Submucosal tumors: comprehensive guide for the diagnosis and therapy of gastrointestinal submucosal tumors. Dig Endosc 25(5):479–489

    Article  Google Scholar 

  3. Cai M, Zhou P, Lourenco LC, Zhang D (2016) Endoscopic full-thickness resection (EFTR) for gastrointestinal subepithelial tumors. Gastrointest Endosc Clin N Am 26(2):283–295

    Article  Google Scholar 

  4. Committee AT, Aslanian HR, Sethi A, Bhutani MS, Goodman AJ, Krishnan K, Lichtenstein DR, Melson J, Navaneethan U, Pannala R, Parsi MA, Schulman AR, Sullivan SA, Thosani N, Trikudanathan G, Trindade AJ, Watson RR, Maple JT (2019) ASGE guideline for endoscopic full-thickness resection and submucosal tunnel endoscopic resection. VideoGIE 4(8):343–350

    Article  Google Scholar 

  5. Meier B, Schmidt A, Glaser N, Meining A, Walter B, Wannhoff A, Riecken B, Caca K (2020) Endoscopic full-thickness resection of gastric subepithelial tumors with the gFTRD-system: a prospective pilot study (RESET trial). Surg Endosc 34(2):853–860

    Article  Google Scholar 

  6. Dobashi A, Rajan E, Knipschield MA, Gostout CJ (2018) Endoscopic full-thickness resection using suture loop needle T-tag tissue anchors in the porcine stomach (with video). Gastrointest Endosc 87(2):590–596

    Article  Google Scholar 

  7. Hu JW, Ge L, Zhou PH, Li QL, Zhang YQ, Chen WF, Chen T, Yao LQ, Xu MD, Chu Y (2017) A novel grasp-and-loop closure method for defect closure after endoscopic full-thickness resection (with video). Surg Endosc 31(10):4275–4282

    Article  Google Scholar 

  8. Kantsevoy SV (2020) The development of the overstitch system and its potentials. Gastrointest Endosc Clin N Am 30(1):107–114

    Article  Google Scholar 

  9. Fernandez-Esparrach G, Sendino O, Sole M, Pellise M, Colomo L, Pardo A, Martinez-Palli G, Arguello L, Bordas JM, Llach J, Gines A (2010) Endoscopic ultrasound-guided fine-needle aspiration and trucut biopsy in the diagnosis of gastric stromal tumors: a randomized crossover study. Endoscopy 42(4):292–299

    Article  CAS  Google Scholar 

  10. Tae HJ, Lee HL, Lee KN, Jun DW, Lee OY, Han DS, Yoon BC, Choi HS, Hahm JS (2014) Deep biopsy via endoscopic submucosal dissection in upper gastrointestinal subepithelial tumors: a prospective study. Endoscopy 46(10):845–850

    Article  Google Scholar 

  11. Choi SJ, Lee KH, Yoo CK, Yoon JH, Jang KS, Kim YJ, Lee HL (2021) Is there pathological uniformity between the periphery and center of a gastrointestinal stromal tumor? J Clin Med 10(4):687

    Article  Google Scholar 

  12. von Mehren M, Randall RL, Benjamin RS, Boles S, Bui MM, Casper ES, Conrad EU 3rd, DeLaney TF, Ganjoo KN, George S, Gonzalez RJ, Heslin MJ, Kane JM 3rd, Mayerson J, McGarry SV, Meyer C, O’Donnell RJ, Pappo AS, Paz IB, Pfeifer JD, Riedel RF, Schuetze S, Schupak KD, Schwartz HS, Van Tine BA, Wayne JD, Bergman MA, Sundar H (2014) Gastrointestinal stromal tumors, version 2.2014. J Natl Compr Canc Netw 12(6):853–62

    Article  Google Scholar 

  13. Nishida T, Goto O, Raut CP, Yahagi N (2016) Diagnostic and treatment strategy for small gastrointestinal stromal tumors. Cancer 122(20):3110–3118

    Article  Google Scholar 

  14. Pang T, Zhao Y, Fan T, Hu Q, Raymond D, Cao S, Zhang W, Wang Y, Zhang B, Lv Y, Zhang X, Ling T, Zhuge Y, Wang L, Zou X, Huang Q, Xu G (2019) Comparison of safety and outcomes between endoscopic and surgical resections of small (</= 5 cm) primary gastric gastrointestinal stromal tumors. J Cancer 10(17):4132–4141

    Article  Google Scholar 

  15. Wang H, Feng X, Ye S, Wang J, Liang J, Mai S, Lai M, Feng H, Wang G, Zhou Y (2016) A comparison of the efficacy and safety of endoscopic full-thickness resection and laparoscopic-assisted surgery for small gastrointestinal stromal tumors. Surg Endosc 30(8):3357–61

    Article  Google Scholar 

  16. An W, Sun PB, Gao J, Jiang F, Liu F, Chen J, Wang D, Li ZS, Shi XG (2017) Endoscopic submucosal dissection for gastric gastrointestinal stromal tumors: a retrospective cohort study. Surg Endosc 31(11):4522–4531

    Article  Google Scholar 

  17. Mori H, Rahman A, Kobara H, Fujihara S, Nishiyama N, Ayaki M, Matsunaga T, Murakami M, Masaki T (2017) Current status of exposed endoscopic full-thickness resection and further development of non-exposed endoscopic full-thickness resection. Digestion 95(1):6–15

    Article  Google Scholar 

  18. Lu J, Jiao T, Li Y, Zheng M, Lu X (2016) Facilitating retroflexed endoscopic full-thickness resection through loop-mediated or rope-mediated countertraction (with videos). Gastrointest Endosc 83(1):223–228

    Article  Google Scholar 

  19. Abe S, Council L, Cui X, Saito Y, Monkemuller K (2015) Endoscopic resection and enucleation of gastric submucosal tumor facilitated by subsequent closure of incision using over-the-scope clip. Endoscopy 47(Suppl 1):E153–E154

    Google Scholar 

  20. Bauder M, Schmidt A, Caca K (2016) Non-exposure, device-assisted endoscopic full-thickness resection. Gastrointest Endosc Clin N Am 26(2):297–312

    Article  Google Scholar 

  21. Ye LP, Yu Z, Mao XL, Zhu LH, Zhou XB (2014) Endoscopic full-thickness resection with defect closure using clips and an endoloop for gastric subepithelial tumors arising from the muscularis propria. Surg Endosc 28(6):1978–1983

    Article  Google Scholar 

  22. Tang AL, Liao XQ, Shen SR, Xiao DH, Yuan YX, Wang XY (2016) Application of clips assisted with foreign body forceps in defect closure after endoscopic full-thickness resection. Surg Endosc 30(5):2127–2131

    Article  Google Scholar 

  23. Wang W, Liu CX, Niu Q, Wang AL, Shi N, Ma FZ, Hu YB (2020) OTSC assisted EFTR for the treatment of GIST: 40 cases analysis. Minim Invasive Ther Allied Technol, 1–8

  24. Weiland T, Fehlker M, Gottwald T, Schurr MO (2013) Performance of the OTSC system in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review. Surg Endosc 27(7):2258–2274

    Article  Google Scholar 

  25. Zhou PH, Yao LQ, Qin XY, Cai MY, Xu MD, Zhong YS, Chen WF, Zhang YQ, Qin WZ, Hu JW, Liu JZ (2011) Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria. Surg Endosc 25(9):2926–2931

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank the nurses and pathologists for their contribution to this work.

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Endoscopy Center, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, Jilin, 130021, China

    Haibo Sun, Tingting Cao, Fan Zhang, Ke Tao & Hong Xu

Authors
  1. Haibo Sun
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Tingting Cao
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Fan Zhang
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Ke Tao
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Hong Xu
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Hong Xu.

Ethics declarations

Disclosures

Haibo Sun, Tingting Cao, Fan Zhang, Ke Tao and Hong Xu have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MOV 85070 KB)

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sun, H., Cao, T., Zhang, F. et al. Gastric defect closure after endoscopic full-thickness resection: the closing while dissecting technique. Surg Endosc 37, 234–240 (2023). https://doi.org/10.1007/s00464-022-09457-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09457-7

Keywords