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.
Similar content being viewed by others
References
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
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
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
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
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
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
Joensuu H, Fletcher C, Dimitrijevic S, Silberman S, Roberts P, Demetri G (2002) Management of malignant gastrointestinal stromal tumours. Lancet Oncol 3:655–664
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
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
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
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
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
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
Zhou PH, Yao LQ, Qin XY (2009) Endoscopic submucosal dissection for colorectal epithelial neoplasm. Surg Endosc 23:1546–1551
Kantsevoy SV (2006) Endoscopic full-thickness resection: new minimally invasive therapeutic alternative for GI-tract lesions. Gastrointest Endosc 64:90–91
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
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
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-011-1644-y