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A modified endoscopic method for resection of gastric submucosal tumor

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Abstract

Background and objective

Endoscopic mucosa-sparing lateral dissection (EMSLD) was developed by our group, and is used to remove gastric submucosal tumor (SMT). This study aims to evaluate the feasibility and safety of this method.

Methods

This retrospective study included 25 patients who underwent EMSLDs at an endoscopy center as a national key unit in china from October 2015 to July 2016. The main data collected were the size of the gastric SMT, its location and origin, en bloc resection rate, operating time, intraoperative and postoperative complications, hospitalization expense, hospital days, and follow-up after hospital discharge.

Results

The mean (SD) size of the gastric SMTs was 18.3 (5.9) mm; 96% (24/25) of the tumors originated in the muscularis propria; and 64% (16/25) and 28% (7/25) were located in the gastric fundus and gastric body, respectively. The rate of en bloc resection was 96% (24/25), and the rate of intraoperative perforations due to endoscopic full-thickness resection was 48% (12/25). All wounds and perforations were effectively closed using endoscopic clips combined with the retained mucosa. The mean operative time was 74.2 (38.0) min. Delayed bleeding and perforation were not observed.

Conclusion

Endoscopic mucosa-sparing lateral dissection is safe and feasible for the removal of gastric SMTs. The wound can be effectively closed using the retained mucosa and endoscopic clips, even if perforation has occurred. EMSLD provides an alternative to the resection of gastric SMTs, especially for tumors with a risk of intraoperative perforation.

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Acknowledgements

All authors thank Dr. En-Qi Qiu for drawing the schematic diagram, as shown in Fig. 1.

Author information

Author notes

  1. Qiang Zhang, Yue Li and Zhou-yang Lian contributed equally to this work.

Authors and Affiliations

  1. Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, No.1838, North of Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China

    Qiang Zhang, Yue Li, Zhen Wang, Li-hui Wang, Yang Bai & Si-de Liu

  2. Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, No. 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, China

    Zhou-yang Lian

Authors
  1. Qiang Zhang
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  2. Yue Li
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  3. Zhou-yang Lian
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  4. Zhen Wang
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  5. Li-hui Wang
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  6. Yang Bai
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  7. Si-de Liu
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Corresponding authors

Correspondence to Qiang Zhang or Si-de Liu.

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Disclosures

Drs. Qiang Zhang, Yue Li, Zhou-yang Lian, Zhen Wang, Li-hui Wang,Yang Bai and Si-de Liu have no conflicts of interest or financial ties to disclose.

Electronic supplementary material

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Supplementary material 1 (WMV 12664 kb)

Supplementary material 2 (WMV 16924 kb)

Supplementary material 3 (DOCX 17 kb)

464_2017_5704_MOESM4_ESM.tif

A tumor located in the greater curvature of the junction of gastric fundus and body near the posterior wall was resected by endoscopic mucosa-sparing lateral dissection (EMSLD). A. A submucosal tumor(SMT), B. The mucosa over the tumor was cut open about a semicircle along the edge of the SMT. C. The tumor was clearly exposed and the gastric mucosa over the tumor was retained. D. The tumor was completely dissected with the occurrence of perforation. Small mucosal incisions, as indicated by the white arrow, were made to assist with the suture of the wound using endoscopic clips. E. The wound was successfully closed. Supplementary material 4 (TIFF 2233 kb)

464_2017_5704_MOESM5_ESM.tif

A tumor located in the greater curvature of the junction of gastric antrum and body was resected by endoscopic mucosa-sparing lateral dissection (EMSLD). After the tumor was resected completely without tumor damage, a large perforation occurred, and the perforation was easily closed using endoscopic clips assisted by the retained mucosa. Supplementary material 5 (TIFF 16192 kb)

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Zhang, Q., Li, Y., Lian, Zy. et al. A modified endoscopic method for resection of gastric submucosal tumor. Surg Endosc 32, 536–543 (2018). https://doi.org/10.1007/s00464-017-5704-9

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