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Feasibility of endoscopic resection without laparoscopic assistance for giant gastric subepithelial tumors originating from the muscularis propria layer (with video)

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Abstract

Background and aims

Currently, published data of endoscopic resection (ER) for giant (≥ 6 cm) gastric subepithelial tumors originating from the muscularis propria layer (MP-SETs) are extremely rare and limited to only case reports. The aim of this study was thus to assess the feasibility of using ER for giant (≥ 6 cm) gastric MP-SETs in a case series.

Methods

Between July 2013 and December 2020, a total of 23 patients with giant (≥ 6 cm) gastric MP-SETs were treated with ER in the endoscopic center of Taizhou hospital. The study assessed outcomes of en bloc resection, complete resection, total complications, and local residual/recurrence of tumors.

Results

The mean procedure time was 112.2 min. En bloc resection was achieved in 22 tumors (95.7%). En bloc removal from the stomach and complete resection were achieved in 6 patients (26.1%). The rate of complete resection differed significantly depending on the minimum tumor diameter (P < 0.001). During hospitalization, 4 patients had complications, including localized peritonitis (3/23, 13.0%) and pulmonary infection (1/23, 4.3%). These 4 patients recovered successfully after conservative medical treatment. Histopathological examination revealed that 18 tumors were gastrointestinal stromal tumors (GISTs), and 5 tumors were leiomyoma. No patients were observed to have residual or recurrent tumors during the follow-up.

Conclusions

Although ER for giant (≥ 6 cm) gastric MP-SETs was associated with several technical challenges and a relatively low complete resection rate, this technique was found to be a feasible therapeutic method for selected patients with a giant (≥ 6 cm) gastric MP-SETs when performed by an experienced endoscopic team.

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Acknowledgements

This study was supported by the Major R&D Project of Zhejiang Province (no. 2019C03040) and the Zhejiang Province Bureau of Health (no. 2020KY1030).

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Authors

Contributions

YZ drafted the manuscript. QM enrolled patients and acquired the follow-up data. X-BZ performed postoperative management. GC performed preoperative consultation. L-HZ enrolled patients and acquired the follow-up data. X-LM designed the study and performed postoperative management. L-PY performed and analyzed the procedure.

Corresponding authors

Correspondence to Xin-Li Mao or Li-Ping Ye.

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Disclosures

Yu Zhang, Qian Meng, Xian-Bin Zhou, Guang Chen, Lin-Hong Zhu, Xin-Li Mao, and Li-Ping Ye have no conflicts of interest to declare relating to this study.

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Zhang, Y., Meng, Q., Zhou, XB. et al. Feasibility of endoscopic resection without laparoscopic assistance for giant gastric subepithelial tumors originating from the muscularis propria layer (with video). Surg Endosc 36, 3619–3628 (2022). https://doi.org/10.1007/s00464-022-09019-x

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  • DOI: https://doi.org/10.1007/s00464-022-09019-x

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