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Zhang M, Liu J, Dong YP, Zhao Q, Lin ML, Gao TJ, Feng JL, Wang YF, Guo YF, Wang Z, Jia W, Yang Z. Comparison between interrupted closure technique and traditional closure technique in endoscopic full-thickness resection for treating gastric subepithelial lesions. World J Gastrointest Surg 2025; 17:106069. [DOI: 10.4240/wjgs.v17.i6.106069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2025] [Revised: 03/17/2025] [Accepted: 04/28/2025] [Indexed: 05/30/2025] Open
Abstract
BACKGROUND Gastric subepithelial lesions (SELs) are elevated lesions originating from the muscularis mucosa, submucosa, or muscularis propria, and may also include extraluminal lesions. For small SELs (less than 5 cm), complete endoscopic excision is the preferred treatment. Endoscopic full-thickness resection (EFTR) has proven to be an effective approach.
AIM To evaluate the efficacy of the interrupted closure technique compared to the traditional closure technique in EFTR for gastric SELs.
METHODS This single-center, prospective, randomized controlled trial was conducted at a tertiary hospital from September 2023 to September 2024. A total of 90 patients who underwent EFTR for gastric SELs were randomly allocated to either the interrupted closure group (n = 44) or the traditional closure group (n = 46).
RESULTS All patients had complete resection and wound closure without any severe postoperative complications. The incidence of intraoperative gas-related complications was significantly lower in the interrupted closure group than in the traditional closure group (2.27% vs 26.09%, P = 0.001), demonstrating interrupted closure technique can reduce the incidence of gas-related issues. Statistical analysis revealed that the incidence of postoperative infection was significantly lower in the experimental group than in the control group (15.91% vs 41.30%, P = 0.008). Additionally, the median duration of antibiotic use was lower in the experimental group (3.5 days vs 5 days, P = 0.013). Abdominal pain levels on postoperative days 1 and 4 were also lower in the experimental group compared to the control group (P < 0.001).
CONCLUSION The interrupted closure technique in EFTR for treating gastric SELs is safe and effective, reducing the incidence of intraoperative gas complications and postoperative infections.
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Affiliation(s)
- Meng Zhang
- Department of Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Jiao Liu
- Department of Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Yun-Peng Dong
- Department of Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
- Department of Gastroenterology, Liaoning Jinqiu Hospital (Liaoning Geriatric Research Institute), Shenyang 110840, Liaoning Province, China
| | - Qian Zhao
- Department of Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Mei-Ling Lin
- Department of Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
- Department of Digestive Endoscopy, Shenyang Coloproctology Hospital, Shenyang 110840, Liaoning Province, China
| | - Teng-Jiao Gao
- Department of Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Jia-Li Feng
- Department of Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Yi-Fei Wang
- Department of Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Yu-Fan Guo
- Department of Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Zhen Wang
- Department of Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Wen Jia
- Department of Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Zhuo Yang
- Department of Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
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Deng J, Liu Z, Sun D. Giant gastric leiomyoma excision using endoscopic submucosal dissection with dental floss clip traction technique: a case report. J Int Med Res 2025; 53:3000605241311122. [PMID: 39829343 PMCID: PMC11744588 DOI: 10.1177/03000605241311122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Accepted: 12/16/2024] [Indexed: 01/22/2025] Open
Abstract
For gastric leiomyomas measuring ≥5 cm, endoscopic resection is necessary. The larger size of these tumors significantly impairs the resection field of view, increasing the risk of intraoperative bleeding and perforation and potentially leading to incomplete tumor removal. The combination of dental floss and tissue clip traction techniques is commonly used for resecting mucosal lesions but is rarely reported for submucosal tumors. We recently completed a case of endoscopic resection of a giant gastric leiomyoma in the body of the stomach, approximately 7 cm in length, using endoscopic submucosal dissection with dental floss clip traction. The dissection was carefully controlled within the muscularis propria layer, avoiding damage to the serosa. No bleeding or perforation occurred. A special technique was employed to avoid damage to the muscle layer. By combining this technique with tissue forceps, better traction stability may have been achieved. During the traction process, slight tension was consistently maintained between the swelling and the muscle layer, preventing perforation due to traction. The resection field remained clear throughout the procedure, which lasted 50 minutes in total. The final outcome was satisfactory. This method may be worthy of clinical application.
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Affiliation(s)
- Jiwen Deng
- The Department of Gastroenterology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen University School of Medicine, Shenzhen, China
| | - Zhaohui Liu
- The Department of Gastroenterology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Dayong Sun
- The Department of Gastroenterology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen University School of Medicine, Shenzhen, China
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Zhang JW, Guo CQ, Zhu SS, Dai N, Liu P, Zhang FB, Zhou HN, Wang JF, Zhou SS, Cao XG. Endoscopic resection of extra-luminal gastric gastrointestinal stromal tumors using a snare assisted external traction technique (with video). Dig Liver Dis 2024; 56:1914-1918. [PMID: 38744556 DOI: 10.1016/j.dld.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/10/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The primary purpose of the study was to explore the clinical efficacy of the novel snare assisted endoscopic resection of extraluminal growing gastric gastrointestinal stromal tumors (gastric GISTs) using external traction, and the secondary purpose was to compare the novel snare assisted endoscopic resection of extraluminal GISTs with the standard laparoscopic procedure. METHODS We retrospectively analyzed the patients who underwent novel external traction assisted endoscopic resection or laparoscopic resection for their extraluminal gastric GIST ≤5 cm in diameter. RESULTS A total of 111 patients (27 in the endoscopic group and 84 in the laparoscopic group) were included in this study. There was no significant difference in tumor diameter and complication rate between the two groups. The overall procedure time was slightly higher in the endoscopic group compared to the laparoscopic group (P = 0.034). However, postoperative hospitalization time (P < 0.001) and postoperative fasting time (P = 0.005) were shorter in the endoscopic group compared to the laparoscopic group. CONCLUSION Snare external traction-assisted endoscopic resection of extraluminal growing gastric GISTs is safe and effective, and it provides a new adjunctive method for endoscopic resection of GIST.
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Affiliation(s)
- Jing-Wen Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Chang-Qing Guo
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Shan-Shan Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Nan Dai
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Ping Liu
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Fang-Bin Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Hai-Ning Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Jian-Feng Wang
- Department of Gastroenterology, Nanyang Central Hospital, Nanyang, 473000, Henan, China
| | - Si-Su Zhou
- Department of Gastroenterology, Nanshi Hospital of Nanyang, Nanyang, 473000, Henan, China
| | - Xin-Guang Cao
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
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4
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Fu B, Du ZQ, Liu WH. Dental floss with rubber band-formed pulley traction facilitating endoscopic full-thickness resection of gastric submucosal tumor in gastric fundus. Dig Endosc 2024; 36:857-858. [PMID: 38804155 DOI: 10.1111/den.14819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024]
Abstract
Watch a video of this article.
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Affiliation(s)
- Biao Fu
- Department of Gastroenterology, Jianyang People's Hospital, Chengdu, China
| | - Zhi-Qiang Du
- Department of Gastroenterology, Jianyang People's Hospital, Chengdu, China
| | - Wei-Hui Liu
- Department of Gastroenterology and Hepatology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Li CY, Wang YF, Luo LK, Yang XJ. Present situation of minimally invasive surgical treatment for early gastric cancer. World J Gastrointest Oncol 2024; 16:1154-1165. [PMID: 38660633 PMCID: PMC11037069 DOI: 10.4251/wjgo.v16.i4.1154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/05/2023] [Accepted: 02/02/2024] [Indexed: 04/10/2024] Open
Abstract
Minimally invasive surgery is a kind of surgical operation, which is performed by using professional surgical instruments and equipment to inactivate, resect, repair or reconstruct the pathological changes, deformities and wounds in human body through micro-trauma or micro-approach, in order to achieve the goal of treatment, its surgical effect is equivalent to the traditional open surgery, while avoiding the morbidity of conventional surgical wounds. In addition, it also has the advantages of less trauma, less blood loss during operation, less psychological burden and quick recovery on patients, and these minimally invasive techniques provide unique value for the examination and treatment of gastric cancer patients. Surgical minimally invasive surgical techniques have developed rapidly and offer numerous options for the treatment of early gastric cancer (EGC): endoscopic mucosal resection (EMR), underwater EMR (UEMR), endoscopic submucosal dissection (ESD), endoscopic full-thickness resection (EFTR), endoscopic submucosal excavation (ESE), submucosal tunnel endoscopic resection), laparoscopic and endoscopic cooperative surgery (LECS); Among them, EMR, EFTR and LECS technologies have a wide range of applications and different modifications have been derived from their respective surgical operations, such as band-assisted EMR (BA-EMR), conventional EMR (CEMR), over-the-scope clip-assisted EFTR, no-touch EFTR, the inverted LECS, closed LECS, and so on. These new and improved minimally invasive surgeries are more precise, specific and effective in treating different types of EGC.
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Affiliation(s)
- Chun-Yan Li
- The First Clinical Medical School, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Yi-Feng Wang
- The First Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
| | - Li-Kang Luo
- The First Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
| | - Xiao-Jun Yang
- The First Clinical Medical School, Lanzhou University, Lanzhou 730000, Gansu Province, China
- General Surgery Clinical Centre, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- The Second Department of General Surgery, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- Lanzhou University People's Clinical Hospital, Lanzhou 730000, Gansu Province, China
- Gansu Research Center of Prevention and Control Project for Digestive Oncology, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- Gansu Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
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6
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Gu L, Wang X, Ouyang M, Li F, Wu Y, Liu X. Facilitating endoscopic full-thickness resection for gastric submucosal tumors with a novel snare traction method (with video). J Gastroenterol Hepatol 2024; 39:535-543. [PMID: 38011894 DOI: 10.1111/jgh.16428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 10/08/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND AIM Endoscopic full-thickness resection (EFTR) is a promising technique in treating gastric submucosal tumors originating from the muscularis propria (SMT-MPs). However, it is challenging without counter-traction. METHODS A snare was inserted through the forceps channel to grasp the part of the tumor or the mucosa connected to the tumor. The outer sheath and inner wire of snare in vitro were fixed by a pair of hemostatic forceps. The handle of snare was cut off, and the endoscope was pulled out without affecting the traction state of snare. Snare-assisted EFTR (EFTR-S) was then performed with counter-traction. One hundred and four patients with gastric SMT-MPs who received the procedure of EFTR with or without snare traction method were retrospectively analyzed using univariate and multiple regressions, and covariates were adjusted in the multiple analysis. RESULTS Compared with EFTR group (n = 36), EFTR-S group (n = 68) showed a higher operative success rate (95.6% vs 72.2%, P = 0.001), a lower incidence of intraoperative hemorrhage (4.4% vs 16.7%, P = 0.038) and shorter operative time among operative successes (53.6 ± 16.6 min vs 67.7 ± 33.4 min, P < 0.001). Univariate logistic analysis showed that snare traction represented a significant factor, which could improve operative successful rate (odds ratio, 8.3; 95% confidence interval, 2.1 to 32.7; P = 0.002). Postoperative outcomes and adverse events among operative successes were similar between the two groups. CONCLUSIONS This novel snare traction method may provide an effective counter-traction and reduce the difficulty of EFTR for gastric SMT-MPs.
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Affiliation(s)
- Lei Gu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaotong Wang
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Miao Ouyang
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Fujun Li
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Yu Wu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease (2020CB1004), Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaowei Liu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease (2020CB1004), Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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7
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Guo HM, Sun Y, Cai S, Miao F, Zheng Y, Yu Y, Zhao ZF, Liu L. A novel technique for endoscope progression in gastroscopy resection: forward-return way for dissection of stromal tumor in the muscularis propria of the gastric fundus. Front Oncol 2023; 13:1077201. [PMID: 37274232 PMCID: PMC10233095 DOI: 10.3389/fonc.2023.1077201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Background The fundus of the stomach is a challenging region for endoscopic resection of gastrointestinal stromal tumors (GISTs), especially in the anterior wall of the fornix at the side of the greater curvature. This study aimed to introduce the Forward-Return Way (FRW) technique in gastric fundus operations and provide evidence of its advantages. The FRW technique allows the gastroscope to access the stomach fornix without entering the gastric antrum after passing through the gastric cardia. Using FRW, the gastroscope body makes a forward return along the wall of the posterior wall of the upper gastric body and the wall of the greater curvature. Methods The clinical data of patients with stromal tumors in muscularis propria at the gastric fundus (STMF) at the Fourth Hospital of China Medical University between May 2020- March 2021 were reviewed. The novel FRW technique was used in the procedures, and the beneficial effects, suitability, applicable lesion site, and success rates of FRW were analyzed. Results A total of 10 cases were reviewed, and the FRW technique was successfully performed in 7 cases (70%). The gastroscope's tip reached the area just below the gastric cardia, allowing endoscopists to successfully access all angles and sites of the stomach's fundus in all seven patients. The lesion was easily accessed, and the gastroscope was stable with good left-right and forward-backwards movements. Conclusion The FRW technique significantly facilitates the resection of the GISTs by aligning the endoscopy body movement direction with the observation direction. Gastrointestinal Stromal Tumor; forward-return of gastroscopy along the gastric body wall; muscularis propria; gastric fundus.
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8
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Ru N, Li LS, Bi YW, Gao F, Zhang B, Chai NL, Linghu EQ. A modified exposed endoscopic full-thickness resection: Traction-assisted resection while defect closing. J Dig Dis 2023; 24:305-310. [PMID: 37300524 DOI: 10.1111/1751-2980.13199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/12/2023] [Accepted: 06/07/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Exposed endoscopic full-thickness resection (Eo-EFTR) has proven effective and economical for patients with gastric submucosal tumors (SMTs), showing great prospects. However, the poor operative field of view, the risk of tumors falling into the peritoneal cavity, especially the difficulties in defect closure, have limited its widespread application. Herein, we described a modified traction-assisted Eo-EFTR technique aimed at simplifying both the dissection and defect closure procedures. METHODS Nineteen patients who underwent the modified Eo-EFTR for gastric SMTs in the Chinese People's Liberation Army General Hospital were enrolled in the study. Following a 2/3 circumferential full-thickness incision, a clip with dental floss was anchored to the resected part of the tumor surface. With the dental floss traction, the gastric defect was reshaped into a V shape, which facilitated the deployment of clips to close the defect. The defect closure and tumor dissection procedures were then performed alternately. Patients' demographics, tumor characteristics, and therapeutic outcomes were evaluated retrospectively. RESULTS All tumors had an R0 resection. The median procedure time was 43 min (range 28-89 min). No severe perioperative adverse events occurred. Two patients experienced transient fever, and three patients complained of mild abdominal pain on the first day after the operation. All patients recovered on the next day with conservative management. No residual lesion or recurrence was reported during the follow-up period of 30.1 months. CONCLUSION The safety and practicability of the modified technique might allow for wide clinical applications of Eo-EFTR in gastric SMTs.
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Affiliation(s)
- Nan Ru
- Department of Gastroenterology, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Long Song Li
- Department of Gastroenterology, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ya Wei Bi
- Department of Gastroenterology, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Fei Gao
- Department of Gastroenterology, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Bo Zhang
- Department of Gastroenterology, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ning Li Chai
- Department of Gastroenterology, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - En Qiang Linghu
- Department of Gastroenterology, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
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9
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Ni L, Liu X, Wu A, Yu C, Zou C, Xu G, Wang C, Gao X. Endoscopic full‑thickness resection with clip‑ and snare‑assisted traction for gastric submucosal tumours in the fundus: A single‑centre case series. Oncol Lett 2023; 25:151. [PMID: 36936023 PMCID: PMC10018235 DOI: 10.3892/ol.2023.13737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Abstract
Exposed endoscopic full-thickness resection (Eo-EFTR) has been recognized as a feasible therapy for gastrointestinal submucosal tumours (SMTs) originating deep in the muscularis propria layer; however, Eo-EFTR is difficult to perform in a retroflexed fashion in the gastric fundus. As a supportive technique, clip- and snare-assisted traction may help expose the surgical field and shorten the operation time in endoscopic resection of difficult regions. However, the application of clip- and snare-assisted traction in Eo-EFTR of SMTs in the gastric fundus is limited. Between April 2018 and December 2021, Eo-EFTR with clip- and snare-assisted traction was performed in 20 patients with SMTs in the gastric fundus at The First Affiliated Hospital of Soochow University. The relevant clinical data were collected retrospectively for all of the patients and analysed. All 20 patients underwent Eo-EFTR successfully without conversion to open surgery or severe adverse events. The en bloc resection rate and R0 resection rate were both 100%. Two patients had abdominal pain and fever after the operation, and five patients had fever, which recovered with medical therapy. No complications, such as delayed bleeding or delayed perforation, were observed. The postoperative pathology indicated that 19 cases were gastrointestinal stromal tumours and one case was leiomyoma. During the follow-up, no residual tumour, local recurrence or distant metastasis was detected by endoscopy or abdominal computed tomography. In conclusion, Eo-EFTR with clip- and snare-assisted traction appears to be a relatively safe and effective treatment for gastric SMTs in the fundus. However, prospective studies on a larger sample size are required to verify the effect of the clip- and snare-assisted traction in Eo-EFTR.
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Affiliation(s)
- Liujing Ni
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China
| | - Xiaolin Liu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China
| | - Airong Wu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China
| | - Chenyan Yu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China
| | - Chentao Zou
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China
| | - Guoting Xu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China
| | - Chao Wang
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China
| | - Xin Gao
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China
- Correspondence to: Dr Xin Gao, Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Gusu, Suzhou, Jiangsu 215000, P.R. China, E-mail:
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10
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Wang K, Gao P, Cai M, Song B, Zhou P. Endoscopic full-thickness resection, indication, methods and perspectives. Dig Endosc 2023; 35:195-205. [PMID: 36355358 DOI: 10.1111/den.14474] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022]
Abstract
Minimally invasive surgery has emerged as the dominant theme of modern surgery, in which endoscopic surgery plays a key role. The technique of endoscopic surgery has evolved continuously with extensive research, improving the treatment modalities as well as expanding the indications for its use. As an active perforation endoscopic technique, endoscopic full-thickness resection (EFTR) is mainly used in the treatment of submucosal tumors (SMTs) of the gastrointestinal tract. With decades of evolution, EFTR has gradually developed into a mature endoscopic operation. Based on clinical experience and current research, indications, techniques, clinical outcomes and future perspectives for EFTR are discussed in this paper. We performed a bibliometric study on EFTR literature and showed robust data through a brief meta-analysis on the topic.
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Affiliation(s)
- Kehao Wang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Pingting Gao
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Mingyan Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Baohui Song
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pinghong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
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11
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Yip HC, Teh JL, Teoh AYB, Chiu P. Pure endoscopic resection versus laparoscopic assisted procedure for upper gastrointestinal stromal tumors: Perspective from a surgical endoscopist. Dig Endosc 2023; 35:184-194. [PMID: 36318279 DOI: 10.1111/den.14463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/31/2022] [Indexed: 11/27/2022]
Abstract
Management of upper gastrointestinal (UGI) tract gastrointestinal stromal tumor (GIST) has evolved significantly over the past two decades. For GIST size smaller than 5 cm, laparoscopic resection has become the current standard. To avoid postoperative gastric deformity and preserve gastric function, laparoscopic endoscopic cooperative surgery (LECS) was developed and various modifications have been reported and utilized successfully. Pure endoscopic resection techniques have also been reported at a similar period of time, which further push the boundary of incisionless surgery in managing these lesions. Both tunneling and nontunneling exposed type endoscopic full thickness resection are well described procedures for resection of small UGI GIST. In this review, a summary of these procedures is provided, and the pros and cons of each technique from the perspective of a surgical endoscopist are discussed in detail. LECS and endoscopic resection are complementary to each other. The choice of technique should be tailored to the location, morphology, and size of the target lesions, taking into account the experience of the laparoscopic surgeons and endoscopists.
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Affiliation(s)
- Hon Chi Yip
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jun Liang Teh
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,National University Health System, Singapore City, Singapore
| | - Anthony Y B Teoh
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Philip Chiu
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Pal P, Ramchandani M, Inavolu P, Reddy DN, Tandan M. Endoscopic Full Thickness Resection: A Systematic Review. JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0042-1755304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Abstract
Background Endoscopic full thickness resection (EFTR) is an emerging therapeutic option for resecting subepithelial lesions (SELs) and epithelial neoplasms. We aimed to systematically review the techniques, applications, outcomes, and complications of EFTR.
Methods A systematic literature search was performed using PubMed. All relevant original research articles involving EFTR were included for the review along with case report/series describing novel/rare techniques from 2001 to February 2022.
Results After screening 7,739 citations, finally 141 references were included. Non-exposed EFTR has lower probability of peritoneal contamination or tumor seeding compared with exposed EFTR. Among exposed EFTR, tunneled variety is associated with lower risk of peritoneal seeding or contamination compared with non-tunneled approach. Closure techniques involve though the scope (TTS) clips, loop and clips, over the scope clips (OTSC), full thickness resection device (FTRD), and endoscopic suturing/plicating/stapling devices. The indications of EFTR range from esophagus to rectum and include SELs arising from muscularis propria (MP), non-lifting adenoma, recurrent adenoma, and even early gastric cancer (EGC) or superficial colorectal carcinoma. Other indications include difficult locations (involving appendicular orifice or diverticulum) and full thickness biopsy for motility disorders. The main limitation of FTRD is feasibility in smaller lesions (<20–25 mm), which can be circumvented by hybrid EFTR techniques. Oncologic resection with lymphadencetomy for superficial GI malignancy can be accomplished by hybrid natural orifice transluminal endoscopic surgery (NOTES) combining EFTR and NOTES. Bleeding, perforation, appendicitis, enterocolonic fistula, FTRD malfunction, peritoneal tumor seeding, and contamination are among various adverse events. Post OTSC artifacts need to be differentiated from recurrent/residual lesions to avoid re-FTRD/surgery.
Conclusion EFTR is safe and effective therapeutic option for SELs, recurrent and non-lifting adenomas, tumors in difficult locations and selected cases of superficial GI carcinoma.
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Affiliation(s)
- Partha Pal
- Department of Interventional Endoscopy, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Mohan Ramchandani
- Department of Interventional Endoscopy, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Pradev Inavolu
- Department of Interventional Endoscopy, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Duvvuru Nageshwar Reddy
- Department of Interventional Endoscopy, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Manu Tandan
- Department of Interventional Endoscopy, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
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Zhang Q, Cai JQ, Wang Z. Usefulness of tumor traction with a snare and endoclips in gastric submucosal tumor resection: a propensity-score-matching analysis. Gastroenterol Rep (Oxf) 2020; 9:125-132. [PMID: 34026219 PMCID: PMC8128025 DOI: 10.1093/gastro/goaa050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/30/2019] [Accepted: 02/06/2020] [Indexed: 11/14/2022] Open
Abstract
Background Endoscopic resection, including endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFR), was used to resect small gastric submucosal tumors (SMTs). Our team explored a method of tumor traction using a snare combined with endoclips to assist in the resection of SMTs. This study aims to explore the safety and effectiveness of the method. Methods This research performed a propensity-score-matching (PSM) analysis to compare ESD/EFR assisted by a snare combined with endoclips (ESD/EFR with snare traction) with conventional ESD/EFR for the resection of gastric SMTs. Comparisons were made between the two groups, including operative time, en bloc resection rate, perioperative complications, and operation-related costs. Results A total of 253 patients with gastric SMTs resected between January 2012 and March 2019 were included in this study. PSM yielded 51 matched pairs. No significant differences were identified between the two groups in perioperative complications or the costs of disposable endoscopic surgical accessories. However, the ESD/EFR-with-snare-traction group had a shorter median operative time (39 vs 60 min, P = 0.005) and lower rate of en bloc resection (88.2% vs 100%, P = 0.027). Conclusions ESD/EFR with snare traction demonstrated a higher efficiency and en bloc resection rate for gastric SMTs, with no increases in perioperative complications and the costs of endoscopic surgical accessories. Therefore, the method seems an appropriate choice for the resection of gastric SMTs.
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Affiliation(s)
- Qiang Zhang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Jian-Qun Cai
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Zhen Wang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
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Hu J, Ge N, Wang S, Guo J, Liu X, Wang G, Sun S. Direct endoscopic full-thickness resection for submucosal tumors with an intraluminal growth pattern originating from the muscularis propria layer in the gastric fundus. BMC Gastroenterol 2020; 20:70. [PMID: 32164583 PMCID: PMC7066799 DOI: 10.1186/s12876-020-01215-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 03/04/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND AIMS Endoscopic full-thickness resection (EFTR) is difficult to perform in a retroflexed fashion in the gastric fundus. The present study aims at exploring whether direct EFTR can be a simple, effective and safe procedure to treat intraluminal-growth submucosal tumors originating from the muscularis propria. METHODS The patients with intraluminal-growth submucosal tumors originating from the muscularis propria in gastric fundus treated by direct EFTR between 01 January 2017 and 01 September 2018 were retrospectively reviewed. In addition, we analyzed the patients with intraluminal-growth submucosal tumors originating from the muscularis propria in gastric fundus treated by traditional EFTR. The differences in tumor resection time, cost-effectiveness, and complication rate were evaluated. RESULTS Forty patients were enrolled in the present study, 20 patients of which were in the direct EFTR group and 20 patients of which were in the traditional EFTR group. En-bloc resections of gastric tumors were successfully performed in all 40 cases. There was no significant difference in the average tumor size of the two groups (24.3 ± 2.9 mm in direct EFTR group verus 24.0 ± 2.6 mm in the traditional group, p = 0.731), but significant difference existed in the operative time between two groups (35.0 ± 8.2 min in direct EFTR group verus 130.6 ± 51.9 min in the traditional group, p<0.05). No complications, such as postoperative bleeding and perforation, occurred in any groups. CONCLUSIONS Direct EFTR is a safe, simple and cost-effective procedure for SMTs with an intraluminal growth pattern originating from the muscularis propria layer in the gastric fundus.
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Affiliation(s)
- Jinlong Hu
- Department of gastroenterolgy, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Nan Ge
- Department of gastroenterolgy, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Sheng Wang
- Department of gastroenterolgy, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Jintao Guo
- Department of gastroenterolgy, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Xiang Liu
- Department of gastroenterolgy, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Guoxin Wang
- Department of gastroenterolgy, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Siyu Sun
- Department of gastroenterolgy, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
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Ge N, Hu JL, Yang F, Yang F, Sun SY. Endoscopic full-thickness resection for treating small tumors originating from the muscularis propria in the gastric fundus: An improvement in technique over 15 years. World J Gastrointest Oncol 2019; 11:1054-1064. [PMID: 31798785 PMCID: PMC6883187 DOI: 10.4251/wjgo.v11.i11.1054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/31/2019] [Accepted: 09/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The fundus of the stomach is regarded as a difficult area for endoscopic resection of small tumors originating from the muscularis propria (MP tumors). Three endoscopic resection techniques have been developed to treat these tumors, including ligation-assisted endoscopic full-thickness resection (L-EFTR), snare-assisted EFTR (S-EFTR), and endoscopic submucosal dissection-assisted EFTR (E-EFTR). To date, no studies have compared these techniques. AIM We aimed to evaluate and compare S-EFTR with L-EFTR and E-EFTR for treating small MP tumors in the gastric fundus. METHODS We retrospectively reviewed patients with primary small MP tumors in the gastric fundus and treated by these three techniques between January 2016 and December 2018 at Shengjing Hospital, China. Standard demographic and clinicopathologic data, including sex, age, tumor size, surgeon details, and pathological results, were collected. Data regarding operation duration, cost, en-bloc resection, and severe complications were also extracted and compared. RESULTS A total of 36 patients (27 women) with a mean age of 55.8 ± 10.20 years were included in this study. The mean tumor size was 9.0 ± 3.98 mm. All the methods showed a 100% en-bloc resection rate and 0% severe complication rate. There was no statistically significant difference among the three groups in the operation duration (P = 0.148). The cost comparison for the whole procedure was as follows: E-EFTR > L-EFTR > S-EFTR (5837.5 ± 7212.96 CNY, 5970.7 ± 3465.27 CNY, 5852.0 ± 6438.25 CNY, respectively, P < 0.001). CONCLUSION S-EFTR, L-EFT, and E-EFTR are all effective for resection of small MP tumors in the gastric fundus. S-EFTR is superior in terms of cost-effectiveness.
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Affiliation(s)
- Nan Ge
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Jin-Long Hu
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Fei Yang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Fan Yang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Si-Yu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Ge N, Hu JL, Yang F, Yang F, Sun SY. Endoscopic full-thickness resection for treating small tumors originating from the muscularis propria in the gastric fundus: An improvement in technique over 15 years. World J Gastrointest Oncol 2019. [DOI: 10.4251/wjo.v11.i11.1054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Li B, Shi Q, Qi ZP, Yao LQ, Xu MD, Lv ZT, Yalikong A, Cai SL, Sun D, Zhou PH, Zhong YS. The efficacy of dental floss and a hemoclip as a traction method for the endoscopic full-thickness resection of submucosal tumors in the gastric fundus. Surg Endosc 2019; 33:3864-3873. [PMID: 31376013 DOI: 10.1007/s00464-019-06920-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/12/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic full-thickness resection (EFTR) provides a significant advancement to the treatment of gastrointestinal submucosal tumors (SMTs). However, technological challenges, particularly in the gastric fundus, hinder its wider application. Here, we investigated the efficacy of a simple traction method that used dental floss and a hemoclip (DFC) to facilitate EFTR. METHODS Between July 2014 and December 2016, we retrospectively reviewed data from all patients with SMTs in the gastric fundus originating from the muscularis propria layer that were treated by EFTR at Zhongshan Hospital of Fudan University. Baseline characteristics and clinical outcomes, including procedure time and complications rate, were compared between groups of patients receiving DFC-EFTR and conventional EFTR. RESULTS A total of 192 patients were included in our analysis (64 in the DFC-EFTR group and 128 in the conventional EFTR group). Baseline characteristics for the two groups were similar. The mean time for DFC-EFTR and conventional EFTR was 44.2 ± 24.4 and 54.2 ± 33.2 min, respectively (P = 0.034). Although no serious adverse events presented in any of our cases, post-EFTR electrocoagulation syndrome (PEECS), as a minor complication, was less frequent in the DFC-EFTR group (3.1% vs. 12.5%, P = 0.036). Univariate and multivariate analysis identified that DFC, when used in EFTR, played a significant role in reducing procedure time and the rate of PEECS. The mean procedure time was significantly shorter in the DFC-EFTR group for lesions over 1.0 cm (P = 0.005), when the lesions were located in the greater curvature of the gastric fundus (P = 0.025) or when the lesions presented with intraluminal growth (P = 0.032). Moreover, when EFTR was carried out by experts, the mean procedure time was 20.4% shorter in the DFC-EFTR group (P = 0.038). CONCLUSIONS This study indicated that DFC-EFTR for SMTs in the gastric fundus resulted in a shorter procedure time and reduced the risk of PEECS, a minor complication.
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Affiliation(s)
- Bing Li
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Qiang Shi
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Zhi-Peng Qi
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Li-Qing Yao
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Mei-Dong Xu
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Zhen-Tao Lv
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Ayimukedisi Yalikong
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Shi-Lun Cai
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Di Sun
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Ping-Hong Zhou
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China.
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China.
| | - Yun-Shi Zhong
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China.
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China.
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Zhang X, Modayil R, Criscitelli T, Stavropoulos SN. Endoscopic resection for subepithelial lesions-pure endoscopic full-thickness resection and submucosal tunneling endoscopic resection. Transl Gastroenterol Hepatol 2019; 4:39. [PMID: 31231706 DOI: 10.21037/tgh.2019.05.01] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/26/2019] [Indexed: 02/06/2023] Open
Abstract
Endoscopic full-thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER) are the frontier of therapeutic endoscopic. These two methods rely on the skillset and equipment of endoscopic submucosal dissection (ESD) while going beyond the boundaries of the gastrointestinal lumen. They are both representatives of natural orifice transluminal endoscopic surgery, with STER being a direct off-shoot of peroral endoscopic myotomy (POEM). Both techniques are designed for the removal of gastrointestinal tumors originating from the muscularis propria but tend to be used in different organs and come with respective challenges. In this review we will go over the history, indication, technique and literature of these two techniques.
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Affiliation(s)
- Xiaocen Zhang
- Mount Sinai St. Luke's-West Hospital Center, New York, NY, USA
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Friedel D, Zhang X, Modayil R, Stavropoulos SN. Endoscopic full-thickness resection. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Chiu PWY. Future of full thickness resection – Devices, indications, robotics, what is missing. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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