Published online Nov 15, 2019. doi: 10.4251/wjgo.v11.i11.1054
Peer-review started: July 12, 2019
First decision: July 31, 2019
Revised: August 31, 2019
Accepted: September 11, 2019
Article in press: September 11, 2019
Published online: November 15, 2019
Processing time: 137 Days and 4.8 Hours
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.
We aimed to evaluate and compare S-EFTR with L-EFTR and E-EFTR for treating small MP tumors in the gastric fundus.
We retrospectively reviewed patients with primary small MP tumors in the gastric fundus and treated them by the 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.
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.
S-EFTR, L-EFT, and E-EFTR are all effective for small MP tumor resection in the gastric fundus. S-EFTR is superior in terms of cost-effectiveness of the treatment. S-EFTR can become the most efficient technique for MP tumor resection in the gastric fundus.
S-EFTR, L-EFT, and E-EFTR are all effective techniques for resection of small MP tumors in the gastric fundus. Other very newly developed techniques have been published, which need to be evaluated in future studies. Prospective and multicenter studies are needed.