Retrospective Study
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World J Gastroenterol. Oct 14, 2014; 20(38): 13981-13986
Published online Oct 14, 2014. doi: 10.3748/wjg.v20.i38.13981
Endoscopic full-thickness resection for gastric submucosal tumors arising from the muscularis propria layer
Liu-Ye Huang, Jun Cui, Shu-Juan Lin, Bo Zhang, Cheng-Rong Wu
Liu-Ye Huang, Jun Cui, Shu-Juan Lin, Bo Zhang, Cheng-Rong Wu, Department of Gastroenterology, Yantai Yu Huang Ding Hospital, Yantai 264000, Shandong Province, China
Author contributions: Huang LY, Cui J and Lin SJ designed and initiated the study; Zhang B performed the literature search; Wu CR performed cross-searching; Huang LY drafted and wrote the paper; Lin SJ critically revised the paper.
Supported by Natural Science Foundation of Shandong Province, No. ZR2013HM004
Correspondence to: Dr. Shu-Juan Lin, Department of Gastroenterology, Yantai Yu Huang Ding Hospital, 20 Yuhuangding East Road, Zhifu District, Yantai 264000, Shandong Province, China. sdlsj123@126.com
Telephone: +86-535-6691999 Fax: +86-535-6240341
Received: April 13, 2014
Revised: June 13, 2014
Accepted: July 15, 2014
Published online: October 14, 2014
Processing time: 185 Days and 22.5 Hours
Abstract

AIM: To evaluate the efficacy, safety and feasibility of endoscopic full-thickness resection (EFR) for the treatment of gastric submucosal tumors (SMTs) arising from the muscularis propria.

METHODS: A total of 35 gastric SMTs arising from the muscularis propria layer were resected by EFR between January 2010 and September 2013. EFR consists of five major steps: injecting normal saline into the submucosa; pre-cutting the mucosal and submucosal layers around the lesion; making a circumferential incision as deep as the muscularis propria around the lesion using endoscopic submucosal dissection and an incision into the serosal layer around the lesion with a Hook knife; a full-thickness resection of the tumor, including the serosal layer with a Hook or IT knife; and closing the gastric wall with metallic clips.

RESULTS: Of the 35 gastric SMTs, 14 were located at the fundus, and 21 at the corpus. EFR removed all of the SMTs successfully, and the complete resection rate was 100%. The mean operation time was 90 min (60-155 min), the mean hospitalization time was 6.0 d (4-10 d), and the mean tumor size was 2.8 cm (2.0-4.5 cm). Pathological examination confirmed the presence of gastric stromal tumors in 25 patients, leiomyomas in 7 and gastric autonomous nerve tumors in 2. No gastric bleeding, peritonitis or abdominal abscess occurred after EFR. Postoperative contrast roentgenography on the third day detected no contrast extravasation into the abdominal cavity. The mean follow-up period was 6 mo, with no lesion residue or recurrence noted.

CONCLUSION: EFR is efficacious, safe and minimally invasive for patients with gastric SMTs arising from the muscularis propria layer. This technique is able to resect deep gastric lesions while providing precise pathological information about the lesion. With the development of EFR, the indications of endoscopic resection might be extended.

Keywords: Submucosal tumor; Stomach; Endoscopic full-thickness resection; Muscularis propria layer; Excision

Core tip: We used endoscopic full-thickness resection (EFR) to remove gastric submucosal tumors (SMTs) arising from muscularis propria layer. EFR removed all the 35 SMTs successfully. The mean operation time was 90 min (60-155 min). The mean hospitalization time was 6.0 d (4-10 d). The mean tumor size was 2.8 cm (2.0-4.5 cm). Pathological examination confirmed gastric stromal tumors in 25 cases, leiomyoma in 7 and Schwannomas in 2. No gastric bleeding, peritonitis or abdominal abscess occurred. EFR is efficacious, safe and minimally invasive for patients with gastric SMTs arising from the muscularis propria layer, is able to resect deep gastric lesion and provide precise pathological information about the lesion.